Malaria Diagnosis: Current Approaches and Future Prospects
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Scaled up efforts by a consortia of organisations in
the diagnosis, treatment and prevention of malaria have led to a
significant reduction in the overall malaria mortality and
morbidity in the past few years. Malaria has, nonetheless,
remained one of the world’s most burdensome diseases with the
over 214 million cases and 438,000 deaths recorded in 2015
(2.68% of global DALYs). This burden is unevenly domiciled in
sub-Saharan Africa where 89% of all cases and 91% of all deaths
occurred. These figures however, only represent a fraction of the
actual global burden of Malaria as surveillance fails to cover
most cases in sub-Saharan Africa where the majority of malaria
endemic regions lack facilities for diagnosis, case management
and active surveillance. The emergence of drug resistant strains
of the Plasmodium species prompted WHO to recommend a
confirmatory diagnosis of each case of Malaria before treatment.
The workability of this recommendation however, begs to be
questioned as the majority of all malaria diagnosis is done via
Clinical diagnosis; which lacks precision, is still the major form
of diagnosis in many malaria endemic regions, and contributes to
the over-diagnosis of malaria and subsequent under-diagnosis of
other febrile illnesses. Of higher import is the risk of the
emergence of drug resistant species due to the unregulated
antimalarial use caused by inaccurate clinical diagnosis.
Microscopy, which is the gold standard of malaria diagnosis, and
the Rapid Diagnostic Tests (RDT) for malaria antigens have
proven to be very useful in the diagnosis of malaria giving high
levels of specificity and sensitivity. They however have the
downside of having relatively high limits of detection,
invasiveness, being labour intensive and expensive in the light of
the low income countries where malaria is endemic. More
sophisticated tools such as those that employ nucleic acid
techniques (Polymerase Chain Reaction and Gene probes) are
not field deployable and are mostly applied for research
purposes. This necessitates the need for new diagnostic
approaches that are suited to the conditions found in malaria
endemic regions. A range of novel diagnostic tools with a do-ityourself
approach, leveraging on previously untapped diagnostic
material such as urine are currently being assessed. These novel
tools promise great results if successful. This review presents an
overview of current diagnostic methods, the prospects in malaria
diagnostics and finally makes an effort to recommend what an
ideal malaria diagnostic tool should be made up of, all the while
focusing on sub-Saharan Africa
Keywords
QH301 Biology