2014 Abba

The University of Birmingham (Live System)
Rapid diagnostic tests for diagnosing

uncomplicated non-falciparum or Plasmodium vivax
malaria in endemic countries
Abba, Katharine; Kirkham, Amanda; Olliaro, Piero L; Deeks, Jonathan; Donegan, Sarah;
Garner, Paul; Takwoingi, Yemisi; Takwoingi, Yemisi
DOI:
10.1002/14651858.CD011431
Document Version
Publisher final version (usually the publisher pdf)
Citation for published version (Harvard):
Abba, K, Kirkham, AJ, Olliaro, PL, Deeks, JJ, Donegan, S, Garner, P, Takwoingi, Y & Takwoingi, Y 2014, 'Rapid
diagnostic tests for diagnosing uncomplicated non-falciparum or Plasmodium vivax malaria in endemic countries'
Cochrane Database of Systematic Reviews, vol 12, CD011431., 10.1002/14651858.CD011431
Link to publication on Research at Birmingham portal
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Download date: 17. Jan. 2016
Rapid diagnostic tests for diagnosing uncomplicated nonfalciparum or Plasmodium vivax malaria in endemic countries
(Review)
Abba K, Kirkham AJ, Olliaro PL, Deeks JJ, Donegan S, Garner P, Takwoingi Y
This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library
2014, Issue 12
http://www.thecochranelibrary.com
Rapid diagnostic tests for diagnosing uncomplicated non-falciparum or Plasmodium vivax malaria in endemic countries (Review)
Copyright 2015 The Authors. The Cochrane Database of Systematic Reviews published by John Wiley & Sons, Ltd. on behalf of The
Cochrane Collaboration.
TABLE OF CONTENTS
HEADER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
PLAIN LANGUAGE SUMMARY . . . . . . . . . . . . . . . . . . . . .
BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . .
OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . .
METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Figure 1.
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Figure 2.
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Figure 3.
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Figure 4.
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Figure 5.
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Figure 6.
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Figure 7.
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Figure 8.
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Figure 9.
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Figure 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Figure 11. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Figure 12. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Figure 13. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . . .
AUTHORS CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . .
ACKNOWLEDGEMENTS
. . . . . . . . . . . . . . . . . . . . . . .
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . .
CHARACTERISTICS OF STUDIES . . . . . . . . . . . . . . . . . . . .
DATA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Test 1. Non-falciparum species only, microscopy, Type 2, ICT Combo Cassette. . . . .
Test 2. Non-falciparum species only, microscopy, Type 2, ICT Malaria Pf/Pv. . . . . .
Test 3. Non-falciparum species only, microscopy, Type 2, NOW Malaria ICT. . . . . .
Test 4. Non-falciparum species only, microscopy, Type 2, Malascan. . . . . . . . .
Test 5. Non-falciparum species only, microscopy, Type 2, VIKIA Ag Pf/Pan. . . . . .
Test 6. Non-falciparum species only, microscopy, Type 2 (All). . . . . . . . . . .
Test 7. Non-falciparum species only, microscopy, Type 3, Parascreen. . . . . . . . .
Test 8. Non-falciparum species only, microscopy, Type 3, CareStart Pf/Pan. . . . . . .
Test 9. Non-falciparum species only, microscopy, Type 3, SD Malaria Antigen Bioline. . .
Test 10. Non-falciparum species only, microscopy, Type 3, First Response Malaria Combo.
Test 11. Non-falciparum species only, microscopy, Type 3, One Step Malaria Pf/Pan. . .
Test 13. Non-falciparum species only, microscopy, Type 4, OptiMAL.
. . . . . . .
Test 14. Non-falciparum species only, microscopy, Type 4, OptiMAL-IT. . . . . . .
Test 15. Non-falciparum species only, microscopy, Type 4, Carestart. . . . . . . . .
Test 17. Non-falciparum species only, microscopy, Other Type, Malariagen Malaria. . . .
Test 18. Non-falciparum species only, PCR, Type 3, CareStart Pf/Pan. . . . . . . .
Test 19. Non-falciparum species only, PCR, Type 3, Parascreen. . . . . . . . . . .
Test 20. Non-falciparum species only, PCR, Type 3, One Step Malaria Pf/Pan.
. . . .
Test 21. Non-falciparum species only, PCR, Type 3, SD Malaria Antigen Bioline.
. . .
Test 22. Non-falciparum species only, PCR, Type 3 (All). . . . . . . . . . . . .
Test 23. Non-falciparum species only, PCR, Type 4, OptiMAL (All). . . . . . . . .
Test 24. P. vivax, microscopy, Pf HRP-2 and Pv pLDH, Carestart Pf/Pv (All). . . . . .
Test 25. P. vivax, microscopy, Pf HRP-2 and Pv pLDH, Biotech Malaria Pf/Pv. . . . .
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i
Test 26. P. vivax, microscopy, Pf HRP-2 and Pv pLDH, Falcivax. . . . .

Test 27. P. vivax, microscopy, Pf HRp-2 and Pv pLDH, Onsite Pf/Pv. . . .
Test 28. P. vivax, microscopy, Pf HRP-2 and Pv pLDH, Pf/Pv Malaria Device.
Test 29. P. vivax, microscopy, Pf HRP-2 and Pv pLDH (All). . . . . . .
Test 30. P. vivax, PCR, Pf HRP-2 and Pv pLDH, Falcivax. . . . . . .
Test 31. P. vivax, PCR, Pf HRP-2 and Pv pLDH, OnSite Pf/Pv. . . . . .
Test 32. P. vivax, PCR, Pf HRP-2 and Pv pLDH, Pf/Pv Malaria Device. . .
Test 33. P. vivax, PCR, Pf HRP-2 and Pv pLDH (All). . . . . . . . .
Test 34. P. vivax, PCR, Type 6, PALUTOP (All). . . . . . . . . . .
ADDITIONAL TABLES . . . . . . . . . . . . . . . . . . . .
APPENDICES . . . . . . . . . . . . . . . . . . . . . . .
WHATS NEW . . . . . . . . . . . . . . . . . . . . . . .
CONTRIBUTIONS OF AUTHORS . . . . . . . . . . . . . . .
DECLARATIONS OF INTEREST . . . . . . . . . . . . . . . .
SOURCES OF SUPPORT . . . . . . . . . . . . . . . . . . .
DIFFERENCES BETWEEN PROTOCOL AND REVIEW . . . . . . .
INDEX TERMS
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ii
[Diagnostic Test Accuracy Review]
Rapid diagnostic tests for diagnosing uncomplicated nonfalciparum or Plasmodium vivax malaria in endemic countries
Katharine Abba1 , Amanda J Kirkham2 , Piero L Olliaro3 , Jonathan J Deeks4 , Sarah Donegan1 , Paul Garner1 , Yemisi Takwoingi4
1 Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. 2 Cancer Research UK Clinical Trials Unit,
School of Cancer Sciences, University of Birmingham, Birmingham, UK. 3 UNICEF/UNDP/World Bank/WHO Special Programme
for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland. 4 Public Health, Epidemiology
and Biostatistics, University of Birmingham, Birmingham, UK
Contact address: Katharine Abba, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool,
Merseyside, L3 5QA, UK. [email protected].
Editorial group: Cochrane Infectious Diseases Group.
Publication status and date: Edited (no change to conclusions), published in Issue 4, 2015.
Review content assessed as up-to-date: 31 December 2013.
Citation: Abba K, Kirkham AJ, Olliaro PL, Deeks JJ, Donegan S, Garner P, Takwoingi Y. Rapid diagnostic tests for diagnosing
uncomplicated non-falciparum or Plasmodium vivax malaria in endemic countries. Cochrane Database of Systematic Reviews 2014, Issue
12. Art. No.: CD011431. DOI: 10.1002/14651858.CD011431.
Copyright 2015 The Authors. The Cochrane Database of Systematic Reviews published by John Wiley & Sons, Ltd. on behalf of
The Cochrane Collaboration. This is an open access article under the terms of the Creative Commons Attribution-Non-Commercial
Licence, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used
for commercial purposes.
ABSTRACT
Background
In settings where both Plasmodium vivax and Plasmodium falciparum infection cause malaria, rapid diagnostic tests (RDTs) need to
distinguish which species is causing the patients symptoms, as different treatments are required. Older RDTs incorporated two test
lines to distinguish malaria due to P. falciparum, from malaria due to any other Plasmodium species (non-falciparum). These RDTs
can be classified according to which antibodies they use: Type 2 RDTs use HRP-2 (for P. falciparum) and aldolase (all species); Type 3
RDTs use HRP-2 (for P. falciparum) and pLDH (all species); Type 4 use pLDH (fromP. falciparum) and pLDH (all species).
More recently, RDTs have been developed to distinguish P. vivax parasitaemia by utilizing a pLDH antibody specific to P. vivax.
Objectives
To assess the diagnostic accuracy of RDTs for detecting non-falciparum or P. vivax parasitaemia in people living in malaria-endemic
areas who present to ambulatory healthcare facilities with symptoms suggestive of malaria, and to identify which types and brands of
commercial test best detect non-falciparum and P. vivax malaria.
Search methods
We undertook a comprehensive search of the following databases up to 31 December 2013: Cochrane Infectious Diseases Group
Specialized Register; MEDLINE; EMBASE; MEDION; Science Citation Index; Web of Knowledge; African Index Medicus; LILACS;
and IndMED.
Selection criteria
Studies comparing RDTs with a reference standard (microscopy or polymerase chain reaction) in blood samples from a random or
consecutive series of patients attending ambulatory health facilities with symptoms suggestive of malaria in non-falciparum endemic
areas.
Data collection and analysis

For each study, two review authors independently extracted a standard set of data using a tailored data extraction form. We grouped
comparisons by type of RDT (defined by the combinations of antibodies used), and combined in meta-analysis where appropriate.
Average sensitivities and specificities are presented alongside 95% confidence intervals (95% CI).
Main results
We included 47 studies enrolling 22,862 participants. Patient characteristics, sampling methods and reference standard methods were
poorly reported in most studies.
RDTs detecting non-falciparum parasitaemia
Eleven studies evaluated Type 2 tests compared with microscopy, 25 evaluated Type 3 tests, and 11 evaluated Type 4 tests. In metaanalyses, average sensitivities and specificities were 78% (95% CI 73% to 82%) and 99% (95% CI 97% to 99%) for Type 2 tests, 78%
(95% CI 69% to 84%) and 99% (95% CI 98% to 99%) for Type 3 tests, and 89% (95% CI 79% to 95%) and 98% (95% CI 97%
to 99%) for Type 4 tests, respectively. Type 4 tests were more sensitive than both Type 2 (P = 0.01) and Type 3 tests (P = 0.03).
Five studies compared Type 3 tests with PCR; in meta-analysis, the average sensitivity and specificity were 81% (95% CI 72% to 88%)
and 99% (95% CI 97% to 99%) respectively.
RDTs detecting P.vivax parasitaemia
Eight studies compared pLDH tests to microscopy; the average sensitivity and specificity were 95% (95% CI 86% to 99%) and 99%
(95% CI 99% to 100%), respectively.
Authors conclusions
RDTs designed to detect P. vivax specifically, whether alone or as part of a mixed infection, appear to be more accurate than older tests
designed to distinguish P. falciparum malaria from non-falciparum malaria. Compared to microscopy, these tests fail to detect around
5% ofP. vivax cases. This Cochrane Review, in combination with other published information about in vitro test performance and
stability in the field, can assist policy-makers to choose between the available RDTs.
PLAIN LANGUAGE SUMMARY

Rapid tests for diagnosing malaria caused by Plasmodium vivax or other less common parasites
This review summarises trials evaluating the accuracy of rapid diagnostic tests (RDTs) for diagnosing malaria due to Plasmodium vivax
or other non-falciparum species. After searching for relevant studies up to December 2013, we included 47 studies, enrolling 22,862
adults and children.
What are rapid tests and why do they need to be able to distinguish Plasmodium vivax malaria
RDTs are simple to use, point of care tests, suitable for use in rural settings by primary healthcare workers. RDTs work by using
antibodies to detect malaria antigens in the patients blood. A drop of blood is placed on the test strip where the antibodies and antigen
combine to create a distinct line indicating a positive test.
Malaria can be caused any one of five species of Plasmodium parasite, but P. falciparum and P. vivax are the most common. In some
areas, RDTs need to be able to distinguish which species is causing the malaria symptoms as different species may require different
treatments. Unlike P. falciparum, P. vivax has a liver stage which can cause repeated illness every few months unless it is treated with
primaquine. The most common types of RDTs for P. vivax use two test lines in combination; one line specific to P. falciparum, and one
line which can detect any species of Plasmodium. If the P. falciparum line is negative and the any species line is positive, the illness is
presumed to be due to P. vivax (but could also be caused by P. malariae, or P. ovale). More recently, RDTs have been developed which
specifically test for P. vivax.
What does the research say
RDTs testing for non-falciparum malaria were very specific (range 98% to 100%) meaning that only 1% to 2% of patients who test
positive would actually not have the disease. However, they were less sensitive (range 78% to 89%), meaning between 11% and 22%
of people with non-falciparum malaria would actually get a negative test result.
RDTs which specifically tested for P. vivax were more accurate with a specificity of 99% and a sensitivity of 95%, meaning that only
5% of people with P. vivax malaria would have a negative test result.
BACKGROUND
Target condition being diagnosed

Malaria is a life-threatening illness caused by protozoan Plasmodium parasites, which are transmitted by many species of Anopheles mosquitoes. In 2008, there were between 190 and 311 million cases of malaria worldwide (WHO 2009b). The two most
common species of parasites that cause malaria are Plasmodium
falciparum andPlasmodium vivax. Falciparum malaria is the most
common cause of severe malaria and malaria deaths and can also
cause other complications, such as anaemia and, in pregnancy, low
birthweight babies. Vivax malaria is a relapsing form, which is
rarely fatal but can cause serious anaemia in children. Other, less
common, Plasmodium species that cause malaria in people include
P. malariae and P. ovale. Malaria is a curable disease, and therefore
malaria-related morbidity and mortality can be reduced. Early,
prompt and accurate diagnosis followed by appropriate treatment
is the key to effective disease management (WHO 2003) and is
a basic tenet of current malaria control policy (WHO 2005; Bell
2006).
People who are exposed repeatedly to Plasmodium infection develop a partial and incomplete immunity. This means that in
highly endemic areas those most at risk are children under the age
of five, who have not yet had the chance to develop immunity. In
less endemic areas, or areas of seasonal or epidemic transmission,
older children and adults are also at risk due to less developed immunity. Travellers from non-endemic to endemic countries are at
highest risk because they have no immunity at all.
15 minutes (Talman 2007). Therefore, RDTs are, in general, suitable for remote areas with limited facilities and relatively untrained
staff. However, they have a limited shelf life and need to be kept
dry and away from temperature extremes. They may also fail to
detect malaria where there are low levels of Plasmodium parasites
in the blood, for example in young children with low immunity,
and false positives are possible due to cross reactions or gametocytaemia (Kakkilaya 2003).
Different types of RDT use different types of antibody or combination of antibodies to detect Plasmodium antigens. Some antibodies aim to detect a particular species while others are panmalarial, aiming to detect all types of Plasmodium. Table 1 lists the
main types of RDT that were available in 2010. Since this classification was developed, the following test types have also become
available:
Pan pLDH only, with possible results of: no malaria; P.
falciparum (Pf ), P. vivax (Pv), P. ovale (Po), or P. malariae (Pm);
invalid
P. vivax specific pLDH only, with possible results of: no
malaria; Pv; invalid;
P. falciparum specific HRP-2 and P. vivax specific pLDH,
with possible results of: no malaria; Pf, Pv, Pf + Pv; invalid.
HRP-2 can stay in the blood for 28 days after initiating the antimalarial therapy (Kakkilaya 2003). Because of this persistent antigenaemia, it is not possible to use these tests in assessing parasite
clearance following treatment, and false positive results may be
found in patients who have recently been treated for malaria. In
contrast, pLDH is rapidly cleared from the blood following parasite death; in fact it may clear more rapidly than the dead parasites
(WHO 2009).
Alternative test(s)
Index test(s)
Rapid diagnostic tests (RDTs) (WHO 2003) detect parasite-specific antigens in a drop of fresh blood through lateral flow immunochromatography (WHO 2006). The World Health Organization (WHO) currently lists 96 commercially available test
kits meeting ISO131485 manufacturing standards (WHO 2009).
RDTs do not require a laboratory or any special equipment (WHO
2006), are simple to use and can give results as a simple positive or
negative result, at thresholds pre-set by the manufacturers, within
Microscopic examination of Giemsa-stained thick and thin blood

films remains the conventional laboratory method and is still regarded as the gold standard. Microscopic examination provides
a good sensitivity and specificity, and it allows species and stage
differentiations and quantification of parasites, all of which are
important in assessing the disease severity and prescribing appropriate therapy. Intensive examination is more likely to reveal parasitaemia so the test is carried out with a fixed number of fields
examined. Infections may be missed if slides are not examined
carefully (Wongsrichanalai 2007). Very low parasitaemia may be
missed even by good quality microscopy; the limit of detection of

thick smear microscopy has been estimated at approximately four
to 20 asexual parasites per L, although under field conditions a
threshold of 50 to 100 asexual parasites per L is more realistic
(Wongsrichanalai 2007). False positive results are also possible; if
blood slides are not prepared carefully, artefacts may be formed
which can be mistaken for Plasmodium parasites (Wongsrichanalai
2007).
The polymerase chain reaction (PCR), which is a molecular
method based on DNA amplification, is the most accurate method
of detecting parasites in the blood. Compared to microscopy, PCR
is less prone to observer error and more sensitive at low levels of
parasitaemia (Snounou 1993). For PCR, the limit of detection
may be as low as 0.004 asexual parasites per L (Hnscheid 2002).
However, whether this increased ability to detect low level parasitaemia makes it a better diagnostic test is uncertain, as sub-microscopic parasitaemia are of unknown clinical significance and
the prevalence of asymptomatic sub-microscopic infection is high
in some areas (May 1999). PCR is currently not widely available
due to logistical constraints and the need for specially trained technicians and a well-equipped laboratory. It is usually used only for
research purposes.
Rationale
A diagnostic test which is simple to perform, rapid and accurate is
important in many situations to ensure prompt specific treatment,
reduce misdiagnosis of non-malarial illness as malaria, limit the
development of drug resistance (Talman 2007) and reduce drug
wastage. The WHO lists some of the situations where RDTs can
be particularly useful in remote areas without access to expert
microscopy, complex emergencies and severe malaria, where rapid
diagnosis is essential to save lives (WHO 2000).
The WHO 2010 guidelines recommend chloroquine for P. vivax
malaria in areas in which parasites remain sensitive to this drug, although they are currently considering recommending artemisininbased combination therapies (ACTs) for all P. vivax infections as
they are effective (Gogtay 2013). Primaquine may be added to
immediate treatment of P. vivax (and P. ovale) to effect a radical
cure and prevent relapse (WHO 2010). Therefore, in areas where
both P. falciparum and P. vivax are endemic, it is often useful to
be able to distinguish between the two species.
The relative costs of microscopy and RDTs vary according to context. Where there is a relatively high prevalence of malaria and an
established microscopy service, microscopy would usually be less
expensive than RDTs because most of the costs associated with
microscopy are fixed costs, and microscopy can also be used to
diagnose other diseases. In areas where malaria is less prevalent, or
very rural areas where access to good quality microscopy services
is limited, RDTs may be less expensive than microscopy (WHO
2008). The cost of RDTs also depends on the type of test used,
which will depend on the types of malaria parasite endemic in the
area; the WHO describes three zones (WHO 2005a) as shown in

Table 2.
RDTs may be used to confirm diagnosis before commencing treatment in people with symptoms of malaria where confirmation by
microscopy is currently unavailable or unused, thereby increasing
the specificity of diagnosis, which would otherwise be made on
symptoms only. Alternatively, RDTs may replace microscopy for
confirmatory diagnosis, where logistical factors and relative costs
indicate that this may be beneficial. The usefulness of RDTs in
these roles will depend to a large extent on their accuracy. The
sensitivity and specificity thresholds that decide whether a test is
useful in practice will depend upon the situation; as malaria endemicity varies enormously by geographic area, and positive and
negative predictive values will vary considerably with endemicity,
relating to the proportion of patients with fever who have malaria.
In addition, microscopy is not a perfect reference standard in itself,
and the relative accuracy of RDTs and microscopy will depend to
a large extent on the performance of the laboratory facilities and
personnel available for microscopy.
Previously published systematic reviews have focused on the accuracy of RDTs for diagnosing malaria in travellers returning to nonendemic countries from endemic countries (Marx 2005). As far as
we know this is the first systematic review to assess the accuracy of
the full range of RDTs for diagnosing non-falciparum orP. vivax
malaria in people with symptoms in malaria-endemic areas.
This review is the second of two Cochrane Reviews assessing the
accuracy of RDTs for diagnosing symptomatic uncomplicated
malaria in endemic countries. It covers two slightly different target
conditions; non-falciparum malaria in the absence of P. falciparum
infection and P. vivax malaria, corresponding to the results obtainable with different RDT test types. The first review reported
separately on RDTs for diagnosing P. falciparum malaria (Abba
2011). The summaries in this review are to assist decision making, in conjunction with other relevant information about these
tests, including in vitro assessment and tests of stability and costs
(WHO 2012).
OBJECTIVES
To assess the diagnostic accuracy of RDTs for detecting non-falciparum or P. vivax malaria parasitaemia in people living in malariaendemic areas who present to ambulatory healthcare facilities with
symptoms suggestive of malaria and to identify which types and
brands of commercial test best detect non-falciparum and P. vivax
malaria.
Investigation of sources of heterogeneity

We planned to investigate heterogeneity in relation to age group,
continent where the study took place, and adequacy of reference
standard.
METHODS
Comparator tests
We included studies regardless of whether they made comparisons
with other RDT tests or not.
Criteria for considering studies for this review

