Performance of Malaria Rapid Diagnostic Test Carried Out by Community Medicine Distributors to Guide Home Management of Malaria in Ona-Ara Local Government Area of Southwest Nigeria

The World Health Organization recommends parasite-based diagnosis of malaria before the administration of artemisinin based combination therapy (ACT). Trained community medicine distributors (CMDs) constitute a credible option in healthcare delivery in resource-limited and hard-to-reach settings.  This study evaluated the performance of mRDT, microscopy and PCR in the diagnosis of malaria among febrile under-5 children in rural South-western  Nigeria. One thousand and forty-three (1,043) febrile children aged 3 – 59 months were enrolled on this study as part of a larger one. The CMDs collected  finger prick blood samples and performed mRDT, prepared thick blood smears for malaria microscopy and blood spots on filter paper for PCR assays.  Malaria was detected in 78.7%, 69.2% and 55% by mRDT, PCR and microscopy, respectively. The sensitivity of mRDT was 88.2% versus 92.5% while  specificity was 42.2% versus 38.2% against PCR and microscopy, respectively. The PPV, NPV and diagnostic accuracy were 88.2% versus 64.8, 61.7% versus  80.6% and 74.0% versus 68.1% respectively. Levels of agreement with PCR and microscopy were fair (κ-value = 0.336 versus 0.322). PCR detected  97.8% P. falciparum, 4.4% P. malariae and 2.5% P. ovale. Trained community medicine distributors can effectively performed malaria rapid diagnostic tests  to guide appropriate home management of malaria in resource-limited settings.