Assessing the Diagnosis of Malaria by Comparing Microscopy, Rapid Diagnostic Tests, and Polymerase Chain Reaction among Suspected Malaria Cases in Upper Denkyira East Municipality, Central Region, Ghana

Abstract

Background: Malaria has been one of the major causes of death in Ghana, especially in children. Appropriate diagnosis is important in the treatment of malaria. Microscopy is the gold standard for malaria diagnosis; however, most rural communities have resorted to the use of Rapid Diagnostic Tests (RDTs) due to the lack of electricity and ease of use. It is therefore important to assess the effectiveness of RDTs in giving accurate results. The study participants were aged 1 - 90 years. Methodology/Principal Findings : This study is a hospital-based cross-sectional study conducted at Dunkwa-on-Offin Municipal Hospital, St. Mark Hospital, and Kyekyewere Health Center. It involved patients with suspected malaria cases who consented to be part of the study. Blood samples were collected from participants for microscopy, RDTs, and Polymerase Chain Reaction (PCR) testing. A total of 310 patients were involved in the study. 67.1% and 32.9% were females and males, respectively. The prevalence of malaria using microscopy, Care Start RDT, Aria Rapid RDT, Acro Biotech RDT, and PCR was 31.3%, 34.5%, 34.5%, 34.5%, and 44.8%, respectively. The prevalence was highest in Kyekyewere (50%), followed by St. Mark Hospital (35%), and lowest in Dunkwa-on-Offin Municipal Hospital (31.3%). Mixed infections were higher than single infections among those who tested positive using all the diagnostic methods. Using PCR as a reference, the sensitivity and specificity of microscopy were 69.57% and 99.42%, respectively. The sensitivity of CareStart, Aria Rapid test, and Acro Biotech RDTs was 79.10%, and their specificities were all 99.43%. Conclusion: The research revealed that PCR had the highest sensitivity compared to RDTs and microscopy. Nevertheless, it cannot be used in routine diagnosis in developing countries and endemic areas due to the high cost involved. The study also established that microscopy should still be the gold standard for diagnosing malaria infection. In remote areas without electricity or microscopy expertise, RDTs can be utilised for early diagnosis to avoid complications associated with late detection.