SJMLS

Sokoto Journal of Medical Laboratory Science 2021; 6(3): 37 - 44

SJMLS - 6 (3) - 006

Comparative Performance Evaluation of Symptomology, Point-of-Care Test and Microscopy in the
Diagnosis of Malaria on Suspected Malaria Cases in Katsina, Nigeria
1 2 1 1 1 1
Yusuf Ado , Mahmoud Yandutse , Mba Chinedu , Usman Lawal , Mustapha M. Jarmai , Khalid Hamza Usman ,
Yahaya Usman* 3, Idris Nasir Abdullahi 3, Abdulhamid Ahmed Mani 4 and Babangida Abdulkarim 4
Medical Laboratory Department, National Obstetric Fistula Center Katsina 1, Department of Chemical
Pathology, Federal Medical Center, Katsina 2, Department of Medical Laboratory Science, Ahmadu Bello
3 4
University, Zaria ,Department of Biology, Umaru Musa Yar`adua University Katsina .
Corresponding author*: [email protected]/ +234 803419216/ORCID: 0000-0003-3972-5351
https://dx.doi.org/10.4314/sokjmls.v6i3.6

Abstract Introduction
Malaria is the most dominant cause of human Malaria is one of the major public health
morbidity and mortality with huge medical, problems. It is the most important cause of
psychological and economic impact in Nigeria. human morbidity and mortality with immense
Prompt and accurate diagnosis is one of the key medical, emotional and economic effect in the
components in the control of malaria disease. In world (WHO, 2017; Beatrice et al., 2012).
Katsina State, clinical (symptomatic) diagnosis Malaria occurs in nearly 100 countries
and Pf HRP-2 RDT are the two main methods worldwide. According to the World Malaria
routinely used for the diagnosis of malaria. Only Report 2013, there were more than 200 million
tertiary, secondary and few primary hospitals malaria cases in 2012. Between 2000 and 2013,
employ microscopy in malaria diagnosis. This the incidence rates of malaria fell by about 30%
study was done to assess the performance of the globally, and by 34% in Africa (Murray et al.,
clinical diagnosis, SD-BioLine (PfHRP-2) rapid 2014). As presented by WHO, malaria is a major
diagnostic tests (RDTs) and Microscopy in the public health problem in Nigeria where it
diagnosis of Malaria disease in Katsina State. In accounts for more cases and deaths than any
this cross-sectional study, involving three other country in the world (Sparkle, 2015; WHO,
hospitals, blood samples of 400 clinically 2015). By 2010, malaria was said to be a risk for
suspected malaria patients were tested for about 97% of Nigeria's population, the
malaria using microscopy with Giemsa-stained remaining 3% of the inhabitants live in the
films and Rapid Diagnostic Test (RDT), using malaria free highlands (Olasehinde et al., 2015).
SD Bioline Pf HRP-2 kit. Malaria prevalence It accounts for approximately 60% of outpatient
using microscopy was 29.8% (119/400). Pf visits and around 30% of hospitalizations among
HRP-2 RDT recorded lower sensitivity with a children under five years of age in Nigeria,
parasite prevalence of 23.8% (95/400). PfHRP-2 contributing to an estimated 11% of maternal
RDT was able to identify only patients infected mortality (Olasehinde et al., 2015).
with P. falciparum in comparison to microscopy
that detected a prevalence of 6% of malaria Traditional practice to diagnose malaria is
infections other than P. falciparum. The research empiric/syndromic diagnosis, where the diagnosis
indicated that clinical diagnosis in Katsina state is made based on clinical history, signs, and/or
is not very effective in malaria treatment. symptoms. In many endemic areas that do not
PfHRP-2 RDT is not an ideal test kit, as there have sufficient diagnostic competency, patients
exist, other Plasmodium species, in Katsina State with febrile illnesses are likely to get the diagnosis
that can equally cause malaria infection. of malaria. Present methods of treatments are not
promising towards eradication in many countries
Key words: Falciparum, Microscopy, Malaria, and the cost of maintaining these interventions has
prevalence, PfHRP-2 RDT, Nigeria reached several billions of dollars each year
(WHO, 2017).