Target conditions
Types of studies
Studies sampling a consecutive series of patients, or a randomly
selected series of patients were eligible. Where the report did not
explicitly state that sampling was consecutive, but we judged that
consecutive sampling was most probable, we included the report.
We excluded studies if they did not present sufficient data to allow
us to extract absolute numbers of true positives, false positives, false
negatives and true negatives. Due to resource constraints, we also
excluded studies if the report did not present enough information
to allow full assessment of eligibility or if the study was reported
only in a non-English language.
Participants
Studies recruiting people living in P. vivax,P. ovale or P. malariae endemic areas attending ambulatory healthcare settings with
symptoms of uncomplicated malaria were eligible.
We excluded studies if participants:
1. were non-immune people returning from endemic
countries or were mainly recent migrant or displaced populations
from non-endemic or very low endemicity areas;
2. had been treated for malaria and the test was performed to
assess treatment outcome;
3. had symptoms of severe malaria;
4. did not have symptoms of malaria;
5. were recruited through active case finding (for example,
door to door surveys).
In studies where only a subgroup of participants was eligible for
inclusion in the review, we included the study provided that we
could extract relevant data specific to that subgroup. If studies included some patients with severe malaria, and we could not extract
data specific to a subgroup of participants with uncomplicated
malaria, we included the study if 90% or more of the participants
had uncomplicated malaria.
Index tests
Studies evaluating any immunochromatography-based RDTs
specifically designed to detect non-falciparum or P. vivax malaria.
We included commercial tests that are no longer available because
they may use the same antibodies and very similar technology to
tests that are currently available or may become available in the
future. Older and more recently available versions of the same test,
for example, OptiMAL and OptiMAL-IT were included separately. We also included prototype tests which are not longer available but which correspond to one of the commercial tests.
Studies aimed to detect non-falciparum or P. vivax malaria. Where

no distinction was made by species, but over 98% of malaria infections were identified by the reference standard as non-falciparum
or P. vivax, the study was eligible for inclusion.
Reference standards
Studies were required to diagnose non-falciparum or P. vivax
malaria using at least one of the following two reference standards:
1. Conventional microscopy of thick blood smears, thin blood
smears or both. Presence of asexual parasites of any density was
regarded as a positive smear;
2. PCR.
The reference standard was required to be performed using blood
samples drawn at the same time as those for the index tests. Where
studies used more than one reference standard, we presented data
relating to comparisons with each reference standard.
Search methods for identification of studies

We used a single search strategy for both Cochrane Reviews in this
series (see Abba 2011).
Electronic searches
To identify all relevant studies, we used the search terms and strategy outlined in Appendix 1 to search the following databases:
Cochrane Infectious Diseases Group Specialized Register; MEDLINE; EMBASE; MEDION; Science Citation Index; Web of
Knowledge; African Index Medicus; LILACS; and IndMED. We
based the search on the following MeSH, full text and keyword
terms: Malaria, Plasmodium, reagent kits, diagnosis, diagnostics,
RDT, dipstick, MRDD, OptiMal, Binax Now, Parasight, Immumochromatography, antigen detection, antigen test, Combo card.
We did not limit the search by language or publication status (although we later excluded non-English language studies due to resource constraints). We restricted the searches to human studies.
We updated the search on 31 December 2013.
Searching other resources

We searched the reference lists of included studies for relevant
publications. Due to resource constraints, we did not search any
other resources.
Data collection and analysis
Selection of studies
We initially used a single selection procedure to identify studies
for inclusion in either of the two Cochrane Reviews in this series. The inclusion criteria differed between the reviews only in
the target condition and parasite species. Therefore, of the study
characteristics examined, we assessed parasite species last , for example a study listed as excluded due to not presenting sufficient
data may also have not been a study of non-falciparum or P. vivax
malaria. One author (KA) initially assessed the titles identified by
the search, excluding those obviously irrelevant to the diagnosis of
malaria using RDTs. We retained titles where we had any doubt
regarding inclusion.
Based on abstract examination, we excluded irrelevant letters, review articles and articles and then excluded other irrelevant notes.
Using a pro forma, two review authors (KA and NM) independently assessed the eligibility of the remaining potentially relevant
articles based on full text publications. We have listed the excluded
studies in the Characteristics of excluded studies table. We resolved
any discrepancies by discussion. Where we could not reach agreement, we consulted a third author (PG or PO). Where it remained
unclear whether a study was eligible for inclusion because of a lack
of detail or poor reporting, we excluded it. Similiarly, we excluded
non-English language reports for logistical reasons.
We named studies according to the surname of the first study
author and the year of publication. The study naming used in
this review uniquely identifies multiple study cohorts within each
study report (for example as Bell 2001a and Bell 2001b), each of
which use different reference standards or present data separately
for more than one population with different characteristics. More
than one RDT may be evaluated in each study cohort, thus the
number of test evaluations exceeds the number of study cohorts,
which exceeds the number of study reports.
Data extraction and management

Two review authors (KA and NM) independently extracted data
and resolved any discrepancies by discussion. In cases of studies
where only a subgroup of participants met the review inclusion
criteria, we extracted and presented data only for that particular
subgroup. Where two versions of one reference standard were used,
for example local clinic and expert standard microscopy, or field
versus laboratory RDT testing, we only included the one most
likely to yield the highest quality results.
For each study, we systematically extracted data on the characteristics of the study, as shown in Appendix 2. We also extracted
data relating to the sensitivity of the RDT at different levels of
parasitaemia (asexual parasites per L of blood) as presented by
the study authors. For each comparison of index test with reference test, we extracted data on the number of true positives,
true negatives, false positives and false negatives in the form of

a two by two table. RDT results are dichotomous; microscopy
results were deemed positive at any level of asexual parasitaemia;
and PCR results used the cut-off points presented by the study
authors. Gametocyte-only parasitaemia was considered negative;
where a study was unclear on how they had classed gametocyteonly parasitaemia, they were assumed to have used the same classification as ourselves and we included the data in the study.
We extracted data for each study (Smidt 2008), using current manufacturers instructions in interpreting the RDT results. P. falciparum malaria only was considered as negative for parasitaemia.
The target condition was defined slightly differently depending
on the type of the test, as follows:
Types 2, 3 and 4 - Non-falciparum malaria in the absence
of falciparum malaria
RDT Types 2, 3 and 4 are designed to detect non-falciparum
species (mainly P. vivax in most situations) when they occur without concurrent P. falciparum infection. They have two test lines,
one specific for P. falciparum and one pan-malarial line to detect all
malaria species. Non-falciparum malaria is identified by a positive
pan-malarial line and negative P. falciparum line; mixed infections
will produce positive results for both the P. falciparum and panmalaria lines and are indistinguishable from P. falciparum alone.
Mixed infections detected by microscopy were considered true
negative if RDT indicated P. falciparum; true positive if RDT
indicated non-falciparum in the absence of P. falciparum; and false
negative if RDT indicated no malaria. This method corresponded
to the method most often described by the authors of the included
studies, first described by Tjitra 1999.
Tests using Pf HRP2 and Pv pLDH - P. vivax (whether
alone or part of mixed infection)
These types of tests are designed to identify P. vivax parasitaemia
specifically, as they have a test line specific to P. vivax. Some also
include other test lines, specific to other types of malaria parasite.
Test results were considered positive for P. vivax whether or not
they also indicated the presence of P. falciparum.
Where study authors interpreted test results or presented data differently, we used all the information presented in the paper to extract data consistent with our own methods; if we were unable to
do this, we did not include the data in the analyses.
Assessment of methodological quality

Three researchers (KA, NM and SJ) assessed the quality of each
individual study using the checklist adapted from the QUADAS
tool (Whiting 2003). We answered each question on the checklist with a yes or no response, or noted unclear if study authors
reported insufficient information to enable a judgement, and we
documented the reasons for the judgement made. We have summarized the criteria we used in Appendix 3.
Statistical analysis and data synthesis
The comparisons made in this review can be considered in a hierarchy. We classified the data on each test type in the primary
studies according to commercial brands. In order to provide a coherent description of the studies contributing to each analysis, we
structured the results first by grouping studies according to their
commercial brand, then grouping brands to form test types. The
analytical strategy thus compared the test accuracy of commercial
brands within each test type before making comparisons between
test types. Comparative analyses first included all studies with relevant data, and were then restricted to studies that made direct
comparisons between tests with the same participants, where such
studies existed.
For each test type, we plotted estimates of the observed sensitivities
and specificities in forest plots and in receiver-operating characteristic (ROC) space. These plots illustrate variation in accuracy between studies. Where adequate data were available, we performed
meta-analyses using the bivariate model (Reitsma 2005) to produce summary sensitivities and specificities. Using a random-effects approach, the model jointly synthesises sensitivity and specificity by allowing for correlation between them across studies. We
made comparisons between tests by adding a covariate for brand
or test type to the bivariate model to investigate association with
sensitivity or specificity, or both. Also, we investigated the effect
of test type on the variances of the random effects of logit sensitivity and logit specificity and we included separate variance terms
where required. We assessed the significance of the difference in
test performance by a likelihood ratio test comparing models with
and without covariate terms for sensitivity and specificity. Where
inadequate studies were available to estimate all parameters, we
simplified the bivariate model to two univariate random-effects
logistic regression models by assuming no correlation between sensitivity and specificity. We fitted the models using the xtmelogit
command in StataCorp 2011.
Where more than one commercial brand of the same test type was
evaluated on the same patients against the same reference standard,

we selected one brand at random from the analysis by test type
in order to avoid bias due to inclusion of the same participants
more than once in the analysis. We included both brands in any
analyses comparing commercial brands.
Investigations of heterogeneity
We inspected forest plots and summary ROC plots to visually assess heterogeneity between study specific estimates of sensitivity
and specificity. We planned to investigate the effect of age group,
continent where the study took place, and adequacy of the reference standard on summary estimates of sensitivity and specificity
by adding each factor as a covariate to the bivariate model.
We did not attempt to assess reporting bias because little is known
about how this should be done for diagnostic test accuracy (DTA)
reviews.
RESULTS
Results of the search

In the initial search we identified 4837 titles, of which we excluded
4325 based on their title or abstract alone. We were unable to
obtain one article in full text form. We retrieved full text articles
for 511 titles; of which we excluded 474 articles; 316 because
they were initially assessed as ineligible; 22 because the reports did
not present enough information for us to assess their eligibility;
21 because they were available only in non-English languages;
21 because we were unable to extract absolute numbers of true
positives, false positives, false negatives and true negatives; and 94
because they did not present data on non-falciparum or P. vivax
malaria, although they were eligible for other reviews in this series.
See Figure 1 for a flow diagram of search and eligibility results.
Figure 1. Study flow diagram.
We therefore included a total of 37 study publications. One of the

included publications described two related studies, and another
publication reported data separately for 10 different sites, making
a total of 47 study cohorts. Seven of the 47 cohorts evaluated more
than one test; one compared four tests, three compared three tests
and three compared two tests. There were a total of 67 test evaluations reporting on a total of 32,466 tests in 22,862 participants.
We have given a summary of the number of studies by test type
and reference standard (microscopy or PCR) in Table 3.
Methodological quality of included studies

We summarised the overall methodological quality of the included
studies in Figure 2. Twenty-seven study cohorts (57%) clearly included a representative spectrum of patients attending ambulatory healthcare setting with symptoms of malaria; the remaining
20 were unclear, most often because they had not adequately described their sampling methods. Twenty study cohorts (43%) reported an adequate reference standard, 19 (40%) did not provide
enough information on the reference standard, and eight (17%)
had an inadequate reference standard, in all cases because a second microscopist did not verify the results. Thirty-five study cohorts (75%) reported blinding of the reference standard results,
11 (23%) did not describe whether the reference standard was
blinded and one (2%) did not blind the reference standard. Thirtyseven (79%) study cohorts blinded the RDT results to the results
of the reference tests, nine (19%) were unclear and one (2%) did
not blind the RDTs. All 47 cohorts reported avoidance of partial
verification, differential verification and incorporation.
Figure 2. Methodological quality graph: review authors judgements about each methodological quality
item presented as percentages across all included studies.
Eleven study cohorts (23%) reported on uninterpretable test results; of these, three excluded uninterpretable results from the analysis, four reported that there were no uninterpretable results, three
repeated any uninterpretable tests and one presented the results for
uninterpretable tests. The proportion of uninterpretable tests was
low in every study that reported this information (maximum 6%).

Thirty study cohorts (64%) did not report on uninterpretable results, but appeared to have no uninterpretable results, because they
had an exact correlation between the number of participants en-
rolled and the number presented in the analysis. Six study cohorts
(13%) did not report on uninterpretable results and also either
did not clearly state the number of participants initially enrolled
or showed a discrepancy between the number of participants enrolled and the number presented in the analysis.
Thirty-seven study cohorts (79%) reported either no withdrawals
from the study or recorded the reasons for any withdrawals; eight
(17%) were unclear as to whether there were any withdrawals;
one (2%) had one participant missing from the analysis, with no
explanation, and another (2%) reported that samples with mixed
infection or where microscopists disagreed were excluded, while
the number of samples excluded, and the original number of participants enrolled, was not presented.
Findings
Target condition: non-falciparum malaria only
In this section we present the results for RDTs which identify
non-falciparum malaria by the presence of a positive pan-malaria
antibody line in the absence of a positive P. falciparum specific
antibody line.
Verified by microscopy
Type 2 tests
There were 11 evaluations of Type 2 RDTs verified with microscopy (Figure 3); eight were undertaken in Asia, two in Africa
and one in South America. The median sample size was 372
(range 113 to 2383), the median prevalence of non-falciparum
only malaria was 14% (range 7% to 32%) and the median percentage of malaria that was non-falciparum was 46% (range 13%
to 80%). None of the evaluations were undertaken only in children under the age of five years. Five different test brands were
evaluated: ICT Malaria Pf/Pv (seven); ICT Malaria combo cassette (one), Malascan (one), NOW Malaria ICT (one) and VIKIA
Malaria Ag Pf/Pan (one). Sensitivities of the tests ranged from
67% to 90%; specificities ranged from 89% to 100%. In metaanalysis (11 evaluations, 6879 participants) the pooled sensitivity was 78% (95% confidence interval (CI) 73% to 82%) and
the specificity was 99% (95% CI 97% to 99%) (Figure 4). Of
the false negative RDT results (where microscopy identified nonfalciparum malaria only, but RDT gave a different result) 65%
(95% CI 43% to 81%) of RDT results indicated no malaria; the
remaining false negative RDT results indicated P. falciparum or
mixed infection (Table 4).
Figure 3. Forest plot of commercial brands of Type 2 tests for detection of non-falciparum species (verified
with microscopy). We ordered studies by continent, age group and study identifier.
10
Figure 4. Summary ROC plot of Type 2 tests for detection of non-falciparum species (verified with
microscopy). The black solid circle corresponds to the summary estimate of sensitivity and specificity, and is
shown with a 95% confidence region.
11
Type 3 tests
There were 25 evaluations of Type 3 RDTs verified with microscopy (Figure 5); eight were undertaken in Asia, 15 in Africa and
two in South America. The median sample size was 200 (range 30
to 2585), the median prevalence of non-falciparum only malaria
was 10% (range 7% to 36%) and the median percentage of malaria
that was non-falciparum was 36% (range 17% to 85%). None of
the evaluations were undertaken only in children under the age
of five years. Five different test brands were evaluated: Parascreen
(14), SD Malaria Antigen Bioline (four), Carestart Pf/Pan (four),
First Response Malaria Combo (two) and One Step Malaria Pf/
Pan (one). Sensitivities of the tests ranged from 25% to 100%;

specificities ranged from 94% to 100%. Two studies evaluated
two brands and so one brand was selected at random for inclusion
in the meta-analysis. Therefore, based on 23 evaluations (11,234
participants), the pooled sensitivity was 78% (95% CI 69% to
84%) and the specificity was 99% (95% CI 98% to 99%) (Figure
6). Of the false negative RDT results (where microscopy identified
non-falciparum malaria only, but RDT gave a different result),
74% (52% to 88%) of RDT results indicated no malaria; the
remaining false negative RDT results indicated P. falciparum or
mixed infection (Table 4).
12
microscopy). The black solid circle corresponds to the summary estimate of sensitivity and specificity, and is
shown with a 95% confidence region.
13
Type 4 tests
There were 11 evaluations of Type 4 RDTs compared microscopy
(Figure 7); six were undertaken in Asia, two in Africa and three
in South America. The median sample size was 289 (range 80 to
896), the median prevalence of non-falciparum only malaria was
27% (range 8% to 33%) and the median percentage of malaria
that was non-falciparum was 51% (range 21% to 100%). None of
the evaluations were undertaken only in children under the age of
five years. Three different test brands were evaluated: OptiMAL
(six), OptiMAL-IT (four) and Carestart Malaria Pf/Pan (one).
Sensitivities of the tests ranged from 63% to 100%; specificities

ranged from 94% to 100%. One study evaluated two brands and
so one brand was selected at random for inclusion in the metaanalysis. Based on 10 evaluations (3831 participants), the pooled
sensitivity was 89% (95% CI 79% to 95%) and the specificity was
98% (95% CI 97% to 99%) (Figure 8). Of the false negative RDT
results (where microscopy identified non-falciparum malaria only,
but RDT gave a different result), 87% (79% to 92%) of RDT
results indicated no malaria; the remaining false negative RDT
results indicated P. falciparum or mixed infection (Table 4).
14
microscopy). The black circle corresponds to the summary estimate of sensitivity and specificity, and is shown
with a 95% confidence region.
15
Other test types

There was one evaluation of Malariagen Malaria, a type of test that
does not fit into the classification presented in Table 1. Malariagen
Malaria uses antibodies to the HRP-2 antigen of P. falciparum and
unspecified monoclonal antibodies for detection of pan-malarial
antigens. The study (Selimuzzaman 2010) was undertaken on a
sample of 262 adults in Asia and the study prevalence of nonfalciparum malaria was 5%. The sensitivity of this test verified
against microscopy was 92% (95% CI 62% to 100%) and the
specificity was 95% (95% CI 92% to 97%).
Comparisons between RDT types
We summarised the comparison of different RDT types in Figure

9, Figure 10, Table 5 and Table 6. There was a statistically significant (P = 0.008) difference in accuracy between test types (Table
5) with Type 4 tests being significantly more sensitive than Type 2
(P = 0.01) and Type 3 (P = 0.03) (Table 6) based on indirect comparisons using all available data. Specificities were similarly high
across the three test types. Few studies directly compared tests and
so meta-analyses restricted to direct comparisons were not possible. The results from the only study (van den Broek 2006) that
directly compared a Type 2 test and a Type 4 test were consistent
with the meta-analytic finding and also demonstrated a statistically significant difference (P < 0.001) in sensitivity (Appendix 4).
16
Figure 9. Forest plot of Type 2, Type 3 and Type 4 tests for detection of non-falciparum species (verified
17
Figure 10. Summary ROC plot comparing Type 2, Type 3 and Type 4 tests for detection of non-falciparum
species (verified with microscopy). The solid circles correspond to the summary estimates of sensitivity and
specificity for each test type, and are shown with 95% confidence regions (dotted lines) and 95% prediction
regions (dashed lines). The summary points for Type 2 and Type 3 and their 95% confidence regions are
identical but the 95% prediction regions differ. The 95% prediction regions illustrate the extent of between
study heterogeneity.
18
Comparison of brands
We compared the test performance of three Type 3 test brandsParascreen (14 studies, 547 participants), Carestart Pf/Pan (four
studies, 3544 participants) and SD Malaria Antigen Bioline (four
studies, 3769 participants). We excluded the other two brandsFirst Response Malaria Combo (two studies, 663 participants) and
One Step Malaria Pf/Pan (one study, 606 participants)-from the
analysis due to limited data. There was no evidence (P = 0.88) to
suggest that the sensitivity or specificity, or both, of type 3 tests
was associated with brand. The summary sensitivity (95% CI)
was 79% (67% to 88%) for Parascreen, 74% (45% to 91%) for
Carestart Pf/Pan, and 80% (73% to 85%) for SD Malaria Antigen
Bioline. The summary specificity (95% CI) was 98% (98% to
99%) for Parascreen, 99% (96% to 100%) for Carestart Pf/Pan,
and 99% (98% to 100%) for SD Malaria Antigen Bioline.
For Type 4 tests, we compared the diagnostic accuracy of the OptiMAL (six studies, 1843 participants) and OptiMAL-IT (four
studies, 1987 participants) brands. We excluded a third brand,
Carestart Pf/Pan (one study, 195 participants), because of limited
data. There was no evidence (P = 0.79) to suggest a difference in
the sensitivity or specificity, or both, of the two brands. The summary sensitivity of OptiMAL was 90% (85% to 93%) and that of
OptiMAL-IT was 91% (49% to 99%). The summary specificities
were 98% (97% to 99%) and 98% (96% to 99%) for OptiMAL
and OptiMAL-IT respectively.
Investigations of heterogeneity
Due to the limited number of studies available for each test type,
we were only able to investigate the effect of continent and adequacy of the reference standard on the sensitivity and specificity of
Type 3 tests for detecting non-falciparum species with microscopy
as reference standard. There were three continents-Africa (14 studies, 5551 participants), Asia (eight studies, 4997 participants) and
South America (two studies, 704 participants)-but we excluded
South America from the analysis due to the limited data available.
There was no evidence (P = 0.55) to suggest a difference in sensitivity or specificity, or both, between studies conducted in Africa
and those in Asia. The summary sensitivity (95% CI) was 74%
(57% to 86%) for Africa and 80% (73% to 85%) for Asia. The
summary specificity (95% CI) was 99% (98% to 99%) for Africa
and 99% (97% to 99%) for Asia. For adequacy of the reference
standard, six studies were scored Yes, 12 studies were scored No
and five studies were scored Unclear; there was no evidence (P =
0.54) to suggest a difference in sensitivity or specificity, or both.
The summary sensitivity and specificity were 77% (67% to 85%)
and 99% (98% to 99%) for studies with an acceptable reference
standard; 78% (65% to 88%) and 99% (98% to 99%) for studies without an acceptable reference standard; and 86% (78% to
91%) and 98% (97% to 99%) for studies where the assessment
was judged to be unclear.
Verified by PCR
Type 2 tests
No study verified a Type 2 test with PCR.
Type 3 tests
There were five evaluations of a Type 3 test verified with PCR
(Figure 11); three were undertaken in Asia and two were undertaken in South America. The median sample size was 327 (range
178 to 606), and the median prevalence of non-falciparum malaria
was 15% (range 7% to 33%). None of the evaluations were undertaken only in children under the age of five years. Four different test brands were evaluated; Parascreen (two studies); SD
Malaria Antigen Bioline (one study), CareStart Pf/Pan (one study)
and One Step Malaria Pf/Pan (one study). Sensitivities of the tests
ranged from 64% to 91% and specificities ranged from 97% to
100%. In meta-analysis, the pooled sensitivity was 81% (95% CI
72% to 88%) and the pooled specificity was 99% (95% CI 97%
to 99%).
19
Figure 11. Summary ROC plot of Type 3 tests for detection of non-falciparum species (verified with PCR).
The solid circles correspond to the summary estimate of sensitivity and specificity, and is shown with a 95%
confidence region.
20
Type 4 tests
One study (Rakotonirina 2008) verified a Type 4 test, OptiMAL,
against PCR and gave results consistent with the summary results
of the six studies that used microscopy as the reference standard
(Appendix 5).
Comparison of results verified by microscopy or PCR
Four studies used both microscopy and PCR as reference standards to verify parasitaemia. Elahi 2013 estimated a sensitivity
of 91% and specificity of 99% for both PCR and microscopy;
Bendezu 2010 estimated a sensitivity of 76% and specificity of
98% with PCR, and sensitivity of 77% and specificity of 99%
with microscopy. The accuracy of CareStart Pf/Pan reported by
Xiaodong 2013 was similar for both reference standards with sensitivity of 91% and specificity of 100%. Yan 2013 evaluated One
Step Malaria Pf/Pan with an estimated sensitivity of 72% when
verified against PCR and 70% against microscopy, and a specificity of 97% with PCR and 99% with microscopy. Ratsimbasoa
2008 verified the Malaria Antigen Bioline test against PCR and
gave results within the 95% CI of the pooled results of the two
studies that used microscopy as the reference standard (Appendix
5).
Target condition: P. vivax

