Case management of malaria: diagnosis

Area of Science:

• Medical diagnostics
• Parasitology
• Public health

Background:

• Malaria diagnosis in South Africa traditionally relies on microscopy.
• Rapid diagnostic tests (RDTs) and molecular methods (e.g., PCR) are also utilized.
• Each diagnostic technique presents unique advantages and limitations.

Purpose of the Study:

• To evaluate the current landscape of malaria diagnostic techniques in South Africa.
• To identify challenges and requirements for effective malaria diagnosis and elimination.
• To emphasize the need for improved quality assurance in diagnostic services.

Main Methods:

• Review of established and emerging malaria diagnostic methods including microscopy, RDTs, PCR, and serology.
• Analysis of findings from a long-running external quality assessment program for malaria diagnosis in South Africa.
• Consideration of requirements for surveillance and field-based diagnostic capabilities.

Main Results:

• Microscopy and RDTs are suitable for clinical case management when quality assured.
• Molecular methods and serology are essential for expanded surveillance and elimination goals.
• External quality assessment revealed deficiencies in routine laboratory malaria diagnosis quality.
• Existing quality systems require strengthening across diagnostic facilities.

Conclusions:

• Enhanced quality assurance is vital for current malaria diagnostic methods.
• Sensitive techniques like nucleic acid amplification tests and serology are necessary for malaria elimination surveillance.
• Strengthening laboratory quality systems is a prerequisite for achieving malaria elimination in South Africa.