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Giemsa-stained microscopy and rapid diagnostic identify and establish the most effective and
tests (RDTs) represent the two diagnostics most ideal method of malaria diagnosis to be adopted
likely to have the largest impact on malaria in Katsina State. This research was done to assess
control today. These two methods, each with the performance of the clinical diagnosis, SD-
peculiar strengths and limitations, together BioLine (PfHRP-2) rapid diagnostic tests
represent the best hope for accurate diagnosis as (RDTs) and microscopy in the diagnosis of
a key component of successful malaria control Malaria disease in Katsina State.
(CDC, 2016).
Materials and Methods
Clinical diagnosis and PfHRP-2 Rapid Study Area
diagnostic tests (RDTs) for malaria are Katsina state is located on the coordinates 12015`N
considered for most patients in dispensaries, and 7030`E. It has a population of 5,801,584 (2006
primary health care centers and some general census) and covers an area of 24,192KM2. It has an
hospitals in Katsina State, where there is a elevation of 519m above sea level, with an
shortage of manpower and poor power settings to international boundary in the North to Niger
equitably handle microcopy. However, there is a Republic. It also shares border in the East with
very little evidence to guide decision-makers on Kano and Jigawa States, in the West with Zamfara
the sensitivity and specificity of clinical State and in the South with Kaduna State.
diagnosis and the RDTs. There is a need to

Figure 1: Map of Katsina State indicating sampling sites (maplandia.com)

Study design and sample size determination Where, n = Number of samples required,
This was a cross-sectional survey. The minimum N = total population = 5,801,584
sample size was determined using the Slovin's e = error tolerance, at confidence level of 95
formula (Stephanie, 2018). percent, the margin error was 0.05
N 5,801,584
n= n= 2 + 400
1 + Ne2 1 + 5,801,584 x 0.05

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Location Total Anaemic, Non- Anaemic, Non- Clinically

Patients MP anaemic, MP anaemic anaemic with
(0-5 Positive MP Negative MP Normal PCV
Years) Positive Negative
GHKTN 44 12 7 2 23 0

GHMANI 16 7 O 4 5 2
TUYMCH 48 7 14 7 20 7

TOTAL/% 108 26 (24.1) 21 (19.4) 13 (12.0) 48 (44.4) 9 (0.8)

(X2 = 0.416, P= 0.95)

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Discussion between malaria and age. Our finding is in
There are basically four major methods used in conformity with the findings in previous reports
malaria diagnosis. These are symptomatic (Wobo et al., 2014; Ike et al., 2008; Mwangi et
(clinical diagnosis), microscopy, antigen test and al., 2005) which found out that children are more
molecular methods. None of the hospitals in vulnerable to malaria infection. Some parents,
Katsina state employs molecular method in mostly from rural areas do not bring their
malaria diagnosis. Symptomatic diagnosis is the children early when they are sick. It was only
most common and often the method used alone when the sickness became unbearable that they
to diagnose malaria. In other hospitals, then rush to hospitals, and that was the more
symptomatic diagnosis is often the initial one, reason for anaemia mostly in children.
followed by one of the other methods. However,
it should be noted that many other diseases Males were generally more prone to malarial
present symptoms very similar to malaria, and infections than females. This agrees with
diagnosis by symptoms alone can be misleading previous reports (Wobo et al., 2014; Mendel and
and even harmful. The first symptoms of malaria White, 1994; Ukpai, 2001). Studies have shown
(Onset of long periodic fevers, chills, sweats, that females have better immunity to malaria and
headaches, muscle pains, nausea and vomiting) varieties of other parasitic diseases and this was
are often not specific and the diagnosis is often attributed to hormonal and genetic factors
wrong as these symptoms are also found in other (Portilo and Sullivan,1997; Mendel and White,
diseases (such as sickle cell crisis, some 1994) suggested that genetic factors could play a
Bacterial and common viral infections). role by endowing females with immuno-
Likewise, the physical findings are often not regulatory potentials to cope better with some
specific (elevated temperature, perspiration, disease infections. This may invariably be
tiredness, chills, and body pains are often taken attributed to the fact that males are more exposed
to be symptoms of malaria). Almost all the to the bites of mosquitoes and other vectors than
patients had fever as one of their complaints, but females, especially when the weather is hot and
only 29.75% of the patients were found to be during farm work. Exception is found during
infected. This shows that most febrile cases are pregnancy and reproductive ages, when females
not due to malaria. This supports the findings of are more prone to malaria attacks due to immune
Chansuda et al. (2007). suppression (Wobo et al., 2014).