In this section we present the results for RDTs which identify P.
vivax by the presence of a positive P. vivax specific antibody line.
The majority of the tests had two test lines, an HRP-2 line to
detect P. falciparum and an pLDH line to detect P. vivax. One
study, which verified results using PCR, evaluated a Type 6 tests,
with additional test with an additional pan line to detect all species
of malaria. In each case, only the Pv PLDH line is considered in
the analysis.
Verified by microscopy
Eight studies evaluated the performance of Pf HRP-2 and Pv

pLDH antibody tests verified with microscopy-four were undertaken in Africa and four in Asia (Figure 12). The median sample size was 361 (range 240 to 1092), with a median prevalence of P. vivax malaria of 19% (range 2% to 45%). Evaluations
were conducted in mixed age groups or adults only. Five different test brands were assessed: CareStart Pf/Pv (three), Falcivax
(two), Biotech Malaria Pf/Pv (one), OnSite Pf/Pv (one), and Pf/
Pv Malaria Device (one). The sensitivities of the tests ranged from
66% to 100%, and specificities ranged from 98% to 100%. In
meta-analysis (eight evaluations, 3682 participants) the summary
sensitivity and specificity (95% CI) were 95% (86% to 99%) and
99% (99% to 100%) respectively (Figure 13).
Figure 12. Forest plot of Pf HRP-2 and Pv pLDH for detection of P. vivax (verified with microscopy). Studies
are ordered by continent, age group and study identifier.
21
Figure 13. Summary ROC plot Pf HRP-2 and Pv pLDH for detection of P. vivax (verified with microscopy).
The black circle corresponds to the summary estimate of sensitivity and specificity, and is shown with a 95%
confidence region.
22
Verified by PCR
Two studies evaluated the performance of three different brands of

Pf HRP-2 and Pv pLDH antibody tests against PCR. One study
was undertaken in Bangladesh and the other in China. Sensitivities ranged from 59% (47% to 70%) to 77% (56% to 91%) and
specificities ranged from 97% (95% to 99%) to 100% (99% to
100%). One study evaluated a Type 6 RDT and reported a sensitivity of 90% (70% to 99%) and specificity of 100% (99% to
100%).
Additional analyses
Sensitivities of tests at different levels of P. vivax

parasitaemia
Type 3 tests
Four studies presented additional data relating to the sensitivity of a
Type 3 RDT against microscopy at different levels of parasitaemia.
In Ratsimbasoa 2008 sensitivity was 93% at levels of 501 to 5000
asexual parasites per L; and 100% at levels above 5000 asexual
parasites per L. In Mohon 2012, sensitivity ranged from 80% at
1 to 100 asexual parasites per L, to 90% at 101 to 500 asexual
parasites per L to 100% at 501 or more asexual parasites per L.
In Yan 2013, sensitivity was 73.3% at under 500 asexual parasites
per L to 100%, and 69% at over 500 asexual parasites per L to
100%. In Kosack 2013 sensitivity was 14% at one to nine asexual
parasites per 100 fields, 70% at one to 10 asexual parasites in 10
fields, 96% at one to 10 asexual parasites per field, and 98% at
more than 10 asexual parasites per field.
Type 2 tests
Type 4 tests
Four studies presented additional data relating to the sensitivity

of Type 2 RDTs against microscopy at different levels of parasitaemia (Fernando 2004; Tjitra 1999; van den Broek 2006;
Wongsrichanalai 2003). The findings varied; all found very low
sensitivities below 100 parasites per L, rising with level of parasitaemia, but the level at which a high sensitivity (over 90%) was
achieved varied between 500 parasites per L and 5,000 parasites
per L.
Three studies presented additional data relating to the sensitivity of

Type 4 RDTs against microscopy at different levels of parasitaemia,
although two had only small numbers. One study presented useful
data (Valecha 2003), reporting a sensitivity of 30% at under 500
asexual parasites per L; 48% at 500 to 999 asexual parasites per
L; 91% at 1000 to 5000 asexual parasites per L; and 100% at
over 5000 asexual parasites per L.
23
Summary of findings
Patients/populations
People presenting with symptoms suggestive of uncomplicated malaria
Prior testing
None
Settings
Ambulatory healthcare settings in P. vivax,P. malariae or P. ovale malaria endemic areas in Asia, Africa and South America
Index tests
Immunochromatography-based rapid diagnostic tests (RDTs) for non-falciparum malaria in the absence of P. falciparum co-infection, or P. vivax malaria with or
without other malaria species
Reference standard
Conventional microscopy, polymerase chain reaction (PCR)
Importance
Accurate and fast diagnosis allows appropriate and quick treatment for malaria to be provided
Studies
37 unique publications reporting 47 studies (22,862 participants)
Quality concerns
Poor reporting of patient characteristics, sampling method and reference standard methods were common concerns
Test type
Quantity of evidence
Average
Number of evaluations (95% CI)
(malaria cases/participants)
sensitivity Average
(95% CI)
specificity Prevalence (%) Consequences in a cohort of 1000
Missed cases
False positives
11
10
15
33
30
66
11
10
15
33
30
66
Target condition (reference standard): non-falciparum malaria (microscopy)

Type 2
11 (958/6879)
HRP-2 (P. falciparum
specific) and aldolase
(pan-specific)
78% (73% to 82%)
Type 3
23 (1537/11,234)
specific) and pLDH (panspecific)
78% (69% to 84%)
99% (97% to 99%)
99% (98% to 99%)
24
Type 4
10 (986/3831)
pLDH (P. falciparum specific) and pLDH (pan-specific)
89% (79% to 95%)
98% (97% to 99%)
19
15
17
17
30
33
14
10
10
15
29
30
57
10
15
30
15
Target condition (reference standard): non-falciparum malaria (PCR)

Type 3
5 (300/1639)
specific) and pLDH (panspecific)
81% (72% to 88%)
99% (97% to 99%)
Target condition (reference standard): P.vivax with or without other malaria species (microscopy)
HRP-2 (P. falciparum 8 (580/3682)
specific) and pLDH (P. vivax-specific)
95% (86% to 99%)
99% (99% to 100%)
Conclusions: The majority of studies evaluated RDTs which are designed to differentiate falciparum malaria from non-falciparum malaria, but cannot differentiate between different nonfalciparum species or identify non-falciparum malaria species within a mixed infection. In these types of tests, specificity for non-falciparum malaria in the absence ofP. falciparum infection
was high, but sensitivity was low, tests missing between 11% and 22% of non-falciparum cases. RDTs which are designed to detect P. vivax specifically, whether alone or part of a mixed
infection, were more accurate with tests missing less than 5% of P. vivax cases. This review can help decision-making about which RDT to use, in combination with other published
information about in vitro test performance and stability in the field
25
DISCUSSION
Summary of main results

Test Types 2, 3 and 4, and other tests that identified non-falciparum malaria through deduction of a positive result for panmalarial antigens along with a negative result for P. falciparum
specific antigens, had sensitivities that ranged in pooled analyses
from 78% (Type 2) to 89% (Type 4). Further analysis of the false
negative results showed that the majority of non-falciparum only
cases that were missed by the RDTs were indicated as no malaria
although some were indicated as P. falciparum or mixed infection.
Type 4 tests were significantly more sensitive than Type 2 tests.
Specificities were consistently high, ranging from 98% (Type 4)
to 99% (Type 2 and Type 3). There were no apparent differences
between microscopy and PCR as the reference standard.
In studies that verified RDTs with microscopy, tests that used a
P. vivax specific antibody line to identify P. vivax had a pooled
sensitivity of 95% (95% CI 86% to 99%) and a pooled specificity
of 99% (95% CI 99% to 100%). In contrast, the two studies that
verified these types of RDTs with PCR demonstrated much lower
sensitivity of 59% (47% to 70%) and 77% (56% to 91%).
In Summary of findings, assuming prevalences of 5%, 15% and
30%, the number of missed non-falciparum or P. vivax malaria
cases and the number of false positives in a hypothetical cohort
of 1000 patients are presented by test type. In the case of tests for
non-falciparum only, the performance may in reality be affected
by the prevalence of P. falciparum parasitaemia; this effect is not
possible to estimate with any accuracy, however it is likely to be
small, and has therefore been ignored.
Strengths and weaknesses of the review
Completeness of evidence
It is probable that some studies eligible for inclusion in the review
were missed by our search strategy. DTA studies are known to be
poorly indexed, and hence liable to be missed, even when searches
are designed to be very sensitive (Whiting 2009). However, our
search was comprehensive.
Accuracy of the reference standards used
Microscopy is an imperfect diagnostic test in itself, raising the
possibility that in some cases of discordant results between microscopy and RDT, the RDT result may in fact have been correct,
and the microscopy results incorrect. However, with the exception of P. vivax specific tests, where only two studies verified by
PCR were available, results for studies which verified RDT results
against PCR gave similar results to those which used microscopy

as a reference standard.
In studies reporting on sensitivity by parasitaemia level, RDTs
tended to reach high levels of sensitivity (above 90%) at levels of
parasitaemia above 500 to 1000 asexual parasites for P. vivax, but
were less reliable at lower levels. This finding corresponds closely
with a similar analysis within a DTA review of RDTs for travellers
with fever returning from malaria endemic to non-endemic areas(
Marx 2005).
Quality of reporting of the included studies
The quality of reporting of the included studies, as assessed by
the number of unclear evaluations of study quality was variable.
Nineteen study cohorts (40%) did not provide enough information for us to adequately assess the adequacy of the reference standard, which we judged to be the most important quality indicator
for this review.
Quality of the included studies
Where sufficient information was provided to assess the quality
of included studies, the quality was variable. Twenty (43%) study
cohorts reported an adequate reference standard, while 37 (79%)
reported that readers of the reference standard were blinded to the
results of the RDTs. For Type 3 tests, we were able to investigate the
effect of adequacy of the reference standard on test performance.
There was no evidence of a difference in test performance between
studies with an adequate, inadequate or unclear reference standard.
Completeness and relevance of the review
This review focused specifically on the use of RDTs for diagnosing
non-falciparum malaria in people living in malaria endemic areas
and attending ambulatory health care setting with symptoms of
malaria; therefore evaluating the tests in the context in which they
are intended to be most often used. Previously published reviews
have evaluated the accuracy of RDTs under laboratory conditions
(WHO 2012) and for use by travellers returning from malaria endemic to non-endemic areas (Marx 2005). By classifying asexual
parasitaemia as positive and gametocytes only as negative we focused on malarial illness requiring curative treatment, in line with
current treatment recommendations (WHO 2010). In the future,
as malaria comes closer to elimination, it may become important
to cure gametocytaemia to prevent transmission, and diagnostic
priorities may change.
Applicability of findings to the review question
Qualities of RDTs
26
RDT types 2, 3 and 4, which aim to identify non-falciparum

malaria only as a proxy for P. vivax may miss between 11% (Type
4) and 22% (Type 2 and Type 3) of cases, with the majority of
missed cases being incorrectly identified as free of malaria. In addition, the design of these tests does not allow the identification
of non-falciparum malaria as part of a mixed infection, or the differentiation of P. vivax from P. ovale and P. malariae. These tests
therefore do not appear adequately sensitive for the identification
of P. vivax, although they may play a role in areas where both P. vivax and P. falciparum occur and are initially treated with the same
drugs. In contrast, RDT types using pLDH designed to detect P.
vivax specifically, whether alone or part of a mixed infection appear to be both highly sensitive (missing 5% of cases) and highly
specific for P. vivax. However, two studies included in this review,
which verified the test with PCR, found much lower sensitivities.
Consideration also needs to be made for variation in sensitivity by
brand (WHO 2012).
Application to clinical decision-making in practice
The evaluations presented in this review were conducted in patients with symptoms of clinical malaria and inferences about the
results relate to this context, and not to mass surveys of well populations. The evaluations should also be read in conjunction with
other published information regarding the in vitro performance,
stability and costs of the tests, including the WHO FIND report
(WHO 2012). Results between this review and the FIND analysis for some RDTs differ slightly. The FIND report tested individual products under laboratory conditions using standardised
blood samples at low and high parasite densities (200 and 2000
parasites per L) and reported the panel detection score; which
is defined as the percentage of times that two tests within a batch
detected parasites at low density, and percentage of times that one
test detected parasites at high density. This measure is slightly different to sensitivity, as it includes an aspect of consistency, whereas
the studies in this review were conducted in field conditions with
patients, and this is likely to account for variations between the
datasets. The results in our review more closely mimic the conditions in which the tests would be used in practice; where parasite
density is generally unknown, and may be affected by storage of
the test, quality of a specific batch, local parasite densities, local
parasite antigen patterns, quality of local microscopy and accuracy
of reading the tests. Equally, these factors bring in more variation
than tests from a laboratory using standardised samples.
RDTs can only influence clinical practice if the results are believed and acted upon. There may be reluctance on the part of
both health providers and patients to believe negative RDT results, leading to unnecessary repeat testing and prescription of antimalarials for negative cases (Tavrow 2000). Various studies have
shown that patients with fever and negative malaria test results,
whether by microscopy or RDT, often still receive antimalarials
(Hamer 2007), thus reducing their potential usefulness and costeffectiveness. However, some educational interventions have been
shown to be effective in reducing prescriptions for antimalarials
in negative cases (Ngasala 2008).
AUTHORS CONCLUSIONS
Implications for practice
RDT types 2, 3 and 4, which aim to identify non-falciparum
malaria only as a proxy for P. vivax are limited by their design as
they are unable to identify P. vivax specifically or to identify any
species of non-falciparum malaria as part of mixed infection. In
addition, they have a relatively low sensitivity for non-falciparum
malaria only. They may be useful in areas where the majority of
malaria is caused by P. falciparum or mixed infection and where
good quality microscopy is not available; our related review (Abba
2011) has shown that these test types are sensitive for the detection
of P. falciparum. RDT types which are designed to detect P. vivax
specifically, whether alone or part of a mixed infection appear to be
both more directly applicable to practice in P. vivax endemic areas
and in the majority of published studies have been shown to be
more accurate. Data were insufficient to determine test accuracy
by parasite density, which will affect the sensitivity and specificity
thresholds that decide whether a test is useful in practice.
Implications for research

More studies are needed to assess the accuracy of the newer RDT
types designed to detect P. vivax specifically, particularly in areas
with low prevalence.
ACKNOWLEDGEMENTS
The academic editor for this review was Dr Karen Steingart.
We are grateful to our affiliated institutions and organizations, and
to the Department of International Development (DFID), UK for
research grants. We acknowledge the referees for their comments.
Also, we thank Nicola Mayan and Sally Jackson for helping with
data extraction.
The editorial base for the Cochrane Infectious Diseases Group is
funded by UKaid from the UK Government for the benefit of
developing countries.
27
REFERENCES
References to studies included in this review

Alam 2011 {published data only}
Alam MS, Mohon AN, Mustafa S, Khan WA, Islam N,
Karim MJ, et al. Real-time PCR assay and rapid diagnostic
tests for the diagnosis of clinically suspected malaria patients
in Bangladesh. Malaria Journal 2011;10:175.
Andrade 2010 {published data only}
Andrade BB, Reis-Filho A, Barros AM, Souza-Neto SM,
Nogueira LL, Fukatano KF, et al. Towards a precise test for
malaria diagnosis in the Brazilian Amazon: comparison
among field microscopy, a rapid diagnostic test, nested
PCR, and a computational expert system based on artificial
neural networks. Malaria Journal 2010;9:117.
Ashton 2010 {published data only}
Ashton RA, Kefyalew T, Tesfaye G, Counihan H, Yadeta D,
Cundill B, et al. Performance of three multi-species rapid
diagnostic tests for diagnosis of Plasmodium falciparum
and Plasmodium vivax malaria in Oromia Regional State,
Ethiopia. Malaria Journal 2010;9:297.
Bell 2001a {published data only}
Bell D, Go R, Miguel C, Walker J, Cacal L, Saul A.
Diagnosis of malaria in a remote area of the Philippines:
comparison of techniques and their acceptance by health
workers and the community. Bulletin of the World Health
Organization 2001;79(10):93341.
Bell 2001b {published data only}
Bell D, Go R, Miguel C, Walker J, Cacal L, Saul A.
Diagnosis of malaria in a remote area of the Philippines:
comparison of techniques and their acceptance by health
workers and the community. Bulletin of the World Health
Organization 2001;79(10):93341.
Bendezu 2010 {published data only}
Bendezu J, Rosas A, Grande T, Rodriguez H, LlanosCuentas A, Escobedo J, et al. Field evaluation of a rapid
diagnostic test (Parascreen) for malaria diagnosis in the
Peruvian Amazon. Malaria Journal 2010;9:154.
Bharti 2008 {published data only}
Bharti PK, Silawat N, Singh PP, Singh MP, Shukla M,
Chand G, et al. The usefulness of a new rapid diagnostic
test, the First Response Malaria Combo (pLDH/HRP2)
card test, for malaria diagnosis in the forested belt of central
India. Malaria Journal 2008;7:126.
Chanie 2011 {published data only}
Chanie M, Erko B, Animut A, Legesse M. Performance of
CareStartT M Malaria Pf/Pv Combo test for the diagnosis of
Plasmodium falciparum and Plasmodium vivax infections in
the Afar Region, North East Ethiopia. Ethiopian Journal of
Health Development 2011;25(3):20611.
Chayani 2004 {published data only}
Chayani N, Das B, Sur M, Bajoria S. Comparison of parasite
lactate dehydrogenase based immunochromatographic
antigen detection assay (OptiMAL) with microscopy for
detection of malaria parasites. Indian Journal of Medical

Microbiology 2004;22(2):1046.
Dev 2004 {published data only}
Dev V. Relative utility of dipsticks for diagnosis of malaria
in mesoendemic area for Plasmodium falciparum and P.
vivax in Northeastern India. Vector-Borne and Zoonotic
Diseases 2004;4(2):12330.
Eibach 2013 {published data only}
Eibach D, Traore B, Bouchrik M, Coulibaly B, Coulibaly
N, Siby F, et al. Evaluation of the malaria rapid diagnostic
test VIKIA malaria Ag Pf/PanT M in endemic and nonendemic settings. Malaria Journal 2013;12:188.
Elahi 2013 {published data only}
Elahi, R, Mohon, A.N, Khan, W.W, Haque, R, Alam, M.S.
Performance of a HRP-2/pLDH based rapid diagnostic test
at the Bangladesh-India-Myanmar border area for diagnosis
of clinical malaria. Malaria Journal 2013;12:378.
Endeshaw 2012a {published data only}
Endeshaw T, Graves PM, Ayele B, Mosher AW, Gebre T,
Ayalew F, et al. Performance of local light microscopy and
the ParaScreen Pan/Pf rapid diagnostic test to detect malaria
in health centers in Northwest Ethiopia. PLoS One 2012;7
(4):e33014.
Endeshaw 2012b {published data only}
in health centres in Northwest Ethiopia. PLoS One 2012;7
(4):e33014.
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Endeshaw 2012f {published data only}
(4):e33014.
28
Endeshaw 2012g {published data only}

(4):e33014.
Endeshaw 2012h {published data only}
(4):e33014.
Endeshaw 2012i {published data only}
(4):e33014.
Endeshaw 2012j {published data only}
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Fernando 2004 {published data only}
Fernando SD, Karunaweera ND, Fernando WP.

