Performance and cost comparison of a rapid diagnostic test for malaria and microscopy: A cross-sectional diagnostic study in Gusau, Nigeria

Abubakar  Sunusi Ishak; Habibu  Umar Isgogo; Abubakar  Ahmad Lawan; Yuda  Chongpison

Authors

Abubakar Sunusi Ishak School of Global Health, Faculty of Medicine, Chulalongkorn University, Thailand
Habibu Umar Isgogo Daula Hospital and Maternity Home, Gusau, Nigeria
Abubakar Ahmad Lawan Daula Hospital and Maternity Home, Gusau, Nigeria
Yuda Chongpison Biostatistics Excellence Center, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

Keywords:

Cost, microscopy, performance, rapid diagnostic tests, resource-limited

Abstract

Background: The shift from traditional microscopy to rapid diagnostic tests (RDTs) for malaria diagnosis is gaining popularity, especially in resource-limited settings where electricity supply is unstable and expertise is limited. However, trust issues arise from inconsistent performance across different RDT kits.

Objectives: This study aimed to identify variations in the performance and cost of an RDT brand for malaria among different population demographics, including pregnant women, young children, and adults, compared with microscopy as a gold standard.

Methods: The research was conducted in northwestern Nigeria and involved 360 participants who were stratified into three groups: children (5–17 years), adults (≥ 18 years), and pregnant women. Samples were examined using RDT and microscopy, and cost data were gathered from retrospective study expenses.

Results: The RDT exhibited higher sensitivity (86.1%) and a positive predictive value of 87.9% in children, but lower sensitivity (59.5%) and specificity (54.3%) in pregnant women. Logistic regression analysis indicated that the likelihood of testing positive decreased by 2.0% for each year of age (P = 0.046) and by 10.0% for each unit increase in body mass index (BMI) (P < 0.001) and was twice that of positivity in those who experienced vomiting (P = 0.004). Moreover, RDT had lower labor costs (₦61) than microscopy (₦746), which requires higher technical expertise.

Conclusion: RDTs offer a rapid diagnostic option for malaria, which may be suitable in resource-constrained settings for certain populations, such as children or adults. However, their limitations in pregnant women and the impact of age and BMI on accuracy necessitate supplementary tests where resources permit.

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