In contrast to the findings of Dicko et al. (2005), The positivity rate was generally lower than
of which they reported that, malaria is the main expected. All the 400 patients that participated in
cause of fever. The mean PCV of malarial this project were attested by clinicians to be sick
positive patients was lower than mean PCV of and their ailment was suspected to be caused by
MPs negative. This is in support of previous malarial parasites. Out of these clinically
reports (Nicholas et al., 2018; Idris et al., 2015) suspected patients, only 29.75% turned out to be
which independently verified that malaria actually infected with malaria parasites. The
infected patients, are more prone to low PCV. findings generally showed that clinical
However, the findings indicated that there was judgements have little utility in malaria
no significant difference between the two diagnosis and there is no single algorithm that
groups. The research also shows that anaemia can be used as a universal indicator. The markers
alone cannot be used as an index to determine normally used are vague and imprecise in
malaria in children. determining actual patients affected with malaria
disease. This postulation is consistent with
Malaria prevalence was highest within children previous reports (Andrea et al., 2016; Dicko et
using both microscopy and RDTs. The age al., 2005; Mwangi et al.,2005).
distribution of prevalence indicates an increase
in parasite prevalence from infanthood to older Eighty per cent of the microscopy-detected
children as the population ages. Statistically infections were P. falciparum, while the remaining
however, there was no significant relationship was either mixed species infections of P. falciparum

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with P. malariae or P. ovale. Others are mono- Bawa, J.A., Auta, T. and Liadi, S. (2014).
infections with either P. malariae or P. ovale. Our Prevalence of malaria: knowledge, attitude
finding is at variance with a previous report (Bawa et and cultural practices of pregnant women in
al., 2015) which detected only P. falciparum among Katsina metropolis, Nigeria. Retrieved from
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68746412.
Comparison on the proportions of positive test Beatrice, A.1., Alice, N.1., Rosario, R., and
results between RDT and microscopic diagnosis Francesco, C. (2012). Epidemiology of
revealed that Microscopy had a higher Malaria in Endemic Areas. Mediterranean
sensitivity rate, compared to the RDT results. Journal of Hematology and Infectious
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than Pf HRP2 RDT kit. It confirmed the findings MJHID.2012.060.
of Azikiwe et al. (2012) and Mukry et al. (2017) CDC (2016). Global Health, Division of
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Conclusion Review of Malaria Diagnostic Tools:
The result of this study showed that clinical Microscopy and Rapid Diagnostic Test
diagnosis cannot be relied upon for accurate (RDT). American Journal of Tropical
malaria diagnosis in Katsina state. The detection Medicine and Hygiene; 77(6):220-231.
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microscopy. Parasite-based diagnosis practice in tropical countries. Cambridge
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Citation: Yusuf Ado, Mahmoud Yandutse, Mba Chinedu, Usman Lawal, Mustapha M. Jarmai, Khalid
Hamza Usman, Yahaya Usman, Idris Nasir Abdullahi, Abdulhamid Ahmed Mani and Babangida
Abdulkarim. Comparative Performance Evaluation of Symptomology, Point-Of-Care Test and
Microscopy in the Diagnosis of Malaria on Suspected Malaria Cases in Katsina, Nigeria. Sokoto
Journal of Medical Laboratory Science; 6(2):37 - 44.

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