Evaluation of a rapid whole blood immunochromatographic
assay for the diagnosis of Plasmodium falciparum and
Plasmodium vivax malaria. Ceylon Medical Journal 2004;49
(1):711.
Fernando SD, Karunaweera ND, Fernando WP, Attanayake
N, Wickremasinghe AR. A cost analysis of the use of the
rapid, whole-blood, immunochromatographic Pf/Pv assay
for the diagnosis of Plasmodium vivax malaria in rural areas
of Sri Lanka. Annals of Tropical Medicine and Parasitology
2004;98(1):513.
Harani 2006 {published data only}
Harani MS, Beg MA, Khaleeq L, Adil SN, Kakepoto GN,
Khurshid M. Role of ICT Malaria immunochromatographic
test for rapid diagnosis of malaria. Journal of the Pakistan
Medical Association 2006;56(4):16771.
Kolaczinski 2004 {published data only}
Klolaczinski J, Mohammed N, Ali A, Ali M, Khan N, Ezard
N, Rowland M. Comparison of the OptiMAL rapid antigen
test with field microscopy for the detection of Plasmodium
vivax and P. falciparum: considerations for the application
of the rapid test in Afghanistan. Annals of Tropical Medicine
and Parasitology 2004;98(1):1520.
Kosack 2013 {published data only}
Kosack CS, Naing WT, Piriou E, Shanks L. Routine parallel
diagnosis of malaria using microscopy and the malaria rapid
diagnostic test SD 05FK60: the experience of Mdecins
Sans Frontires in Myanmar. Malaria Journal 2013;12:167.
Mekonnen 2010 {published data only}
Mekonnen Z, Ali S, Belay G, Suleman S, Chatterjee S.
Evaluation of the performance of Carestart Malaria Pf/Pf
Combo rapid diagnostic test for the diagnosis of malaria in

Jimma, southwestern Ethiopia. Acta Tropica 2010;113(3):
2858.
Metzger 2011 {published data only}
Metzger WG, Vivas-Martnez S, Giron A, Vaccari E,
Campos E, Rodrguez I, et al. Assessment of routine malaria
diagnosis in the Venezuelan Amazon. Transactions of the
Royal Society of Tropical Medicine and Hygiene 2011;105(5):
2628.
Moges 2012 {published data only}
Moges B, Amare B, Belyhun Y, Tekeste Z, Gizachew M,
Workineh M, et al. Comparison of CareStart HRP2/pLDH
COMBO rapid malaria test with light microscopy in northwest Ethiopia. Malaria journal 2012;11:234.
Mohon 2012 {published data only}
Mohon AN, Elahi R, Podder MP, Mohiuddin K, Hossain
MS, Khan WA, et al. Evaluation of the OnSite (Pf/Pan)
rapid diagnostic test for diagnosis of clinical malaria.
Malaria Journal 2012;11:415.
Pattanasin 2003 {published data only}
Pattanasin S, Proux S, Chompasuk D, Luwiradaj K,
Jacquier P, Looareesuwan S, et al. Evaluation of a new
plasmodium lactate dehydrogenase assay (OptiMAL-IT) for
the detection of malaria. Transactions of the Royal Society of
Tropical Medicine and Hygiene 2003;97(6):6724.
Rakotonirina 2008 {published data only}
Rakotonirina H, Barnadas C, Raherijafy R,
Andrianantenaina H, Ratsimbasoa A, Randrianasolo L, et
al. Accuracy and reliability of malaria diagnostic techniques
for guiding febrile outpatient treatment in malaria-endemic
countries. American Journal of Tropical Medicine and
Hygiene 2008;78(2):21721.
Ratsimbasoa 2007 {published data only}
Ratsimbasoa A, Randriamanantena A, Raherinjafy R,
Rasoarilalao N, Mnard D. Which malaria rapid test for
Madagascar? Field and laboratory evaluation of three test
and expert microscopy of samples from suspected malaria
patients in Madagascar. American Journal Of Tropical
Medicine and Hygiene 2007;76(3):4815.
Ratsimbasoa A, Fanazava L, Radrianjafy R, Ramilijaona J,
Rafanomezantsoa H, Mnard D. Short report: Evaluation
of two new immunochromatographic assays for diagnosis of
malaria. American Journal of Tropical Medicine and Hygiene
2008;79(5):6702.
Samane 2010 {published data only}
Samane AK, Nahid HZ, Saaed S, Khazen H, Ali H, Ahmad
R, et al. Comparison of microscopy and RDTs techniques
for laboratory detection of malaria. African Journal of
Biotechnology 2010;9(10):15146.
Selimuzzaman 2010 {published data only}
Selimuzzaman SM, Islam SJ, Nahar Z, Das R, Rahman
MA, Rahman MA. Malariagen malaria Pf/Pv antigen rapid
test: a simple and effective tool for diagnosis of malaria in
the far-flung hilly areas of Bangladesh. Mymensingh Medical
Journal 2010;19(1):949.
29
Sharew 2009 {published data only}

Sharew B, Legesse M, Animut A, Jima D, Medhim G, Erkko
B. Evaluation of the performance of CareStart Malaria Pf/Pv
Combo and Paracheck Pf tests for the diagnosis of malaria
in Wondo Genet, southern Ethiopia. Acta Tropica 2009;
111(3):3214.
Singh 2000a {published data only}
Singh N, Saxena A, Valecha N. Field evaluation of the ICT
Malaria Pf/Pv immunochromatographic test for diagnosis
of Plasmodium falciparum and P. vivax infection in forest
villages in Chhindwara, central India. Tropical Medicine and
International Health 2000;5(11):76570.
Singh 2003 {published data only}
Singh N, Valecha N, Nagpal AC, Mishra SS, Varma HS,
Subbaro SK. The hospital- and field-based performances of
the OptiMAL tests, for malaria diagnosis and treatment
monitoring in central India. Annals of Tropical Medicine and
Parasitology 2003;97(1):513.
Singh N, Shukla MM, Shukla MK, Mehra RK, Sharma
S, Bharti PK, et al. Field and laboratory comparative
evaluation of rapid malaria diagnostic tests versus traditional
and molecular techniques in India. Malaria Journal 2010;9:
191.
Tjitra 1999 {published data only}
Tjitra E, Suprianto S, Dyer M, Currie BJ, Anstey
NM. Field evaluation of the ICT malaria Pf/Pv
immunochromatographic test in detection of Plasmodium
falciparum and Plasmodium vivax in patients with a
presumptive clinical diagnosis of malaria in eastern
Indonesia. Journal of Clinical Microbiology 1999;37(8):
24127.
Trouvay 2013 {published data only}
Trouvay M, Palazon G, Berger F, Volney B, Blanchet D,

Faway E, et al. High performance of histidine-rich protein 2
based rapid diagnostic tests in French Guiana are explained
by the absence of pfhrp2 gene deletion in P. falciparum.
PLoS One 2013;8(9):e74269.
Valecha 2003 {published data only}
Valecha N, Singh N, Yadav RS, Dev V, Aggarwal A,
Subbarao SK. Field evaluation of OptiMAL48 rapid malaria
diagnostic test in India. Acta Parasitologica 2003;48(3):
22932.
van den Broek 2006 {published data only}
van den Broek I, Hill O, Gordillo F, Angarita B, Hamade
P, Counihan H, et al. Evaluation of three rapid tests for
diagnosis of P. falciparum and P. vivax malaria in Colombia.
American Journal of Tropical Medicine and Hygiene 2006;75
(6):120915.
Wongsrichanalai 2003 {published data only}
Wongsrichanalai G, Arevalo I, Laoboonchai A, Yingyuen
K, Miller RS, Magill AJ, et al. Rapid diagnostic
devices for malaria: field evaluation of a new prototype
immunochromatographic assay for the detection of
Plasmodium falciparum and non-falciparumPlasmodium.

(1):2630.
Xiaodong 2013 {published data only}
Xiaodong S, Tambo E, Chun W, Zhibin C, Yan D,
Jian W, et al. Diagnostic performance of CareStartT M
malaria HRP2/pLDH (Pf/pan) combo test versus standard
microscopy on falciparum and vivax malaria between
China-Myanmar endemic borders. Malaria Journal 2013;
12:6.
Yan 2013 {published data only}
Yan J, Li N, Wei X, Li P, Zhao Z, Wang L, et al. Performance
of two rapid diagnostic tests for malaria diagnosis at the
China-Myanmar border area. Malaria Journal 2013;12:73.
References to studies excluded from this review

Abeku 2008 {published data only}
Abeku TA, Kristan M, Jones C, Beard J, Mueller DH,
Okia M, et al. Determinants of the accuracy of rapid
diagnostic tests in malaria case management: evidence from
low and moderate transmission settings in the East African
highlands. Malaria Journal 2008;7:202.
Abul Faiz 2000 {published data only}
Abul Faiz M, Rashid R, Palit R, Rahman MR, BinYunus E,
Hussain A, et al. ParaSight-F test results in cerebral malaria
patients before and after treatment in Chittagong Medical
College Hospital, Bangladesh. Transactions of the Royal
Society of Tropical Medicine and Hygiene 2000;94(1):567.
Ademowo 2012 {published data only}
Ademowo G. Evaluation of the relative performance of
rapid diagnostic test products (Partec and ParacheckPf ) in the diagnosis of malaria in febrile children. 6th
EDCTP Forum: Strengthening Research Partnerships for
Better Health and Sustainable Development Addis Ababa
Ethiopia; 2011 09-12 Oct; Addis Ababa. Tropical Medicine
and International Health. 2012:589.
Adesanmi 2011 {published data only}
Adesanmi TA, Okafor HU, Okoro AB, Mafe AG. Diagnosis
of malaria parasitemia in children using a rapid diagnostic
test. Nigerian Journal of Clinical Practice 2011;14(2):
195200.
A-Elgayoum 2009 {published data only}
A-Elgayoum SME, El-Feki AE-KA, Mahgoub BA, ElRayah el-A, Giha HA. Malaria overdiagnosis and burden
of malaria misdiagnosis in the suburbs of central Sudan:
special emphasis on artemisinin-based combination therapy
era. Diagnostic Microbiology and Infectious Disease 2009;64
(1):2834.
Afzaal 2001 {published data only}
Afzaal S, Singh M, Fatima S, Koshy AA. Rapid diagnostic
tests for malaria. Journal of the Association of Physicians of
India 2001;49:2615.
Ahmad 2003 {published data only}
Ahmad SQ, Abbasi SA, Tariq MA, Mirza SA, Salamat A.
Evaluation of Plasmodium-lactate dehydrogenase based
immunochromatographic kit for the diagnosis of malaria.
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Ahmed 2010 {published data only}
Ahmed MU, Mahmud MC, Shamsuzzaman AK,
Musa AK, Ahmed SU, Alam M, et al. Role of
immunochromatographic test for rapid diagnosis of malaria.
Mymensingh Medical Journal 2010;19(1):1069.
Albertini 2012 {published data only}
Albertini A, Djalle D, Faye B, Gamboa D, Luchavez J,
Mationg ML, et al. Preliminary enquiry into the availability,
price and quality of malaria rapid diagnostic tests in the
private health sector of six malaria-endemic countries.
Tropical Medicine and International Health 2012;17(2):
14752.
Allen 2011 {published data only}
Allen LK, Hatfield JM, DeVetten G, Ho JC, Manyama
M. Reducing malaria misdiagnosis: the importance of
correctly interpreting Paracheck Pf faint test bands in a
low transmission area of Tanzania. BMC Infectious Diseases
2011;11:308.
Anonymous 2005 {published data only}
Anonymous. Micro moves against malaria. New Scientist
2005;187(2517):53.
Ansah 2008 {published data only}
Ansah EK. A comparison of microscopy with rapid
diagnostic tests for malaria in rural Ghana. American
Journal of Tropical Medicine and Hygiene 2008;79(6):91.
Ansah 2010 {published data only}
Ansah EK, Narh-Bana S, Epokor M, Akanpigbiam S,
Quartey AA, Gyapong J, et al. Rapid testing for malaria
in settings where microscopy is available and peripheral
clinical where only presumptive treatment is available: a
randomised controlled trial in Ghana. BMJ 2010;340:c930.
Araz 2000 {published data only}
Araz E, Tanyuksel M, Ardic N, Tabuk C. Performance of a
commercial immunochromatographic test for the diagnosis
of vivax malaria in Turkey. Transactions of the Royal Society
of Tropical Medicine and Hygiene 2000;94(1):556.
Arcanjo 2007 {published data only}
Arcanjo AL, de Lacerda MVG, Alecrim WD, Alecrim
MDC. Evaluation of the Optimal-IT and ICT P.f./P.v
rapid dipstick tests for diagnosing malaria within primary
healthcare in the municipality of Manaus, Amazonas
[Avaliao dos testes rpidos OptimalIT e ICTP.f./P.v.
para o diagnstico da malria, na Ateno Bsica de Sade,
no municpio de Manaus, Amazonas]. Revista Da Sociedade
Brasileira de Medicina Tropical 2007;40(1):8890.
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Ardic N, Koru O. Rapid diagnostic tests in malaria. Nobel
Medicus 2012;8(2):105.
Arora 2003 {published data only}
Arora S, Gaiha M, Arora A. Role of the Parasight-F test
in the diagnosis of complicated Plasmodium falciparum
malarial infection. Brazilian Journal of Infectious Diseases
2003;7(5):3328.
Arrspide 2004a {published data only}

Arrspide N, Puray C, Guzmn E, Verano M, Medina
S, Mendizbal S, et al. Use of rapid tests for detecting
Plasmodium falciparum in blood donors in Peru [Uso de
pruebas rpidas immunocromatogrficas para la deteccin
de Plasmodium falciparum en donantes de sangre en Per].
Revista Peruana de Medicina Experimental y Salud Pblica
2004;21(2):7682.
Arrspide 2004b {published data only}
Arrspide NV, Marquio WQ, Gutirrez SG. Evaluation
of an immunoassay ICT P.f/P.v for the diagnosis of
Plasmodium falciparum and Plasmodium vivax in the local
macroregion of northern Peru [Evaluacin de una prueba
inmunocromatogrfica ICT P.f/P.v para el diagnstico de
malaria por Plasmodium falciparum y Plasmodium vivax en
establecimientos de la macroregin norte del Per]. Revista
Peruana de Medicina Experimental y Salud Pblica 2004;21
(3):1348.
Arrspide 2006 {published data only}
Arrspide V, Flores RP, Ruiz JC. Evaluation of a rapid test
based on pLDH detection for the diagnosis of malaria in
endemic areas of Peru [Evaluacin de una prueba rpida
basada para el diagnstico de malaria en reas endmicas del
Per]. Revista Peruana de Medicina Experimental y Salud
Pblica 2006;23(2):816.
Ashley 2009 {published data only}
Ashley EA, Touabi M, Ahrer M, Hutagalung R, Htun
K, Luchavez J, et al. Evaluation of three parasite lactate
dehydrogenase-based rapid diagnostic tests for the diagnosis
of falciparum and vivax malaria. Malaria Journal 2009;8:
241.
Ashley EA, Touabi M, Ahrer M, Hutagalung R, Htun
K, Lwin M, et al. Evaluation of 3 rapid diagnostic tests:
CareStartT M Malaria 3 line pLDH (pan, Pf ), Optimal-IT
PLDH (pan, Pf ) and CarestartT M 2 line pLDH (pan) for
the diagnosis of malaria in Myanmar. American Journal of
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Aslan G, Ulukanligil M, Seyrek A, Erel O. Diagnostic
performance characteristics of rapid dipstick test for
Plasmodium vivax malaria. Memrias do Instituto Oswaldo
Cruz 2001;96(5):6836.
Assal 1999 {published data only}
Assal A, Kauffmann-Lacroix C, Rodier MH, Dard ML,
Houssay D, Jacquemin JL. Comparison of two techniques
for detection of anti-Plasmodium falciparum antibodies:
Falciparum-spot IF (Biomerieux) and Malaria IgG Celisa
(BMD). Transfusion Clinique et Biologique 1999;6(2):
11923.
Avila 2002 {published data only}
Avila PE, Kirchgatteri K, Brunialti KCS, Oliveira AM,
Siciliano RF, Di Santi SM. Evaluation of a rapid dipstick
test, Malar-check, for the diagnosis of Plasmodium
falciparum malaria in Brazil. Revista do Instituto de Medicina
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Ayeh-Kumi PF, Akalifa BG, Obeng Nkrumah N, Asmah
RH, Dayie NTKD. Performance of rapid DiaMed OptiMalIT malaria test in an endemic Ghanaian setting. Journal
of Parasitic Diseases 2011;35(2):12933.
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Bartoloni A, Strohmeyer M, Sabatinelli G, Benucci M, Serni
U, Paradisi F. False positive ParaSight-F test for malaria in
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Azazy AA. Performance and accuracy of an
immunodiagnostic antigen detection test in diagnosing
Plasmodium falciparum among Yemeni patients. Annals of
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Bassene H, Kenge P, Ndiath MO, Sokhna C, Dupressoir T,
Fontenille D, et al. Comparison of PCR, ELISA-CSP and
direct microscopic observation methods for the detection of
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in Sengal. Bulletin de la Socit de Pathologie Exotique 2009;
102(4):2337.
Azikiwe 2012 {published data only}

Azikiwe CCA, Ifezulike CC, Siminialayi IM, Amazu LU,
Enye JC, Nwakwunite OE. A comparative laboratory
diagnosis of malaria: Microscopy versus rapid diagnostic
test kits. Asian Pacific Journal of Tropical Biomedicine 2012;
2(4):30710.
Babacar 2008 {published data only}
Babacar F, Ndiaye JL, Diallo I, Tine RC, Seck I, Ba-Fall F, et
al. Feasibility of the rapid diagnostic tests (RDTs) field use
for malaria case management in Senegal. American Journal
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Baiden F, Webster J, Tivura M, Delimini R, Berko Y,
Amenga-Etego S, et al. Accuracy of rapid tests for malaria
and treatment outcomes for malaria and non-malaria cases
among under-five children in rural Ghana. PLoS One 2012;
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Baltzell KA, Shakely D, Hsiang M, Kemere J, Ali AS,
Bjrkman A, et al. Prevalence of PCR detectable malaria
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Banchongaksorn T, Yomokgul P, Panyim S, Rooney W,
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Banchongaksorn 1997 {published data only}
Banchongaksorn T, Prajakwong S, Rooney W, Vickers P.
Operational trial of ParaSight-F (dipstick) in the diagnosis
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Barber 2013 {published data only}
Barber BE, William T, Grigg MJ, Piera K, Yeo TW,
Anstey NM. Evaluation of the sensitivity of a pLDH-based
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Bassett MT, Taylor P, Bvirakare J, Chiteka F, Govera E.
Clinical diagnosis of malaria: can we improve?. Journal of
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Beadle C, Long GW, Weiss WR, McElroy PD, Maret
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Bechem 1999 {published data only}
Bechem NN, Leke RFG, Tietche F, Taylor DW. Evaluation
of rapid test for histidine rich protein 2 for diagnosis of
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Beg 2005 {published data only}
Beg MA, Ali SS, Haqqee R, Khan MA, Qasim Z, Hussain
R, et al. Rapid immunochromatography-based detection of
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Belizario VY, Pasay CJ, Bersabe MJ, de Leon WU, Guerrero
DM, Bugaoisan VM. Field evaluation of malaria rapid
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Medicine and Public Health 2005;36(3):55261.
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Bell DR, Wilson DW, Martin LB. False-positive results of a
Plasmodium falciparum histidine-rich protein 2-detecting
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Bellagra N, Ajana F, Caillaux M. ParaSight F in the diagnosis
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Bendezu J. Field evaluation of a rapid malaria diagnostic test
(Parascreen) for malaria diagnosis in the Peruvian Amazon.
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Bjorkman A. The use of rapid diagnostic tests for measuring
malaria transmission. 7th European Congress on Tropical
Medicine and International Health; 2011 03-06 Oct;
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Comparison of different methods for delayed post-mortem
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Bhat Sandhya K, Sastry Apurba S, Nagaraj ER, Mannur
S, Sastry Anand S. Laboratory diagnosis of malaria by
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Bhatt KM. Laboratory diagnosis of malaria: an overview.
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Birku Y, Welday D, Ayele D, Shepherd A. Rapid diagnosis
of severe malaria based on the detection of Pf-HRP-2
antigen. Ethiopian Medical Journal 1999;37(3):1739.
Bisoffi 2009a {published data only}
Bisoffi Z, Sirima BS, Angheben A, Lodesani C, Gobbi F,
Tinto H, et al. Rapid malaria diagnostic tests vs. clinical
management of malaria in rural Burkina Faso: safety and
effect on clinical decisions. A randomized trial. Tropical
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Bisoffi 2009b {published data only}
Bisoffi Z, Gobbi F, Angheben A, Van den Ende J. The
role of rapid diagnostic tests in managing malaria. PLoS
Medicine 2009;6(4):e1000063.
Bisoffi 2011 {published data only}
Bisoffi Z, Sodiomon Sirima B, Meheus F, Lodesani C,
Gobbi F, Angheben F, et al. A cost benefit analysis of malaria
rapid diagnostic tests for adults and children in Burkina
Faso. 7th European Congress on Tropical Medicine and
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Biswas 2004 {published data only}
Biswas S. Inter-test comparison between filter paper
absorbed blood eluate and serum for malaria serology by
enzyme immunoassay: an operational feasibility. Journal of
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Bojang 1999 {published data only}

Bojang KA. The diagnosis of Plasmodium falciparum
infection in Gambian children, by field staff using the rapid,
manual, ParaSight-F test. Annals of Tropical Medicine and
Bouchaud 2000 {published data only}
Bouchaud O, Houz S, Longuet C, di Piazza JP, Ruggieri
C, Scardin Y, et al. Use of the Parasight-F diagnostic test
for imported malaria in a travel clinic. American Journal of
Tropical Medicine and Hygiene 2000;63(1-2):769.
Bouyou Akotet 2013 {published data only}
Bouyou Akotet MK, Mawili-Mboumba DP, Madoungou
B, Kombila M. Performances of malaria P.f/Pan rapid test
device Acon (Pf HRP2/pan aldolase) and malaria Pf rapid
test device Acon (Pf HRP2) for the diagnosis of malaria
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Brenier-Pinchart 2000 {published data only}
Brenier-Pinchart MP, Pinel C, Croisonnier A, Brion JP,
Faure O, Ponard D, et al. Diagnosis of malaria in nonendemic countries by the ParaSight-F test. American Journal
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Bruxvoort 2008 {published data only}
Bruxvoort K, Khatib RA, Abdulah SM, Kahigwa E, Kachur
SP, McMorrow ML. Variable sensitivity of malaria rapid
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Bualombai P, Prajakwong S, Aussawatheerakul H,
Congpuong K, Sudathip S, Thimasarn K, et al.
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Bualombai 2008 {published data only}
Bualombai P, Balachandra K, Dhepaksorn P, Congpuong
K, Satimai W. The validation of DMSC Malaria Pf/Pv
rapid diagnostic device for the detection of non-falciparum
malaria in Thailand in 2006. American Journal of Tropical
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Buchachart K, Krudsood S, Nacher M, Chindanond D,
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Buhalata 2011 {published data only}
Buhalata SN, Massaga JJ. Performance of ParaHIT and
OptiMAL tests in the diagnosis of malaria in Mwanza,
north-western Tanzania. Tanzania Journal of Health Research
2011;13(1):4853.
Bujanover 2002 {published data only}
Bujanover S, Shwartz E. Quick detection of malaria. Israel
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Cabezas 2004 {published data only}
Cabezas CS, Arrspide NV, Marquio WQ, Gutirrez
SS, lvarez EM, Chuquipiondo JR, et al. Evaluation
of the use of a rapid immunochromatographic test for
health workers to diagnose malaria in rural areas of the
Peruvian Amazon [Evaluacin del uso de una prueba rpida
inmunocromatogrfica en promotores de salud para el
diagnstico de la malaria en reas rurales de la Amazonia
peruana]. Revista Peruana de Medicina Experimental y Salud
Publica 2004;20(1):411.
Caraballo 1996 {published data only}
Caraballo A, Ache A. The evaluation of a dipstick test
for Plasmodium falciparum in mining areas of Venezuela.
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Carmona Fonseca 2010 {published data only}
Carmona Fonseca J, Gallego AF, Flrez EA, Agudelo Garca
OM, Maestre Buitrago A. Now ICT malaria Pf/Pv frente
a microscopa (gota gruesa-extendido) para diagnstico de
malaria en Urab (Colombia). Iatreia 2010;23(2):13745.
Cavallo 1997 {published data only}
Cavallo JD, Hernandez E, Gerome P, Plotton N, Debord
T, Le Vagueresse R. Serum HRP-2 antigens and imported
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Chaijaroenkul 2011 {published data only}
Chaijaroenkul W, Wongchai T, Ruangweerayut R,
Na-Bangchang K. Evaluation of rapid diagnostics for
Plasmodium falciparum and P. vivax in Mae Sot malaria
endemic area, Thailand. Korean Journal of Parasitology
2011;49(1):338.
Chatterjee 2008 {published data only}
Chatterjee K, Chand P. Evaluation of the Rapid in Bios
malaria kit for the detection of malaria LDH antigen in
human blood. Vox Sanguinis 2008;95:31.
Cheng 2006 {published data only}
Cheng A, Bell D. Evidence behind the WHO guidelines:
hospital care for children: what is the precision of rapid
diagnostic tests for malaria?. Journal of Tropical Pediatrics
2006;52(6):3869.
Chilton 2006 {published data only}
Chilton D, Malik ANJ, Armstrong M, Kettelhut M, ParkerWilliams J, Chiodini PL. Use of rapid diagnostic tests for
diagnosis of malaria in the UK. Journal of Clinical Pathology
2006;59(8):8626.
Chinkhumba 2010 {published data only}

Chinkhumba J, Skarbinksi J, Chilima B, Campbell
C, Ewing V, San Joaquin M, et al. Comparative field
performance and adherence to test results of four rapid
diagnostic tests among febrile patients more than five years
of age in Blantyre, Malawi. Malaria Journal 2010;9:209.
Chinkhumba 2012 {published data only}
Chinkhumba J, Nyanda M, Skarbinski J, Mathanga DP.
Performance of two malaria rapid diagnostic tests in febrile
adult patients with and without human immunodeficiency
virus-1 infection in Blantyre, Malawi. American Journal of
Chiodini 1998 {published data only}
Chiodini PL. Non-microscopic methods for diagnosis of
malaria. Lancet 1998;351(9096):801.
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Chiodini PL. New diagnostics in parasitology. Infectious
Disease Clinics of North America 2005;19(1):26770.
Chitkara 2004 {published data only}
Chitkara A, Ahmed FU. Test for rapid diagnosis of
Plasmodium falciparum infection. Indian Journal of
Community Medicine 2004;23:1734.
Cho 2001 {published data only}
Cho D, Kim KH, Park SC, Kim YK, Lee KN, Lim CS.
Evaluation of rapid immunocapture assays for diagnosis of
Plasmodium vivax in Korea. Parasitology Research 2001;87
(6):4458.
Cho 2011 {published data only}
Cho C-H, Nam MH, Kim JS, Han ET, Lee WJ, Oh JS, et
al. Genetic variability in Plasmodium vivax aldolase gene in
Korean isolates and the sensitivity of the Binax Now malaria
test. Tropical Medicine and International Health 2011;16(2):
2236.
Cnops 2011 {published data only}
Cnops L, Boderie M, Gillet P, Van Esbroeck M, Jacobs J.
Rapid diagnostic tests as a source of DNA for Plasmodium
species-specific real-time PCR. Malaria Journal 2011;10:67.
Coleman 2002a {published data only}
Coleman RE, Maneechai N, Ponlawat A, Kumpitak C,
Rachapaew N, Miller RS, et al. Short report: Failure of the
OptiMAL rapid malaria test as a tool for the detection of
asymptomatic malaria in an area of Thailand endemic for
Plasmodium falciparum and P. vivax. American Journal of
Coleman 2002b {published data only}
Coleman RE, Maneechai N, Rachapaew N, Kumpitak
C, Soyseng V, Miller RS, et al. Field evaluation of the
ICT Malaria Pf/Pv immunochromatographic test for
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37983.
Cong le 2002 {published data only}
Cong le D, Sergiev VP, Rabinovich SA, Nhah DH, Huong
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Cooke AH, Chiodini PL, Doherty T, Moody AH, Ries J,
Pinder M. Comparison of a parasite lactate dehydrogenasebased immunochromatographic antigen detection assay
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parasites in human blood samples. American Journal of
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Craig MH, Sharp BL. Comparative evaluation of four
techniques for the diagnosis of Plasmodium falciparum
infections. Transactions of the Royal Society of Tropical
Craig 2002 {published data only}
Craig MH, Bredenkamp BL, Williams CHV, Rossouw
EJ, Kelly VJ, Kleinschmidt I, et al. Field and laboratory
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Cropley 2000 {published data only}
Cropley IM, Lockwood DN, Mack D, Pasvol G, Davidson
RN. Rapid diagnosis of Falciparum malaria by using
the ParaSight F test in travellers returning to the United
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Cuadros 2007 {published data only}
Cuadros J, Martn-Rabadn P, Merino FJ, DelgadoIrribarren A, Garcia-Bujalance S, Rubio JM. Malaria
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comparison with multiplex polymerase chain reaction in
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Davoodian 2011 {published data only}
Davoodian P, Daryanavard A, Safari R, Eqbal Eftekhaari
T, Khalilzadeh M, Fekri S, et al. Rapid diagnosing test in
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Dawoud 2008 {published data only}
Dawoud HA, Ageely HM, Heiba AA. Comparison of two
commercial assays and microscopy with PCR for diagnosis
of malaria. Journal of the Egyptian Society of Parasitology
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de Carsalade 2009 {published data only}
de Carsalade GY, Lam Kam R, Lepere JF, de Brettes A,
Peyramond D. Can the thick drop/smear examination
for malaria be replaced by a rapid diagnostic test in first
intention? The Mayotte experience. Mdecine et Maladies
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de Dominguez 1996 {published data only}
de Dominguez N, Rodriguez-Acosta A. Glutamate
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Delaunay P, Estran-Pomares C, Marty P. Malaria diagnosis:
thickdrop and bloodsmear examination, and rapid test.
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Deletoille P, Prou O. Value of rapid diagnosis of Plasmodium
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De Monbrison 2004 {published data only}
De Monbrison F, Grome P, Chaulet JF, Wallon M, Picot
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de Oliveira 2007 {published data only}
de Oliveira AM, Skarbinski J, Ouma PO, Kariuki S,
Barnwell JW, Otieno K, et al. Malaria rapid diagnostic
test use in performance by facility-based health workers in
western Kenya. American Journal of Tropical Medicine and
Hygiene 2007;77:338 (abstract number).
de Oliveira AM, Skarbinski J, Ouma PO, Kariuki S,
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diagnostic tests as part of routine malaria case management
in Kenya. American Journal of Tropical Medicine and Hygiene
2009;80(3):4704.
Devi 2002 {published data only}
Devi G, Indumathi VA, Sridharan D, Srinivas BPR,
Sandhya BMR. Evaluation of paraHIT strip test for
diagnosis of malaria infection. Indian Journal of Medical
Sciences 2002;56(10):48994.
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Diarra A, Nbi I, Tiono A, Sanon S, Soulama I, Oudraogo
A, et al. Seasonal performance of a malaria rapid diagnosis
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Dietze R, Perkins M, Boulos M, Luz F, Reller B, Corey G R.
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Di Perry G, Olliaro P, Nardi S, Allegranzi B, Deganello
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Di Santi SM, Lima G, Levi JE, Geraldi M, Arroyo Sanchez
MC, Segurado AA, et al. Real-time PCR, nested PCR
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Drakeley C, Reyburn H. Out with the old, in with the new:
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Dubarry M, Luilier M, Malot N, Bayard P, Lambin P, Prou
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Durand F, Faure O, Brion JP, Pelloux H. Invalid result
of Plasmodium falciparum malaria detection with the
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Durand F, Crassous B, Fricker-Hidalgo H, Carpentier F,
Brion JP, Grillot R, et al. Performance of the Now Malaria
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Durrheim DN, Govere J, la Grange JJP, Mabuza A. Rapid
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Dyer ME, Tjitra E, Currie BJ, Anstey NM. Failure of
the pan-malarial antibody of the ICT Malaria P.f/P.v
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Plasmodium malariae infection. Transactions of the Royal
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Plasmodium vivax aldolase-specific monoclonal antibodies
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Eisen 2000 {published data only}
Eisen DP, Saul A. Disappearance of pan-malarial antigen
reactivity using the ICT Malaria P.f/P.v (TM) kit parallels
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Elmardi KA, Malik EM, Abdelgadir T, Ali SH, Elsyed AH,
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conditions using artemisinin-based combination therapy
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El Moamly AMAR. Antigen capture immunochromatographic strip format in detecting parasite-specific
lactate dehydrogenase to diagnose malaria in non-immune
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Endeshaw TG, Teshome NJ, Graves PM, Shargie EB,
Ejigsemahu Y, Ayele B, et al. Evaluation of light microscopy
and rapid diagnostic test for the detection of malaria
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Endeshaw T, Graves PM, Shargie EB, Gebre T, Ayele B,
Yohannes G, et al. Comparison of Parascreen Pan/Pf,
Paracheck Pf and light microscopy for detection of malaria
among febrile patients, Northwest Ethiopia. Transactions of
the Royal Society of Tropical Medicine and Hygiene 2010;104
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Existe A, Freeman N, Boncy J, Magloire R, Vely JF, Chang
M, et al. Rapid tests for malaria-Haiti 2010. Journal of the
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Falade CO, Adesina-Adewole B, Dada-Adegbola HO,
Ajayi IO, Akinyemi JO, Ademowo OG, et al. Evaluation
of Paracheck-PfT M rapid malaria diagnostic test for the
diagnosis of malaria among HIV-positive patients in Ibadan,
south-western Nigeria. Pathogens and Global Health 2013;
107(2):6977.
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Fan B, Zhang ZX, Wen RS. Diagnosis of falciparum malaria
using ICT. Chinese Journal of Parasitology and Parasitic
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Fancony 2013 {published data only}
Fancony C, Sebastio YV, Pires JE, Gamboa D, Nery SV.
Performance of microscopy and RDTs in the context of
malaria prevalence survey in Angola: a comparison using
PCR as the gold standard. Malaria Journal 2013;12:284.
Farcas 2003 {published data only}
Farcas GA, Zhong KJY, Lovegrove FE, Graham CM,
Kain KC. Evaluation of the Binax NOW ICT test versus
polymerase chain reaction and microscopy for the detection
of malaria in returned travellers. American Journal of
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Farcas GA, Zhong KJY, Mazzulli T, Kain KC. Evaluation
of the RealArt Malaria LC real-time PCR assay for malaria
diagnosis. Journal of Clinical Microbiology 2004;42(2):
6368.
Ferro 2002 {published data only}
Ferro BE, Gonzalez IJ, de Carvajal Fd, Palma GI, Saravia
NG. Performance of OptiMAL in the diagnosis of
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a malaria referral center in Colombia. Memrias do Instituto
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Figueiredo Filho 2003 {published data only}
Figueiredo Filho AF, Figueredo MC, Nascimento JM,
Calvosa VSP, Pvoa MM, Machado RLD. Performance of
an immunochromatography test for vivax malaria in the
Amazon region, Brazil. Revista de Sade Pblica 2003;37
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Fogg 2008 {published data only}
Fogg C, Twesigye R, Batwala V, Piola P, Nabasumba
C, Kiguli J, et al. Assessment of three new parasite
lactate dehydrogenase (pan-pLDH) tests for diagnosis of
uncomplicated malaria. Transactions of the Royal Society of
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Forney JR, Magill AJ, Wongsrichanalai C, Sirichaisinthop J,
Bautista CT, Heppner DG, et al. Malaria rapid diagnostic
devices: performance characteristics of the ParaSight F
device determined in a multisite field study. Journal of
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Magill AJ, Wongrichalanai C, Forney JR, Bautista C,
Sirichasinthop A, Andersen EM, et al. Performance
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472.
Forney 2003 {published data only}
Forney JR, Wongsrichanalai C, Magill AJ, Craig LG,
Sirichaisinthop J, Bautista CT, et al. Devices for rapid
diagnosis of malaria: evaluation of prototype assays that
detect Plasmodium falciparum histidine-rich protein 2 and
a Plasmodium vivax-specific antigen. Journal of Clinical
Microbiology 2003;41(6):235866.
Fryauff 1997 {published data only}
Fryauff DJ, Gomez-Saladin E, Purnomo, Sumawinata I,
Sutamihardja MA, Tuti S, et al. Comparative performance
of the ParaSight F test for detection of Plasmodium
falciparum in malaria-immune and nonimmune populations
in Irian Jaya, Indonesia. Bulletin of the World Health
Organization 1997;75(6):54752.
Fryauff 2000 {published data only}
Fryauff DJ, Purnomo, Sutamihardja MA, Elyazar IR,
Susanti I, Krisin, et al. Performance of the OptiMAL assay
for detection and identification of malaria infections in
asymptomatic residents of Irian Jaya, Indonesia. American
Journal of Tropical Medicine and Hygiene 2000;63(3-4):
13945.
Funk 1999 {published data only}
Funk M, Schlagenhauf P, Tschopp A, Steffen R. MalaQuick
versus ParaSight F as a diagnostic aid in travellers malaria.
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Garavelli 2002 {published data only}

Garavelli PL. Diagnosis of malaria with
immunochromatographic test: The Novara experience.
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Garcia M, Marlborough D. A rapid
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Gatti 2002 {published data only}
Gatti S, Bernuzzi AM, Bisoffi Z, Raglio A, Gulletta M,
Scaglia M, et al. Multicentre study in patients with
imported malaria, on the sensitivity and specificity of a
dipstick test (ICT Malaria P.f./P.v.) compared with expert
microscopy. Annals of Tropical Medicine and Parasitology
2002;96(1):158.
Gatti 2007 {published data only}
Gatti S, Gramegna M, Bisoffi Z, Raglio A, Gulletta M,
Klersy C, et al. A comparison of three diagnostic techniques
for malaria: a rapid diagnostic test (NOW Malaria), PCR
and microscopy. Annals of Tropical Medicine and Parasitology
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Gaye 1998 {published data only}
Gaye O, Diouf M, Dansokho EF, McLaughlin G, Diallo S.
Diagnosis of Plasmodium falciparum malaria using ParaSight
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1998;5(2):18992.
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Gaye O, Diouf M, Diallo S. A comparison of thick smears,
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Gelaglie AK. Performance of four rapid diagnostic tests
for diagnosis of falciparum and non-falciparum malaria
in endemic areas of Gondar region, Northern Ethopia.
14th International Congress on Infectious Diseases (ICID);
2010 09-12 Mar; Miami. 14th International Congress on
Infectious Diseases (ICID) Abstracts. 2010.
Gerstl 2009 {published data only}
Gerstl S, Dunkley S, Mukhtar A, De Smet M, Baker A,
Maikere J. Assessment of two malaria rapid diagnostic
tests, with follow-up of positive pLDH test results, in a
hyperendemic falciparum malaria area. Tropical Medicine
and International Health 2009;14(Suppl 2):92.
Ghanchi 2009 {published data only}
Ghanchi NK, Beg MA, Hussain R. Estimation of parasite
load using rapid diagnostic test ICT (R) Now Malaria P.f/
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Ghosh 2000 {published data only}
Ghosh SK, Titus Burk E, Valecha N, Murugendrappa MV,
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Ghouth AS, Nasseb FM, Al-Kaldy KH. The accuracy of
the first response histidine-rich protein2 rapid diagnostic
test compared with malaria microscopy for guiding field
treatment in an outbreak of falciparum malaria. Tropical
Gillet 2009a {published data only}
Gillet P, Bosselaers K, Cnops L, Bottieau E, Van Esbroeck
M, Jacobs J. Evaluation of the SD FK70 malaria Ag
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Gillet P, Mori M, van Esbroeck M, van den Ende J, Jacobs J.
Assessment of the prozone effect in malaria rapid diagnostic
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Grobusch 2002 {published data only}
Grobusch MP, Hnscheid T, Zoller T, Jelinek T, Burchard
GD. Rapid immunochromatographic malarial antigen
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and Infectious Diseases 2002;21(11):81820.
Grobusch 2003a {published data only}
Grobusch MP, Hnscheid T, Gbels K, Slevogt H, Zoller
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Gillet 2009c {published data only}

Gillet P, van Dijk DP, Bottieau E, Cnops L, Van Esbroeck
M, Jacobs J. Test characteristics of the SD FK80 Plasmodium
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Grobusch 2003b {published data only}

Grobusch MP, Hnscheid T, Gbels K, Slevogt H, Zoller
T, Rgler G, et al. Comparison of three antigen detection
tests for diagnosis and follow-up of falciparum malaria
in travellers returning to Berlin, Germany. Parasitology
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Gillet 2011 {published data only}

Gillet P, Scheirlinck A, Stokx J, De Weggheleire A, Chaque
HS, Canhanga OD, et al. Prozone in malaria rapid
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Gupta 2001 {published data only}

Gupta MK, Misra RN, Chawla N, Mani H, Chowdhry CN,
Singh SP. Immunochromatographic test: a new dimensions
in diagnosis of Plasmodium falciparum malaria. Medical
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Gogtay 1999 {published data only}

Gogtay NJ, Kotwani RN, Rajgor D, Kanbur A, Karnad
DR, Kshirsagar NA. Serial ParaSight-F test in patients with
severe malaria. Indian Journal of Malariology 1999;36(3-4):
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Gogtay 2003 {published data only}
Gogtay NJ, Dalvi SS, Rajgor D, Chogle AR, Karnad DR,
Ramdas M, et al. Diagnostic and prognostic utility of
rapid strip (OptiMAL and Paracheck) versus conventional
smear microscopy in adult patients of acute, uncomplicated
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Guthmann 2002 {published data only}

Guthmann JP, Ruiz A, Priotto G, Kiguli J, Bonte L, Legros
D. Validity, reliability and ease of use in the field of five
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Goh XT, Lim YA, Vythilingam I, Chew CH, Lee PC, Ngui
R, et al. Increased detection of Plasmodium knowlesi in
Sandakhan division, Sabah as revealed by PlasmoNexT M .
Gomes 2013 {published data only}
Gomes LT, Tada MS, Katsuragawa TH, Povoa MM, Viana
GMR, Alecrim MdGC, et al. Low sensitivity of malaria
rapid diagnostic tests stored at room temperature in the
Brazilian Amazon region. Journal of Infection in Developing
Countries 2013;7(3):24352.
Gonzles-Cern 2005 {published data only}
Gonzlez-Cern L, Rodrguez MH, Betanzos AF, Abada
A. Efficacy of a rapid test to diagnose Plasmodium vivax in
symptomatic patients of Chiapas, Mexico. Salud Pblica de
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Grobusch 1999 {published data only}
Grobusch MP, Alpermann U, Schwenke S, Jelinek T,
Warhurst DC. False-positive rapid tests for malaria in
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Gutierrez Y, Paco G, Romero L, Gonzles J Pear LM,
Gimenez T. Fluorometers; a rapid and simple method
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un mtodo rpido y sencillo para evaluar la Actividad
Antipaldica]. Biofarbo 2005;13(13):310.
Hada 2011 {published data only}
Hada S, Das ML, Singh YI. Diagnostic methods of malaria
in Eastern Nepal: a comparative study of traditional and
two rapid diagnostic tests. Nepal Medical College Journal:
NMCJ 2011;13(4):2616.
Haditsch 2004 {published data only}
Haditsch M. Quality and reliability of current malaria
diagnostic methods. Travel Medicine and Infectious Disease
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Hance 2005 {published data only}
Hance P, Garnotel E, De Pina JJ, Vedy S, Ragot C, Chadli
M, et al. Rapid immunochromatographic tests for detection
of malaria: principles and strategies for use. Mdecine
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Hnscheid 1999 {published data only}
Hnscheid T. Diagnosis of malaria: a review of alternatives
to conventional microscopy. Clinical and Laboratory
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Happi 2004 {published data only}

Happi CT, Gbotosho GO, Sowunmi A, Falade CO,
Akinboye DO, Oladepo O, et al. Malaria diagnosis: false
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Harchut 2013 {published data only}
Harchut K, Standley C, Dobson A, Klaassen B, RambaudAlthaus C, Althaus F, et al. Over-diagnosis of malaria by
microscopy in the Kilombero Valley, Southern Tanzania:
an evaluation of the utility and cost-effectiveness of rapid
diagnostic tests. Malaria Journal 2013;12:159.
Hashizume 2006 {published data only}
Hashizume M, Kondo H, Murakami T, Kodama M,
Nakahara S, Lucas MES, et al. Use of rapid diagnostic tests
for malaria in an emergency situation after the flood disaster
in Mozambique. Public Health 2006;120(5):4447.
Hawkes 2009 {published data only}
Hawkes M, Katsuva JP, Masumbuko CK. Use and
limitations of malaria rapid diagnostic testing by community
health workers in war-torn Democratic Republic of Congo.
Hernandes 2001 {published data only}
Hernandez E, De Pina JJ, Fabre R, Garrabe E, Raphenon G,
Cavallo JD. Evaluation of the OptiMal test in the diagnosis
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Holmberg M, Wahlberg J, Lundeberg J, Pettersson U,
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Hopkins 2007 {published data only}
Hopkins H, Kambale W, Kamya MR, Staedke SG, Dorsey
G, Rosenthal PJ. Comparison of HRP2 and pLDH-based
rapid diagnostic tests for malaria with longitudinal followup in Kampala, Uganda. American Journal of Tropical
Medicine and Hygeine 2007;76(6):10927.
Hopkins 2008 {published data only}
Hopkins H, Bebell L, Kambales W, Dokomajilar C,
Rosenthal PJ, Dorsey G. Rapid diagnostic tests for malaria
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Hossain 2008 {published data only}
Hossain MA, Afroj S, Rahman MR, Yunus EB, Samad
R, Asna ZH, et al. Evaluation of alternative diagnostic
techniques for diagnosis of cerebral malaria in a tertiary
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Houmsou 2011 {published data only}
Houmsou RS, Amuta EU, Sar TT, Adagba AH. Malarial
infection among patients attending a Nigerian semiurban based hospital and performance of HRP-2 pf
Rapid diagnostic Test (RDT) in screening clinical cases of
Plasmodium falciparum malaria. Translational Biomedicine

2011;2:1.
Houz 2009 {published data only}
Houz S, Boly MD, Le Bras J, Deloron P, Faucher JF.
PfHRP-2 and PfLDH antigen detection for monitoring the
efficacy of artemisinin-based combination therapy (ACT)
in the treatment of uncomplicated falciparum malaria.
Houz 2011 {published data only}
Houz S, Hubert V, Cohen DP, Rivetz B, Le Bras J.
Evaluation of the Clearview Malaria pLDH Malaria
Rapid Diagnostic Test in a non-endemic setting. Malaria
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Humar 1997 {published data only}
Humar A, Ohrt C, Harrington MA, Pillai D, Kain KC.
Parasight F test compared with the polymerase chain
reaction and microscopy for the diagnosis of Plasmodium
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Huong 2002 {published data only}
Huong NM, Davis TME, Hewitt S, Huong N, Uyen TT,
Nhan DH, et al. Comparison of three antigen detection
methods for diagnosis and therapeutic monitoring of
malaria: a field study from southern Vietnam. Tropical
Iqbal 2000 {published data only}
Iqbal J, Sher A, Rab A. Plasmodium falciparum histidinerich protein 2-based immunocapture diagnostic assay for
malaria: cross-reactivity with rheumatoid factors. Journal of
Clinical Microbiology 2000;38(3):11846.
Iqbal J, Hira PR, Sher A, Al-Enezi AA. Diagnosis of
imported malaria by Plasmodium lactate dehydrogenase
(pLDH) and histidine-rich protein 2 (PfHRP-2)-based
immunocapture assays. American Journal of Tropical
Medicine and Hygiene 2001;64(1-2):203.
Iqbal J, Khalid N, Hira PR. Comparison of two commercial
assays with expert microscopy for confirmation of
symptomatically diagnosed malaria. Journal of Clinical
Microbiology 2002;40(12):46758.
Iqbal J, Muneer A, Khalid N, Ahmed MA. Performance of
the OptiMAL test for malaria diagnosis among suspected
malaria patients at the rural health centres. American Journal
Iqbal J, Siddique A, Jameel M, Hira PR. Persistent
histidine-rich protein 2, parasite lactate dehydrogenase, and
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falciparum monoinfection. Journal of Clinical Microbiology
2004;42(9):423741.
Ishengoma 2011 {published data only}
Ishengoma DS, Francis F, Mmbando BP, Lusingu JP,
Magistrado P, Alifrangis M, et al. Accuracy of malaria rapid
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on treatment of malaria in an area with declining malaria
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Jang 2013 {published data only}
Jang JW, Cho CH, Han ET, An SS, Lim CS. pLDH level of
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Jelinek T, Kilian AH, Henk M, Mughusu EB, Nothdurft
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Jelinek T, Grobusch MP, Schwenke S, Steidl S, von
Sonnenburg F, Nothdurft HD, et al. Sensitivity and
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Jelinek T, Grobusch MP, Nothdurft HD. Use of dipstick
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Joshi HH, Mahakunkijcharoen Y, Tantivanich S, Sharma
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Kahama-Maro 2008 {published data only}
Kahama-Maro J, DAcremont V, Mtasiwa D, Genton B,
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at different health systems levels in Dar es Salaam: rapid
diagnostic tests should also be implemented in hospitals and

urban settings. American Journal of Tropical Medicine and
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Kahama-Maro 2011 {published data only}
Kahama-Maro J, DAcremont V, Mtasiwa D, Genton B,
Lengeler C. Low quality of routine microscopy for malaria
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Karbwang J, Tasanor O, Kanda T, Wattanagoon Y,
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Kashif AH, Adam GK, Mohmmed AA, Elzaki SE,
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Katakai Y, Komaki-Yasuda K, Tangpukdee N, Wilairatana
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of falciparum and vivax malaria parasite density. Tropical
Medicine and Health 2011;39(4):1058.
Kattenberg 2011 {published data only}
Kattenberg J, Tahita M, Taal A, Zoeten J, Versteeg I,
Tinto H, et al. Antigen persistence of rapid diagnostic
tests and its implications for the diagnosis of malaria in
pregnancy. An evaluation in Nanoro, Burkina Faso. 7th
European Congress on Tropical Medicine and International
Health; 2011 03-06 Oct; Barcelona. Tropical Medicine and
International Health. 2011:1389.
40
Kaur 2000 {published data only}

Kaur H, Mani A. Evaluation & usefulness of a
immunochromatographic test for rapid detection of
Plasmodium falciparum infection. Indian Journal of Medical
Sciences 2000;54(10):4214.
Kim 2013 {published data only}

Kim JY, Ji SY, Goo YK, Na BK, Pyo HJ, Lee HN, et al.
Comparison of rapid diagnostic tests for the detection of
Plasmodium vivax malaria in South Korea. PLoS One 2013;
8(5):e64353.
Kaushal 1995 {published data only}

Kaushal DC, Kaushal N, Chandra D, Palni R.
Immunodiagnosis of malaria based on detection of parasite
enzyme. Journal of Parasitic Diseases 1995;19:214.
Knappik 2002 {published data only}

Knappik M, Peyerl-Hoffmann G, Jelinek T. Plasmodium
falciparum: use of a NANP19 antibody-test for the
detection of infection in non-immune travellers. Tropical
Medicine and International Health 7;8:6526.
Kaushal 1997 {published data only}

Kaushal DC, Kaushal NA. Immunodiagnosis of malaria.
Journal of Parasitic Diseases 1997;21(1):3140.
Kawai 2009 {published data only}
Kawai S, Hirai M, Haruki K, Tanabe K, Chigusa Y. Crossreactivity in rapid diagnostic tests between human malaria
and zoonotic simian malaria parasite Plasmodium knowlesi
infections. Parasitology International 2009;58(3):3002.
Keating 2009 {published data only}
Keating J, Miller JM, Bennett A, Moonga HB, Eisele TP.
Plasmodium falciparum parasite infection prevalence from a
household survey in Zambia using microscopy and a rapid
diagnostic test: implications for monitoring and evaluation.
Acta Tropica 2009;112(3):27782.
Khairnar 2009 {published data only}
Khairnar K, Martin D, Lau R, Ralevski F, Pillai DR.
Multiplex real-time quantitative PCR, microscopy and rapid
diagnostic immuno-chromatographic tests for the detection
of Plasmodium spp: performance, limit of detection analysis
and quality assurance. Malaria Journal 2009;8:284.
Khan 2004 {published data only}
Khan SA, Anwar M, Hussain S, Qureshi AH, Ahmad A,
Afzal S. Comparison of OptiMAL malarial test with light
microscopy for the diagnosis of malaria. Journal of the
Pakistan Medical Association 2004;54(8):4047.
Kilian 1997 {published data only}
Kilian AHD, Mughusu EB, Kabagambe G, von Sonnenburg
F. Comparison of two rapid, HRP-2-based diagnostic tests
for Plasmodium falciparum. Transactions of the Royal Society
Kilian 1999 {published data only}
Kilian AHD, Kabagambe G, Byamukama W, Langi P,
Weis P, von Sonnenburg F. Application of the ParaSightF dipstick test for malaria diagnosis in a district control
programme. Acta Tropica 1999;72(3):28193.
Kim SH, Nam MH, Roh KH, Park HC, Nam DH, Park
GH, et al. Evaluation of a rapid diagnostic test specific
for Plasmodium vivax. Tropical Medicine and International
Health 2008;13(12):1495500.
Kim KH, Jang JW, Woo MK, Oh JS, Han ET, Lee WJ,
et al. Evaluation of four rapid diagnostic tests for the
diagnosis of Plasmodium vivax in Korea. Tropical Medicine
and International Health 2011;16(11):142731.
Kodisinghe 1997 {published data only}

Kodisinghe HM, Perera KL, Premawansa S, Naotunne T,
Wickramasinghe AR, Mendis KN. The ParaSight-F dipstick
test as a routine diagnostic tool for malaria in Sri Lanka.
Hygiene 1997;91(4):398402.
Koita 2012 {published data only}
Koita OA, Doumbo OK, Ouattara A, Tall LK, Konar A,
Diakit M, et al. False-negative rapid diagnostic tests for
malaria and deletion of the histidine-rich repeat region of
the hrp2 gene. American Journal of Tropical Medicine and
Hygiene 2012;86(2):1948.
Kumar 1996 {published data only}
Kumar A, Sharma VP, Thavaselvam D, Sumodan PK.
Clinical trials of a new immunochromatographic test for
diagnosis of Plasmodium falciparum malaria in Goa. Indian
Journal of Malariology 1996;33(4):16672.
Kumar A, Sumodan PK, Sharma VP. Clinical trials of an
indigenous diagnostic kit Paracheck-F for the diagnosis of
Plasmodium falciparum malaria in Goa. Journal of Parasitic
Diseases 2000;24:435.
Kumar KR, Sudarshan KS. Clinical evaluation of a rapid
diagnostic kit (Paracheck-Pf) for diagnosis of Plasmodium
falciparum in Karnataka state of India. Indian Journal of
Preventive and Social Medicine 2004;35(1):104.
Kumar N, Singh JPN, Pande V, Mishra N, Srivastava B,
Kapoor R, et al. Genetic variation in histidine rich proteins
among Indian Plasmodium falciparum population: possible
cause of variable sensitivity of malaria rapid diagnostic tests.
Kumar N, Pande V, Bhatt RM, Shah NK, Mishra N,
Srivastava B, et al. Genetic deletion of HRP2 and HRP3 in
Indian Plasmodium falciparum population and false negative
malaria rapid diagnostic test. Acta Tropica 2013;125(1):
11921.
Kweka 2011 {published data only}
Kweka EJ, Lowassa A, Msangi S, Kimaro EE, Lyatuu
EE, Mwangonde BJ, et al. Low sensitivity of paraHITF rapid malaria test among patients with fever in rural
health centers, Northern Tanzania. Journal of Infection in
Developing Countries 2011;5(3):2048.
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Kyabayinze 2008 {published data only}

Kyabayinze DJ. Field validity and comparative persistent
antigenicity of HRP-2 rapid diagnostic tests for malaria
in a hyperendemic region of Uganda. American Journal of
Kyabayinze DJ, Tibenderana JK, Odong GW, Rwakimari
JB, Counihan H. Operational accuracy and comparative
persistent antigenicity of HRP2 rapid diagnostic tests for
Plasmodium falciparum malaria in a hyperendemic region of
Uganda. Malaria Journal 2008;7:221.
Llanos-Zavalaga 2002 {published data only}

Llanos-Zavalaga LF, Villacorta JV, Reyes RL, Lecca LG,
Mendoza DR, Mayca JP, et al. Evaluation of the ICT
Test Malaria P.f/P.v (AMRAD) for the detection of P.
falciparum and P. vivax malaria in an endemic area of the
Peruvian Amazon [Evaluacin de la prueba ICT Malaria P.f/
P.v (AMRAD) para la deteccin de P. falciparum y P. vivax
en una zona endmica de la Amazona peruana]. Revista
Peruana de Medicina Experimental y Salud Publica 2002;19
(1):3942.
Labb 2001 {published data only}

Labb AC, Pillai DR, Hongvangthong B, Vanisaveth V,
Pomphida S, Inkathone S, et al. The performance and
utility of rapid diagnostic assays for Plasmodium falciparum
malaria in a field setting in the Lao Peoples Democratic
Republic. Annals of Tropical Medicine and Parasitology 95;7:
6717.
Mahajan 2000 {published data only}

Mahajan SK, Siwach SR, Kishore K, Chaudhry D, Sen R,
Aggarwal HK, et al. Evaluation of a rapid dipstick antigen
capture assay for the diagnosis of falciparum malaria. Indian
Practitioner 2009;53(5):3259.
Lee 1999 {published data only}

Lee MA, Aw LT, Singh M. A comparison of antigen dipstick
assays with polymerase chain reaction (PCR) technique and
blood film examination in the rapid diagnosis of malaria.
Annal of the Academy of Medicine of Singapore 1999;28(4):
498501.
Lee SW, Jeon K, Jeon BR, Park I. Rapid diagnosis of
vivax malaria by the SD Bioline Malaria Antigen test
when thrombocytopenia is present. Journal of Clinical
Lee GC, Jeon ES, Le DT, Kim TS, Yoo JH, Kim HY, et al.
Development and evaluation of a rapid diagnostic test for
Plasmodium falciparum, P. vivax, and mixed-species malaria
antigens. American Journal of Tropical Medicine and Hygiene
2011;85(6):98993.
Makler 1998 {published data only}

Makler MT, Piper RC, Milhous WK. Lactate dehydrogenase
and the diagnosis of malaria. Parasitology Today 1998;14(9):
3767.
Makler 2009 {published data only}
Makler MT, Piper RC. Rapid malaria tests: where do were
go after 20 years?. American Journal of Tropical Medicine
and Hygiene 2009;81(6):9216.
Malik 2004 {published data only}
Malik S, Khan S, Das A, Samantaray JC. Plasmodium lactate
dehydrogenase assay to detect malarial parasites. National
Medical Journal of India 2004;17(5):2379.
Mankhambo 2002 {published data only}
Mankhambo L, Kanjala M, Rudman S, Lema VM,
Rogerson SJ. Evaluation of the OptiMAL rapid antigen test
and species-specific PCR to detect placental Plasmodium
falciparum infection at delivery. Journal of Clinical
Lema 1999 {published data only}

Lema OE, Carter JY, Nagelkerke N, Wangai MW, Kitenge P,
Gikunda SM, et al. Comparison of five methods of malaria
detection in the outpatient setting. American Journal of
Mason 2002 {published data only}

Mason DP, Kawamoto F, Lin K, Laoboonchai A,
Wongsrichanalai C. A comparison of two rapid field
immunochromatographic tests to expert microscopy in the
diagnosis of malaria. Acta Tropica 2002;82(1):519.
Lepre 2004 {published data only}

Lepre JF, Macarry A. Malaria diagnosis and treatment in
a rural Health Centre in Mayotte (Comoro archipelago,
2002). Sant 2004;14(1):510.
Mawili-Mboumba 2010 {published data only}

Mawili-Mboumba DP, Bouyou Akotet MK, Ngoungou EB,
Kombila M. Evaluation of rapid diagnostic tests for malaria
case management in Gabon. Diagnostic Microbiology and
Infectious Disease 2010;66(2):1628.
Lim 2001 {published data only}

Lim HS, Kim HS. Evaluation of diagnostic methods of reemerging malaria in Korean patients. Yonsei Medical Journal
2001;42(1):8490.
Llanos Zavalaga 2000 {published data only}
Llanos Zavalaga LF, Huayta Zacaras E, Mendoza Requena
D, Rosas Aguirre A, Contreras Ros C, Peinada Rodrguez
J. Knowledge and perceptions of health workers in malaria
endemic areas in Peru on the rapid test Parasight-F
[Conocimientos y percepciones de los trabajadores de salud
de zona endmica de malaria en el Per sobre la prueba de
diagnstico rpido ParaSightF]. Revista Medica Herediana
2000;11(4):11521.
Mayxay 2004 {published data only}

Mayxay M, Newton PN, Yeung S, Pongvongsa T, Phompida
S, Phetsouvanh T, et al. Short communication: An
assessment of the use of malaria rapid tests by village health
volunteers in rural Laos. Tropical Medicine and International
Health 2004;9(3):3259.
Mboera 2006a {published data only}
Mboera LEG, Fanello CI, Malima RC, Talbert A, Fogliati
P, Bobbio F, et al. Comparison of the Paracheck-Pf test
with microscopy, for the confirmation of Plasmodium
falciparum malaria in Tanzania. Annals of Tropical Medicine
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McCutchan 2008 {published data only}

McCutchan TF, Piper RC, Makler MT. Use of malaria rapid
diagnostic test to identify Plasmodium knowlesi infection.
Emerging Infectious Diseases 2008;14(11):17502.
McMorrow 2010 {published data only}
McMorrow ML, Masanja MI, Kahigwa E, Abdullah SMK,
Kachur SP. Quality assurance of rapid diagnostic tests for
malaria in routine patient care in rural Tanzania. American
Meena 2009 {published data only}
Meena M, Joshi D, Joshi R, Sridhar S, Waghdhare S,
Gangane N, et al. Accuracy of a multispecies rapid
diagnostic test kit for detection of malarial parasite at the
point of care in a low endemicity region. Transactions of the
Royal Society of Tropical Medicine and Hygeine 2009;103
(12):123744.
Menan 1996 {published data only}
Menan EIH, Adou-Bryn KD, Mobio SP, Cisse M, Penali
K, Kone M. Assessment of parasitological examinations of
blood for malaria at the Pasteur Institute Cte dIvoire
(IPCI) in 1992: the impact of chemotherapy on the
laboratory results [Bilan des examens parasitologiques du
sang pour la recherche du paludisme a lInstitut Pasteur de
Cte dIvoire (I.P.C.I) en 1992: impact de la chimiotherapie
sur les resultats de laboratoire]. Medecine dAfrique Noire
1996;43(3):12933.
Mendiratta 2006 {published data only}
Mendiratta DK, Bhutada K, Narang R, Narang P. Evaluation
of different methods for diagnosis of P. falciparum malaria.
Indian Journal of Medical Microbiology 2006;24(1):4951.
Mendoza 2007 {published data only}
Mendoza NM, Garca M, Corts LJ, Vela C, Erazo R, Prez
P, et al. Evaluation of two rapid diagnostic tests, NOW
ICT Malaria Pf/Pv and OptiMAL, for diagnosis of malaria.
Biomedica 2007;27(4):57180.
Mendoza 2013 {published data only}
Mendoza NM, Cucunuba ZM, Aponte S, Gonzalez NE,
Bernal SD. [Field evaluation for diagnostic accuracy of
the rapid test SD Bioline Malaria Antigen Pf/Pv(R) in
Colombia]. Biomedica 2013;33(4):587597.
Mengesha 1999 {published data only}
Mengesha T, Gebreselassie H, Mohammed T, Assefa T,
Woldemichael T. ParaSight-F dipstick antigen tests in the
diagnosis of falciparum malaria in Ethiopia. East African
Medical Journal 1999;76(11):6269.
Mens 2007 {published data only}
Mens P, Spieker N, Omar S, Heijnen M, Schallig H, Kager
PA. Is molecular biology the best alternative for diagnosis of
malaria to microscopy? A comparison between microscopy,
antigen detection and molecular tests in rural Kenya and
urban Tanzania. Tropical Medicine and International Health
2007;12(2):23844.
Mens 2010 {published data only}
Mens PF, Matelon RJ, Nour BYM, Newman DM, Schallig
HDFH. Laboratory evaluation on the sensitivity and
specificity of a novel rapid detection method for malaria

diagnosis based on magneto-optical technology (MOT).
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Mharakurwa 1997a {published data only}
Mharakurwa S, Shiff CJ. Post treatment sensitivity studies
with the ParaSight-F test for malaria diagnosis in Zimbabwe.
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Mharakurwa 1997b {published data only}
Mharakurwa S, Manyame B, Shiff CJ. Trial of ParaSight-F
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Miantuasila 2012 {published data only}
Miantuasila O. Comparison between molecular and
conventional diagnostic tools for the diagnosis of malaria
and sickle cell gene carriage. 6th EDCTP Forum:
Strengthening Research Partnerships for Better Health and
Sustainable Development; 2011 09-12 October; Addis
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Mikhail 2011 {published data only}
Mikhail AF, Leslie TJ, Mayan MI, Zekria R, Mohammad
N, Hasanzai MA, et al. Field trial of three different
Plasmodium vivax-detecting rapid diagnostic tests with
and without evaporative cool box storage in Afghanistan.
Miller 2001 {published data only}
Miller RS, McDaniel P, Wongsrichanalai C. Following the
course of malaria treatment by detecting parasite lactate
dehydrogenase enzyme. British Journal of Haematology
2001;113(2):55862.
Miller 2008 {published data only}
Miller RS. Comparison of performance characteristics of
the Binax NOW Malaria test using venous and fingerstick
samples. American Journal of Tropical Medicine and Hygiene
2008;79(6):533.
Mills 1999 {published data only}
Mills CD, Burgess DC, Taylor HJ, Kain KC. Evaluation of
a rapid and inexpensive dipstick assay for the diagnosis of
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Mills LA, Kagaayi J, Nakigozi G, Galiwango RM, Ouma
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malaria rapid diagnostic for excluding malaria as the cause
of fever among HIV-positive adults in rural Rakai, Uganda.
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Mills 2010a {published data only}
Mills LA, Kagaayi J, Shott JP, Newell K, Bwanika JB,
Ssempijja V, et al. Performance of prototype malaria rapid
diagnostic test versus thick film microscopy among HIVpostive subjects in rural Rakai, Uganda. Transactions of the
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2379.
Minja 2012 {published data only}
Minja DT, Schmiegelow C, Oesterholt M, Magistrado PA,
Bostrm S, John D, et al. Reliability of rapid diagnostic
tests in diagnosing pregnancy-associated malaria in northeastern Tanzania. Malaria Journal 2012;11:211.
Minodier 2005 {published data only}
Minodier P. Malaria diagnosis: rapid detection tests.
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for rapid diagnosis of malaria. Archives de Pediatrie 2005;12
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Mishra 1999 {published data only}
Mishra B, Samantaray J C, Mirdha BR. Evaluation of a
rapid antigen capture assay for the diagnosis of falciparum
malaria. Indian Journal of Medical Research 1999;109:169.
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Mishra MN, Misra RN. Immunochromatographic methods
in malaria diagnosis. Medical Journal Armed Forces India
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Mohanty 1999 {published data only}
Mohanty S, Mishra SK, Mohanty A, Das BS.
Immunochromatographic test for the diagnosis of
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Mohapatra PK, Prakash A, Khan AM, Bhattacharyya
DR, Goswami BK, Mahanta J. Evaluation of a manual
immunochromatographic test for detection of Plasmodium
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Montoya AE, Menco J, Osorio N, Zuluaga MA, Duque J,
Torres G, et al. Concordance between thick blood smear,
immunochromatography and polymerase chain reaction for
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Moody 2000 {published data only}
Moody A, Hunt-Cooke A, Gabbett E, Chiodini P.
Performance of the OptiMAL malaria antigen capture
dipstick for malaria diagnosis and treatment monitoring at

the Hospital for Tropical Diseases, London. British Journal
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Moody 2002a {published data only}
Moody A. Rapid diagnostic tests for malaria parasites.
Clinical Microbiology Reviews 2002;15(1):6678.
Moody 2002b {published data only}
Moody AH, Chiodini PL. Non-microscopic method for
malaria diagnosis using OptiMAL IT, a second-generation
dipstick for malaria pLDH antigen detection. British
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Moonasar 2007 {published data only}
Moonasar D, Goga AE, Frean J, Kruger P, Chandramohan
D. An exploratory study of factors that affect the
performance and usage of rapid diagnostic tests for malaria
in the Limpopo Province, South Africa. Malaria Journal
2007;6:74.
Moonasar 2009 {published data only}
Moonasar D, Goga AE, Kruger PS, La Cock C, Maharaj R,
Frean J, et al. Field evaluation of a malaria rapid diagnostic
test (ICT Pf ). South African Medical Journal 2009;99(11):
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Morankar 2011 {published data only}
Morankar S, Tegene A, Kassahun W, Sulueiman S, Negatu
YA, Yazachew M, et al. Validity and reliability of RDT for
diagnosis of malaria among febrile children in Jimma Town:
southwest Ethiopia. Ethiopian Medical Journal 2011;49(2):
1318.
Moulin 2009 {published data only}
Moulin F, Gendrel D. Imported malaria: diagnostic traps
and rapid tests. Archives de Pdiatrie 2009;16(Suppl 2):
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Msellem 2009 {published data only}
Msellem MI, Mrtensson A, Rotllant G, Bhattarai A,
Strmberg J, Kahigwa E, et al. Influence of rapid malaria
diagnostic tests on treatment and health outcome in fever
patients, Zanzibar: a crossover validation study. PLoS
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Mtove 2011 {published data only}
Mtove G, Hendriksen ICE, Amos B, Mrema H, Mandia V,
Manjurano A, et al. Treatment guided by rapid diagnostic
tests for malaria in Tanzanian children: safety and alternative
bacterial diagnoses. Malaria Journal 2011;10:290.
Mueller 2007 {published data only}
Mueller I, Betuela I, Ginny M, Reeder JC, Genton B.
The sensitivity of the OptiMAL rapid diagnostic test
to the presence of Plasmodium falciparum gametocytes
compromises its ability to monitor treatment outcomes in
an area of Papua New Guinea in which malaria is endemic.
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Muhindo 2012 {published data only}
Muhindo HM, Ilombe G, Meya R, Mitashi PM,
Kutekemeni A, Gasigwa D, et al. Accuracy of malaria rapid
diagnosis test Optimal-IT() in Kinshasa, the Democratic
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Munier 2009 {published data only}

Munier A, Diallo A, Sokhna C, Chippaux JP. Assessment
of a rapid diagnostic test for malaria in rural health care
facilities in Senegal. Medicine Tropicale 2009;69(5):
496500.
Murahwa 1999 {published data only}
Murahwa FC, Mharakurwa S, Mutambu SL, Rangarira R,
Musana BJ. Diagnostic performance of two antigen capture
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97100.
Murray 2003 {published data only}
Murray CK, Bell D, Gasser RA, Wongsrichanalai C. Rapid
diagnostic testing for malaria. Tropical Medicine and
Murray 2008 {published data only}
Murray CK, Gasser RA Jr, Magill AJ, Miller RS. Update on
rapid diagnostic testing for malaria. Clinical Microbiology
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Mwanza 2005 {published data only}
Mwanza S, Njunju E, Mbewe B, Chileshe N, Mataa N,
Kalungwana N. Evaluation of the hexagon malaria rapid
diagnostic test kit in five communities on the copperbelt
province of Zambia. Acta Tropica 2005;95S:S3034.
Myjak 2004 {published data only}
Myjak P, Nahorski W, Zarnowska-Prymek H, Pietkiewicz H.
Usefulness of the OptiMAL Rapid Malaria test for rapid
detection of malaria imported to Poland. Wiadomo ci
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Naing 2002a {published data only}
Cho-Min-Naing, Gatton ML. Performance appraisal of
rapid on-site malaria diagnosis (ICT Malaria Pf/Pv test) in
relation to human resources at village level Myanmar. Acta
Tropica 2002;81(1):139.
Nema 2005 {published data only}
Nema SK, Chopra GS, Gupta RM, Rai R, Diwan RN.
Diagnosis of malaria infection using non-radioactive malaria
diagnostic system (NOMADS). Medical Journal Armed
Forces India 2005;61(4):3369.
Neumann 2008 {published data only}
Neumann CG, Bwibo NO, Siekmann JH, McLean ED,
Browdy B, Drorbaugh N. Comparison of blood smear
microscopy to a rapid diagnostic test for in-vitro testing
for P. falciparum malaria in Kenyan school children. East
African Medical Journal 2008;85(11):5449.
Nicastri 2009a {published data only}
Nicastri E, Bevilacqua N, Sa Schepisi SM, Paglia MG,
Meschi S, Ame SM, et al. Accuracy of malaria diagnosis
by microscopy, rapid diagnostic test, and PCR methods
and evidence of antimalarial overprescription in non-severe
febrile patients in two Tanzanian hospitals. American
Nigussie 2008 {published data only}
Nigussie D, Legesse M, Animut A, Mariam AH, Mulu A.
Evaluation of Paracheck Pf and Parascreen Pan/Pf tests for
the diagnosis of malaria in an endemic area, South Ethiopia.

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Nkrumah 2010 {published data only}
Nkrumah B, Agyekum A, Acquah SEK, May J, Tannich
E, Brattig N, et al. Comparison of the novel Partec rapid
diagnostic test to the conventional giemsa stain and the gold
standard real-time PCR. Journal of Clinical Microbiology
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Nkrumah 2011 {published data only}
Nkrumah B, Acquah SE, Ibrahim L, May J, Brattig N,
Tannich E, et al. Comparative evaluation of two rapid field
tests for malaria diagnosis: Partec Rapid Malaria Test
and Binax Now Malaria Rapid Diagnostic Test. BMC
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Nour 2011 {published data only}
Nour B. Using RDTS as a malaria diagnostic tool in wad
Medani different hospitals - Central Sudan. 7th European
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2011 03-06 Oct; Barcelona. Tropical Medicine and
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Nwuba 2001 {published data only}
Nwuba RI, Anumuda CI, Omosun YO, Sodeinde O,
Nwagwu M. Evaluation of a rapid immunochromatographic
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Nyunt 2013 {published data only}
Nyunt MH, Kyaw MP, Win KK, Myint KM, Nyunt
KM. Field evaluation of HRP2 and pan pLDH-based
immunochromatographic assay in therapeutic monitoring
of uncomplicated falciparum malaria in Myanmar. Malaria
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Ochola 2006 {published data only}
Ochola LB, Vounatsou P, Smith T, Mabaso MLH, Newton
CRJC. The reliability of diagnostic techniques in the
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Omar MS, Malik GM, Al-Amari OM, Abdalla SE, Moosa
RA. The rapid manual ParaSight-F test for diagnosing
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OMS 1999 {published data only}
Organisation Mondiale de la Sante USAID. Directive pour
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Onile B, Taiwo S. Recent advances in the laboratory
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Osman MMM, Nour BYM, Sedig MF, De Bes L, Babikir
AM, Mohamedani AA, et al. Informed decision-making
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Ouattara A, Doumbo S, Saye R, Beavogui AH, Traor B,
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Ozbilge H, Kurcer MA, Dogan N, Zeyrek F. Comparison
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Pabn A, Alvarez G, Ynez J, Cspedes C, Rodrguez
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Pakalapati D, Garg S, Middha S, Kochar A, Subudhi
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Palmer CJ, Lindon JF, Klaskala WI, Quesada JA, Kaminsky
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Radrianasolo L, Tafangy PB, Raharimalala LA, Ratsimbasoa
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immunochromatographic test kit for the diagnosis of
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Ramutton T, Hendriksen IC, Mwanga-Amumpaire J,
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for malaria outbreak management. Transactions of the Royal
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tests with HRP-2 antigen in children under 5 years in an area
of high risk of malaria transmission in Papua New Guinea
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Richter J, Gbels K, Mller-Stver I, Hoppenheit B,
Hussinger D. Co-reactivity of plasmodial histidinerich protein 2 and aldolase on a combined immunochromographic-malaria dipstick (ICT) as a potential
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Rodulfo H, De Donato M, Mora R, Gonzlez L, Contreras
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Runsewe-Abiodun IT, Efunsile M, Ghebremedhin B,
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blood smear in diagnosis of malaria. Indian Practitioner
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malaria endemic and non-endemic regions. Laboratoriums
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a strategy of diagnostic-treatment of first class level health
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Sharma MK, Rao VK, Agarwal GS, Rai GP, Gopalan
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Singh N, Valecha N. Evaluation of a rapid diagnostic test,
Determine malaria pf , in epidemic-prone, forest villages of
central India (Madhya Pradesh). Annals of Tropical Medicine
Singh N, Shukla M. An assessment of the usefulness of a
rapid immuno-chromatographic test Determine malaria
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Singh N, Saxena A, Awadhia SB, Shrivastava R, Singh MP.
Evaluation of a rapid diagnostic test for assessing the burden
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Singh N, Mishra AK, Shukla MM, Chand SK, Bharti PK.
Diagnostic and prognostic utility of an inexpensive rapid
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Singh 2005c {published data only}
Singh N, Saxena A. Usefulness of a rapid on-site Plasmodium
falciparum diagnosis (Paracheck PF) in forest migrants
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occupational activities in central India. American Journal of
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Singh N, Bharti PK, Singh MP, Mishra S, Shukla MM,
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Skarbinski J, Ouma PO, Causer LM, Kariuki SK, Barnwell
JW, Alaii JA, et al. Effect of malaria rapid diagnostic
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Smego 2000 {published data only}
Smego RA Jr, Beg A. Rapid diagnostic modalities for
malaria. Journal of the Pakistan Medical Association 2000;50
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Sotimehin SA, Runsewe-Abiodun TI, Oladapo OT,
Njokanma OF, Olanrewaju DM. Performance of a rapid
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Soto Tarazona 2004 {published data only}
Soto Tarazona A, Solari Zerpa L, Mendoza Requena
D, Llano-Cuentas A, Magill A. Evaluation of the rapid
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Srinivasan 2000 {published data only}
Srinivasan S, Moody AH, Chiodini PL. Comparison of
blood-film microscopy, the OptiMAL dipstick, Rhodamine123 fluorescence staining and PCR, for monitoring
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Stauffer WM, Newberry AM, Cartwright CP, Rosenblatt
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accuracy of clinical diagnosis, local microscopy and a rapid
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Swarthout TD, Counihan H, Senga RK, van den Broek
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Tahar R, Sayang C, Ngane Foumane V, Soula G, MoyouSomo R, Delmont J, et al. Field evaluation of rapid
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Indicates the major publication for the study
55
CHARACTERISTICS OF STUDIES
Characteristics of included studies [ordered by study ID]

Alam 2011
Clinical features and settings
Presenting signs and symptoms: Fever

Previous treatments for malaria: No explicit exclusions based on previous treatment
and no information presented on previous treatment
Clinical setting: Matiranga Upazila Health Complex (UHC)
Country: Bangladesh
Malaria endemicity: Perennial transmission of malaria with 2 peaks in pre-monsoon
(MarchMay) and post-monsoon (September to November) periods
Malaria endemic species: P. falciparum and P. vivax
Participants
Sample size: 338

Age: Median age was 14 years and the range was 18 months to 82 years
Sex: Both males and females eligible. 50.3% of participants were female
Co-morbidities or pregnancy: Not mentioned, either as an inclusion criteria or characteristic of included participants
Study design
Participants prospectively enrolled, not reported whether participants consecutively enrolled. The study evaluated 4 RDTs: Paracheck test was performed at concurrently with
the microscopy. The remaining 3 RDTs were performed using stored samples. Samples
from each individual were tested by all tests
Target condition and reference standard(s) Type(s) of malaria parasite tested for: P. falciparum andP. vivax
Reference standard test(s) used: Microscopy, thick and thin smear slides and PCR
Who performed the reference standard tests, and where? 2 independent microscopists:
1 employed by the study and the other at Matiranga UHC; not reported for PCR
If microscopy was used, how many high power fields were looked at? 200 fields in
the Giemsa-stained thick film
How many observers or repeats were used? 2 observers
How were discrepancies between observers resolved? By a third microscopist posted
at the Khagrachari Civil Surgeons office situated 20 km away from Matiranga UHC
Index and comparator tests
Commercial name of the test: Paracheck (Orchid Biomedical System, India), FalciVax
Pf (Zephyr Biomedicals, India), Onsite Pf (CTK Biotech Inc, USA) and Onsite Pf/Pv
(CTK Biotech Inc, USA)
Parasite species the test is designed to detect:
Paracheck: P. falciparum
Onsite Pf: P. falciparum
FalciVax: P. vivax and P. falciparum
Onsite Pf/Pv: P. vivax and P. falciparum
Designated type:
Paracheck: Type 1
Onsite Pf: Type 1
FalciVax: Type Other (HRP-2 antigen for P. falciparum and pLDH antigen for P.
vivax)
Onsite Pf/Pv: Type Other (HRP-2 antigen for P. falciparum and pLDH antigen
56
Alam 2011
(Continued)
for P. vivax)
Batch numbers: Not provided
Transport and storage conditions: Not provided
Who performed the index test, and where? Not reported. All the RDTs were used
following the manufacturers instructions
Follow-up
Notes
Source of funding: funded by icddr,b and its donors. Paracheck provided by NMCP;
Onsite Pf and Onsite Pf/Pv provided by CTK Biotech Inc, USA as a donation
Table of Methodological Quality

Item
Authors judgement
Description
Representative spectrum?
All tests
Unclear
Febrile patients referred to microscopy for

malaria diagnosis. Other characteristics, inclusion and exclusion criteria not described
Acceptable reference standard?

All tests
Yes
Microscopy: 2 experienced, independent

microscopists assessed each slide. There was
provision for a third microscopist to resolve any disagreement between them. 200
fields were viewed, another 200 fields were
viewed if malaria was identified, to identify
mixed infections
PCR is also a reference standard.
Partial verification avoided?

All tests
Yes
All participants receiving index tests had

their diagnosis verified by reference test
Differential verification avoided?

All tests
Yes
The same reference tests were used regardless of the index test results
Incorporation avoided?
All tests
Yes
The reference standard was microscopy and

PCR.
Reference standard results blinded?

All tests
Unclear
Blinding not described.
Index test results blinded?

All tests
Unclear
Uninterpretable results reported?

All tests
Unclear
Number enrolled in the study was explicitly stated and corresponded to the number presented in the analysis; therefore there
were no withdrawals due to invalid results
57
Alam 2011
(Continued)
Withdrawals explained?
All tests
Yes
The number recruited into the study was

clearly stated and corresponded with the
number included in the analysis, therefore
there were no withdrawals
Andrade 2010
Presenting signs and symptoms: Malaria-related symptoms

Previous treatments for malaria: Not mentioned, either as an inclusion criteria or
characteristic of included participants
Clinical setting: Diagnostic centres of the Brazilian National Foundation of Health
(FUNASA)
Country: Brazil
Malaria endemicity: Not stated
Participants
Sample size: 311

Age: Median age was 33.5 years and the range was 4 to 65 years
Sex: Both males and females eligible. 60.5% of participants were male
Co-morbidities or pregnancy: Not mentioned, either as an inclusion criteria or characteristic of included participants
Study design
Participants were recruited consecutively. The sampling method was not described. 1
RDT was evaluated
Target condition and reference standard(s) Type(s) of malaria parasite tested for: P. falciparum and P. vivax malaria
Reference standard test(s) used: Microscopy thick and thin blood films and nested
PCR
Who performed the reference standard tests, and where? Experienced malaria field
microscopists from the FUNASA performed microscopy; not stated who performed the
nested PCR. All tests were repeated and confirmed at the main laboratory at the Centro
de Pesquisas Goncalo Moniz, Bahia, Brazil
If microscopy was used, how many high power fields were looked at? Not stated
How many observers or repeats were used? 2 repeats with 2 different observers
How were discrepancies between observers resolved? Not stated
Commercial name of the test: Optimal-IT RDT (DiaMed China Ltd, Hong Kong,
China)
Parasite species the test is designed to detect: P. falciparum and P. vivax malaria
Designated type: Antigens test detects stated
Batch numbers: Not stated
Transport and storage conditions: Not stated
Who performed the index test, and where? Not stated
Follow-up
Not applicable
Notes
Source of funding: FINEP (010409605)/FNDCT-CT Amaznia.
58
Andrade 2010
(Continued)

Item
Authors judgement
Description
All tests
Yes
Patients were attending a clinic with symptoms of malaria. Study authors excluded
people who had lived in the area for less
than 6 months or had received antimalarials in the last 2 weeks

All tests
Unclear
2 independent microscopists performed

microscopy, 1 in the field and 1 in the central laboratory. The number of fields viewed
is not stated

All tests
Yes
All participants who received the index test

also received the reference tests

All tests
Yes
All tests
Yes
The index test does not form part of the

reference standard.

All tests
Unclear
Not reported whether the tests were read

blindly.

All tests
Unclear
Not reported whether the tests were read

blindly.

All tests
Unclear
All tests
Yes
were no withdrawals
59
Ashton 2010
Presenting signs and symptoms: Symptoms of uncomplicated malaria (axillary temperature > 37.5C or report of fever in the previous 48 hours)
Previous treatments for malaria: Not mentioned, either as an inclusion criteria or
Clinical setting: 1 health centre and 3 health posts per woreda
Country: Ethiopia
Participants
Sample size: 2400

Age: All ages over 6 months eligible. Actual age profile of participant population not
presented
Sex: Both males and females eligible. Actual proportions of males and females in the
participant population not stated
Co-morbidities or pregnancy: Patients with any life-threatening diseases were excluded.
No exclusion criteria based on pregnancy. No details about the frequency of pregnancy
in the patient population are presented
Study design
Enrolment was consecutive and prospective. 3 RDTs were evaluated (CareStart,

ParaScreen and ICT Combo). Each individual received all the tests
Reference standard test(s) used: Microscopy thick and thin blood films
Who performed the reference standard tests, and where? Staff at the health centre and
experienced microscopists at a regional malaria reference laboratory who was blinded to
the initial results. And a third, blinded, reading was conducted to address discrepancies
If microscopy was used, how many high power fields were looked at? 200 fields at
1000 magnification
How many observers or repeats were used? 2
How were discrepancies between observers resolved? They were corrected according
to a third, blinded, readings: presence or absence of asexual parasites, difference in species,
or > 50% difference in parasite count. Microscopy results and parasite counts were
corrected according to the third reading
Commercial name of the test:

CareStart pf-HRP2/pan-pLDH (AccessBio, USA, catalogue number G0131SK)
ParaScreen pf-HRP2/pan-pLDH (Zephyr Biomedicals, India, catalogue
number 50310025)
ICT Combo pf-HRP2/pan-aldolase (ICT Diagnostics, South Africa, catalogue
number ML02)
Parasite species the test is designed to detect: Multi-species
Designated type:
CareStart and ParaScreen - Type 3
ICT Combo - Type 2
Transport and storage conditions:
RDTs were transported unrefrigerated by air to Addis Ababa, where they were stored
at ambient conditions until transfer to field sites. Temperature was monitored (Tinytag,
Gemini Data Loggers, UK) but not controlled while RDTs were transported by road to
60
Ashton 2010
(Continued)
health centres and during storage at the health centres. Temperatures during transport
reached a maximum 36C, but at health facilities temperatures did not exceed 30C.
Who performed the index test, and where? Health extension workers or nurses at the
health centres
Follow-up
Not applicable
Notes
Source of funding: United States Agency for International Development (Cooperative

Agreement 663-A-00-09-00404-00). BC is funded by the ACT Consortium which is
supported by a grant from the Bill & Melinda Gates Foundation to the London School
of Hygiene and Tropical Medicine. Manufacturers supplied CareStart and ParaScreen
RDTs free of charge for this evaluation, and ICT Combo was provided at a reduced
price.

Item
Authors judgement
Description
All tests
Yes
Participants were visiting an outpatient department of a health centre with symptoms

suggestive of malaria

All tests
Yes
2 independent microscopists viewed the

slides, a third viewed any discrepancies; 200
fields were looked at

All tests
Yes

also received the reference test

All tests
Yes
All tests
Yes

reference standards

All tests
Yes
RDT and microscopy results were read

by different staff at the health centre, each
blinded to the results of the other diagnostic technique

All tests
Yes
RDT and microscopy results were read

by different staff at the health centre, each
blinded to the results of the other diagnostic technique

All tests
Unclear
61
Ashton 2010
(Continued)
All tests
Yes
were no withdrawals
Bell 2001a
Presenting signs and symptoms: History of fever, headache, chills or rigors occurring
within the preceding 3 days; or more distant history of fever or non-specific signs suggestive of malaria
Previous treatment for malaria: Participants who had recently taken antimalarials were
not excluded; 5% of participants reported prior antimalarial use
Clinical setting: Village health workers in 5 barangaya (districts)
Country: Philippines (Agusan del Sur Province in the northeast of the island of Maindano)
Malaria endemicity: Generally low perennial transmission, with pockets of high transmission
Malaria endemic species: P. falciparum andP. vivax
Participants
Sample size: 350

Age: Eligible age range not stated. Mean age of the participants was 19.5 years
Sex: Both males and females eligible. There were 171 male and 179 female participants
Co-morbidities and pregnancy: Not mentioned, either an exclusion criteria or characteristic of included participants
Parasite density of microscopy positive cases: Not presented
Study design
Enrolment was prospective. The sampling method was not described. 1 RDT was evaluated
Target condition and reference standard(s) Target condition: Malaria parasitaemia

Reference standard: Microscopy of thick and thin blood smears
Who performed the reference standard tests, and where? An experienced local microscopist for all slides; selected slides were also read by an experienced parasitologist.
Microscopy was performed in a local laboratory and hospital laboratory in Australia
If microscopy was used, how many high power fields were looked at? 100
How many observers or repeats were used? 1, except in discordant cases where RDT
and microscopy results differed, all cases RDT-positive for P. vivax and 20% of cases
negative by slide and RDT, in which case a second reader was used
How were discrepancies between observers resolved? The second, off-site reading was
taken as the correct 1
Commerical name of RDT: ICT Malaria Pf/Pv (Amrad-ICT, Sydney, Australia)

Parasite(s) designed to detect: P. falciparum or mixed infection, non-falciparum malaria
species only
Designated type: Type 4
Transport and storage conditions: Refrigerated until 2 weeks before use
Person(s) performing RDT: Researchers
62
Bell 2001a
(Continued)
RDT setting: Study villages

Follow-up
Not applicable
Notes
Source of funding: The Australian National Health and Medical Research Council

Item
Authors judgement
Description
All tests
Unclear
All participants had approached village

health workers with symptoms suggestive
of malaria, but the sampling method was
not described

All tests
Yes
An experienced microscopist viewed at least

100 high powered fields and discordant results were re-examined

All tests
Yes


All tests
Yes
The same reference test was used regardless

of the index test results
All tests
Yes

reference standard.

All tests
Yes
slides were read by a local microscopist

who was not aware of the results of the ICT
tests

All tests
Yes
RDTs were performed 2 to 4 weeks before

microscopy.

All tests
Yes
The paper reported that there was 1 uninterpretable microscopy result
All tests
Unclear
The number of participants originally enrolled in the study was not stated; therefore
it is unclear whether there were any withdrawals
63
Bell 2001b
Presenting signs and symptoms: History of fever, headache, child or rigors occurring
within the preceding 3 days; or more distant history of fever or non-specific signs suggestive of malaria
Previous treatment for malaria: Patients treated with antimalarials during the 4 weeks
preceding the test were excluded from the analysis
Clinical setting: Health centre in Visaya
Country: Philippines (Agusan del Sur Province in the northeast of the island of Maindano)
Malaria endemicity: Generally low perennial transmission, with pockets of high transmission
Participants
Sample size: 113

Age: Eligible age range not stated. Mean age of the participants was 19.8 years
Sex: Both males and females eligible. There were 73 male and 40 female participants
Co-morbidities and pregnancy: Not mentioned, either as an exclusion criteria or characteristic of included participants
Study design

Reference standard: Microscopy of thick and thin blood smears
Who performed the reference standard tests, and where? Not stated.
Setting: Regional Health Units
If microscopy was used, how many high power fields were looked at? Not stated,
but probably 100 as in the other trial reported together in the same paper
How many observers or repeats were used? Not stated
How were discrepancies between observers resolved? Not applicable

species only
Transport and storage conditions: Stored by barangay health workers at room temperature, averaging about 25C for up to 6 months
Person(s) performing RDT: Barangay health workers
RDT setting: Health centre
Follow-up
Not applicable
Notes
Source of funding: The Australian National Health and Medical Research Council

Item
Authors judgement
Description
64
Bell 2001b
(Continued)
All tests
Unclear
All participants were attending a health

centre with history of fever, headache, child
or rigors within the preceding 3 days; more
distant history of fever or non-specific signs
suggestive of malaria; but the sampling
method was not described

All tests
Unclear
No details given of the microscopy process.

All tests
Yes


All tests
Yes

All tests
Yes

reference standard.

All tests
Yes
Clear that blinding had taken place, as it

was not possible to match up all the RDT
and microscopy results by name and date

All tests
Yes
Clear that blinding had taken place, as it

was not possible to match up all the RDT
and microscopy results by name and date

All tests
Yes
25 of 393 tests done were considered invalid because of an indistinct control band.
Invalid results were excluded from the analysis
All tests
Yes
Only 113 microscopy results could be

matched with RDT results by name and
date; the others were lost from the analysis
65
Bendezu 2010
Presenting signs and symptoms: History of fever with or without chills, sweating and
headache
Previous treatments for malaria: No history of anti-malarial treatment during the last
2 weeks
Clinical setting: Health facilities
Country: Peru
Malaria endemicity: Despite a reduction of the incidence by up to 40% during the last
4 years in Peru, malaria due to P. falciparum and P. vivax remains an important public
health problem, especially in the Amazon region where more than 70% of the cases of
the country are reported.
Participants
Sample size: 332

Age: Eligible age range not stated. Mean age was 32 16 years
Sex: Not mentioned either as an inclusion criteria or a characteristic of participants
Co-morbidities or pregnancy: Not mentioned either as an inclusion criteria or a characteristic of participants
Study design
Reference standard test(s) used: Microscopy thick and thin blood films and PCR
Who performed the reference standard tests, and where? Reference standards were
carried out by different staff blinded to each other result. Expert microscopy was carried
out by experts in the 6 health centres; not described for PCR
How many observers or repeats were used? 10% of the slides were examined by a
second expert microscopist at the reference laboratory
Commercial name of the test: ParaScreen (Zephyr Biomedical Systems)

Parasite species the test is designed to detect: P. falciparum or mixed infection, nonfalciparum species only
Designated type: ParaScreen - Type 3
Batch numbers: Lot 101051
Transport and storage conditions: Not described
Who performed the index test, and where? Not stated
Follow-up
Notes
Source of funding: by The Global Fund to fight AIDS, Tuberculosis and Malaria
through the - Organismo Andino de Salud - Convenio Hipolito Unanue (Principal
Recipient of the Multi-Country Malaria Project Malaria control on the cross border
areas of the Andean Region: A community based approach-PAMAFRO), Grant Number MAA-305-G01-M; and by the Directorate General for Development Cooperation
(DGCD) of the Belgian Government (framework agreement 02, 2003-2007), project
95501
66
Bendezu 2010
(Continued)

Item
Authors judgement
Description
All tests
Yes
Participants were attending health centres

with fever and no history of malaria treatment within the last 2 weeks

All tests
No
Only 10% of slides were viewed twice. The

number of high power fields viewed before
declaring a sample negative was not stated

All tests
Yes


All tests
Yes
All tests
Yes

reference standard.

All tests
Yes
Reported that the tests were read blindly.

All tests
Yes

All tests
Unclear
All tests
Yes
were no withdrawals
Bharti 2008
Presenting signs and symptoms: Fever or history of fever, and suspicion of malaria
Previous treatment for malaria: No exclusions based on previous treatment; it was
undertaken in a remote area with no medical facilities
Clinical setting: Mobile field clinics in ten villages
Country: India (remote forested region of Jabalpur during the peak monsoon season)
Malaria endemicity: Low endemic areas with higher transmission during the monsoon
67
Bharti 2008
(Continued)
Participants
Sample size: 291

Age: All age groups eligible. Actual age range of participants 1 to 60 years
Sex: Both males and females eligible. Male: female ratio 1:1.15
Co-morbidities and pregnancy: No criteria based on co-morbidities or pregnancy. No
details of the frequency of these conditions in the participant population presented
Parasite density of microscopy positive cases: Range 80 to 111,920 parasites per L,
mean 8011, standard deviation 21,595
Study design
Enrolment was consecutive and prospective. 1 RDT was evaluated

Reference standard: Microscopy thick blood films
Who performed the reference standard tests, and where? Experienced microscopist
in the laboratory of NIMR
How many observers or repeats were used? 1 for all samples, 2 independent readers
for samples discordant between microscopy and RDT
How were discrepancies between observers resolved? Where the second reading gave
a different result from the first, the results of the second reading were confirmed by a
third examination by another technician
Commerical name of RDT: First Response Combo Malaria Ag card test (Premier Medical Corporation Ltd, Mumbai, India)
species only
Batch numbers: 61F0107
Transport and storage conditions: RDTs were stored properly, at temperature of 4C
to 30C, and used within their shelf life
Person(s) performing RDT: Field laboratory assistants. Independent staff re-read the
saved tests after 2 months and matched them with the originally recorded results
RDT setting: Field laboratory
Follow-up
Not applicable
Notes
Source of funding: Indian Council of Medical Research, Delhi. Test kits provided by
Premier Medical Corporation Ltd

Item
Authors judgement
Description
All tests
Yes
Participants were a consecutive sample of

people attending mobile field clinics with
fever or history of fever, and suspicion of
malaria
68
Bharti 2008
(Continued)

All tests
Yes
An experienced microscopist viewed at least

100 high power fields before declaring a
slide negative, and results discordant with
RDT were independently re-examined by
a second microscopist, and a third if necessary

All tests
Yes


All tests
Yes

All tests
Yes

reference standard.

All tests
Yes
Microscopy was undertaken without reference to the RDT.

All tests
Yes
RDTs were undertaken on site, and the results recorded before the microscopy results
became available

All tests
Yes
The paper reported that there were no invalid results.
All tests
Yes
The number of participants enrolled in the

study was clearly stated and corresponded
to the number presented in the analysis;
therefore there were no withdrawals
Chanie 2011
Presenting signs and symptoms: Suspected malaria: clinical symptoms of malaria, fever
Previous treatments for malaria: 12.5% of the subjects had anti-malaria treatment in
the preceding month
Clinical setting: Outpatient departments of 3 health facilities
Country: Ethiopia
Malaria endemicity: High endemicity
Participants
Sample size: 1092

Age: Mean 22.3 (SD 12.8); range 3 months to 78 years of age
Sex: 48.57% female, 51.43% male
Co-morbidities or pregnancy: Co-morbidities and pregnancy not stated
Study design
Participants prospectively enrolled, not reported whether participants consecutively enrolled. The study evaluated 1 RDT
69
Chanie 2011
(Continued)
Target condition and reference standard(s) Type(s) of malaria parasite tested for: P. falciparum and P. vivax
Reference standard test(s) used: Microscopy thick and thin smears
Who performed the reference standard tests, and where? Experienced malaria technicians performed the microscopic test. Location not reported (presumably at each of
the participating health centres)
If microscopy was used, how many high power fields were looked at? A minimum
of 100 high power fields examined on a thick smear
How many observers or repeats were used? Not stated
How were discrepancies between observers resolved? 20% of the positive and 10%
of the negative slides and discordant results between RDT and microscopic tests were
examined by another well experienced technician
Commercial name of the test: CareStart Malaria Pf/Pv Combo (Access Bio Inc, New
Jersey, USA)
Parasite species the test is designed to detect: P. falciparum and P. vivax
Designated type: Type Other (HRP-2 antigen for P. falciparum and pLDH antigen for
P. vivax)
Batch numbers: Lot No H38 IV and Lot No H28 IV
Transport and storage conditions: Lot No H38 IV and Lot No H28 IV
Who performed the index test, and where? Experienced malaria technicians performed
the index test
Follow-up
Not applicable
Notes
Source of funding: Addis Ababa University, The Federal Ministry of Health of Ethiopia.
RDT kits were donated by Acces Bio Inc

Item
Authors judgement
Description
All tests
Yes
All participants were attending primary

health centres with fever and symptoms of
malaria, sampling was consecutive

All tests
Yes
...discordant results between RDT and

microscopic tests were examined by another well experienced technician. Experienced malaria technicians viewed 200
white blood cells or 100 fields

All tests
Yes
Characteristics of participants are well described and the only exclusion criterion was
refusal to participate in the study

All tests
Yes
The same reference standard was used.
70
Chanie 2011
(Continued)
All tests
Yes
The reference standard was microscopy.

All tests
Unclear
Blinding procedures not stated. However,

microscopic evaluation and RDT were
performed independently. Results were
recorded in separate sheets

All tests
Unclear
Blinding procedures not stated. However,

microscopic evaluation and RDT were
performed independently. Results were
recorded in separate sheets

All tests
Unclear
All tests
Yes

clearly stated, and corresponded with the
number included in the analysis, therefore
there were no withdrawals
Chayani 2004
Presenting signs and symptoms: Specific symptoms: rigor, chills, rise of high temperature and profuse sweating; or irregular fever, joint pain and jaundice
Previous treatment for malaria: No explicit exclusions based on previous treatment
and no information presented on previous treatment
Clinical setting: Diagnostic and research centre (takes referrals from physicians for the
diagnosis of malaria)
Country: Orissa, India
Malaria endemic species: In sample, 78.6% P. falciparum, 21.4% P. vivax
Participants
Sample size: 232

Age: Not mentioned, either as inclusion criteria or characteristic of participants
Sex: Not mentioned, either as inclusion criteria or characteristic of participants
Co-morbidities and pregnancy: Not mentioned, either as inclusion criteria or characteristic of participants
Study design
Enrolment was prospective. The sampling method was unclear. 1 RDT was evaluated

Reference standard: Microscopy thick and think blood smear
Who performed the reference standard tests, and where? Microscopists in a diagnostic
and research centre
71
Chayani 2004
(Continued)
How many observers or repeats were used? 2 independent observers
How were discrepancies between observers resolved? A third microscopists opinion
was taken into account
Commerical name of RDT: OptiMAL (DiaMed, AG, Cressier, Switzerland)

species only
Person(s) performing RDT: Not stated
RDT setting: Not stated
Follow-up
Not applicable
Notes
Source of funding: Not stated

Item
Authors judgement
Description
All tests
Unclear
All participants were attending an ambulatory clinic with rigor, chills, rise of high
temperature and profuse sweating; or irregular fever, joint pain and jaundice. However
the sampling method was not described

All tests
Yes
2 independent microscopists viewed 200

high powered fields before declaring a slide
negative

All tests
Yes


All tests
Yes

All tests
Yes

reference standard.

All tests
Unclear

All tests
Unclear

All tests
No
The number of participants originally enrolled in the study was not explicitly stated;
72
Chayani 2004
(Continued)
therefore it is not possible to judge whether

any were excluded from the analysis due to
invalid test results
All tests
Unclear
therefore it is not possible to judge whether
there were any withdrawals
Dev 2004

Previous treatment for malaria: No information presented on previous treatment; no
suggestion of any exclusions based on previous treatment
Clinical setting: Malaria clinics
Country: India (Assam)
Malaria endemicity: Mesoendemic
Participants
Sample size: 336; but varied by RDT evaluated (10 to 139)

Age: Infants under 12 months excluded; actual age range 1 to 60 years
Co-morbidities and pregnancy: No exclusions criteria based on co-morbidities or pregnancy were stated, and no details of the frequency of these conditions in the participant
population is presented
mean 59,842, standard deviation (SD) 78,780
Study design
Enrolment was prospective. The sampling method was not described. 7 RDTs were
evaluated; it is unclear how each RDT was allocated, as no participant received all the
tests

Reference standard: Microscopy thick and thin blood smears
Who performed the reference standard tests, and where? Technician; all positive slides
and 20% of negative slides were also examined by the senior technician for confirmation
of result. Setting was the laboratory at the malaria clinics
How many observers or repeats were used? 1 in the case of most smears judged negative
by the technician. 2 in the case of 20% of those initially judged negative, and all those
judged positive
How were discrepancies between observers resolved? The judgement of the senior
technician was used
Commerical name of RDT:

Paracheck Pf (Orchid Biomedical Systems, Goa, India)
ParaSight-F (Beckton Dickinson, Franklin Lakes, NJ)
ParaHIT-F (Span diagnostics Ltd, Surat, India)
73
Dev 2004
(Continued)
ICT Malaria Pf (ICT Diagnostics, Sydney, Australia)

New Pf-1 mini (Monozyme India Ltd, Secundrabad, India)
SD Malaria Pf/Pv (SD Diagnostics Inc, Korea)
Diamed OptiMAL (Flow Inc. Portlad, OR)
Parasite(s) designed to detect:
Paracheck Pf - P. falciparum
ParaSight-F - P. falciparum
ParaHIT-F - P. falciparum
ICT Malaria Pf - P. falciparum
New Pf-1 mini - P. falciparum
SD Malaria Pf/Pv - P. falciparum or mixed infection, non-falciparum malaria
species only
Diamed OptiMAL - P. falciparum or mixed infection, non-falciparum malaria
species only
Designated type:
Paracheck Pf - Type I
ParaSight-F - Type I
ParaHIT-F - Type I
ICT Malaria Pf - Type I
New Pf-1 mini - Type I
SD Malaria Pf/Pv - Type 3
Diamed OptiMAL - Type 4
Person(s) performing RDT: The laboratory attendant performed the test and recorded
his or her interpretation. The test kit result was then re-read for verification by the senior
technician
RDT setting: Malaria clinic laboratory
Follow-up
Not applicable
Notes
Source of funding: Mian source of funding not stated. Test kits supplied by the Government of Assam

Item
Authors judgement
Description
All tests
Unclear
All participants were attending malaria

clinics with fever; however, during the
study period, 6663 blood smears were examined but only 336 were evaluated with
RDT kits, and the sampling method for
RDT evaluation was unclear

All tests
Unclear
2 observers were used in the vast majority

of cases; however, it is unclear whether the
observers worked independently
74
Dev 2004
(Continued)

All tests
Yes


All tests
Yes

All tests
Yes

reference standard.

All tests
Yes
Microscopy and RDT results were compared by an independent observer

All tests
Yes
Microscopy and RDT results were compared by an independent observer

All tests
No
No information presented on numbers initially allocated each RDT, so not possible

to judge this
All tests
Unclear
No information presented on numbers initially allocated each RDT, so not possible

to judge this
Eibach 2013
Presenting signs and symptoms: Suspected malaria with a temperature > 37.5C
Previous treatments for malaria: More than 90% of the patients reported receiving
traditional or registered drugs, including antipyretics, antimalarials and antibiotics previously. However, the quality of drugs, the dosage and the duration of treatment remained
unknown
Clinical setting: General health centre
Country: Mali
Malaria endemicity: Hyperendemic in the peripheral villages, mesoendemic in the
periurban area and hypoendemic in the city
Malaria endemic species: 95% P. falciparum
Participants
Sample size: 727

Age: Mean 23.5 (SD 14.9) median = 21, range 1 to 60)
Sex: Not reported
Co-morbidities or pregnancy: Not reported
Study design
Participants prospectively enrolled, not reported whether participants consecutively enrolled. The study evaluated 2 RDTs
Target condition and reference standard(s) Type(s) of malaria parasite tested for: P. falciparum, PAN malaria
Who performed the reference standard tests, and where? Local investigators
75
Eibach 2013
(Continued)
How many observers or repeats were used? Thick and thin smears were assessed by
2 local investigators, and by an expert at the Parasitology Department of the Lyon
University Hospital, as a quality control
How were discrepancies between observers resolved?
Local investigators resolved all discrepancies between themselves by consensus. All discordant results between microscopy and the 2 RDTs were resolved by PCR and test
characteristics were recalculated according to the PCR-corrected results
Commercial name of the test: VIKIA Malaria Ag Pf/Pan (IMAccess, Lyon, France),
CareStart Malaria (AccessBio, USA)
VIKIA Malaria Ag Pf/Pan: P. falciparum or mixed infection, non-falciparum malaria
species only
CareStart Malaria: P. falciparum or mixed infection, non-falciparum malaria species only
Designated type: VIKIA Malaria Ag Pf/Pan: Type 2
CareStart Malaria: Type 3
Batch numbers: VIKIA Malaria Ag Pf/Pan: RD MA2 110527
CareStart Malaria: G21MR
Transport and storage conditions: Not reported
Who performed the index test, and where? Local community health workers trained
to use both tests .
Follow-up
Not applicable
Notes
Source of funding: The study was supported by IMACCESS.

Data from the Lyon part of the study was not included as it did not match inclusion
criteria
The VIKIA Malaria Ag Pf/Pan test was read at different time points (15, 20, 30, 60
minutes), while the CareStart Malaria test was read after 20 minutes as recommended
2 drops of blood were spotted onto filter paper, individually stored in a plastic bag and
sent to the Parasitology Department of the Lyon University Hospital for PCR correction

Item
Authors judgement
Description
All tests
Yes
Consecutive sample of people attending a

clinic with symptoms of malaria

All tests
Yes
Microscopy was undertaken by 2 trained

local health workers and corrected by PCR
at the Parasitology Department of the Lyon
University Hospital

All tests
Yes


All tests
Yes
The same reference test was used.
76
Eibach 2013
(Continued)
All tests
Yes
Standard microscopy and PCR.

All tests
Yes
All microscopists were blinded to the results

of the RDTs.

All tests
Yes
RDTs were performed immediately after

sampling.

All tests
Unclear
All tests
Yes
The number of participants enrolled was

clearly stated, and the number included in
the analysis corresponds to this number, indicating no withdrawals
Elahi 2013
Presenting signs and symptoms: Febrile patients with clinical symptoms

Previous treatments for malaria: Not described
Clinical setting: Health posts in remote border areas
Country: Bangladesh
Malaria endemicity: Endemic
Malaria endemic species: 74% P. falciparum, 26% P. vivax,P. malariae and P. ovale were
also present in the area, but were not found within the study sample
Participants
Sample size: 327

Age: Not reported
Sex: Not reported
Study design
Target condition and reference standard(s) Type(s) of malaria parasite tested for: P. falciparum, PAN malaria
Reference standard test(s) used: Microscopy thick and thin smears; quantitative PCR
Who performed the reference standard tests, and where? Experienced microscopists
at the field sites
How many observers or repeats were used? 2 independent microscopists, blinded to
the findings of the other
How were discrepancies between observers resolved? Where there was a discrepancy
between the 2 microscopists, the sample was excluded from the study. The number
excluded for this reason was not stated
77
Elahi 2013
(Continued)
Commercial name of the test: Parascreen (Zephyr Biomedical Systems, India)

Parasite species the test is designed to detect: P. falciparum or mixed infection, nonfalciparum malaria species only
Batch numbers: 101159
Who performed the index test, and where? Laboratory personnel at the Parisitology
Laboratory, icddr,b
Follow-up
Not applicable
Notes
Source of funding: icddr,b and its donors, which provide unrestricted support to icddr,
b for its operations and support. Parascreen was donated by the manufacturer

Item
Authors judgement
Description
All tests
Unclear
Recruitment was prospective, but the sampling procedure was not stated. Samples
with mixed infections or where the 2 microscopists findings did not agree were excluded, and the number excluded was not
stated

All tests
Unclear
Microscopy was undertaken by 2 experienced microscopists, but the number of

fields viewed before declaring a slide negative was not stated
PCR was also used as a separate, additional
reference standard

All tests
Yes
All participants received both the reference

test and the index test

All tests
Yes

All tests
Yes
Microscopy was used as the reference standard.

All tests
Yes
Microscopists were blinded to prior results.

All tests
Unclear
Blinding not described, however, index and

reference tests were undertaken at different
locations
78
Elahi 2013
(Continued)

All tests
No
Uninterpretable results were not reported

on.
All tests
No
It was stated that samples with mixed infection or where microscopists disagreed were
excluded; however, the number of samples
excluded and the original number of participants enrolled was not presented
Endeshaw 2012a
Presenting signs and symptoms: Clinically presumptive malaria: an axillary temperature greater than or equal to 37.5C or
history of fever in the previous 48 hours
Previous treatments for malaria: Not stated
Clinical setting: Ten health centres
Country: Ethiopia
Malaria endemicity: The study was conducted in an area with range of transmission
intensities, during the peak transmission period of malaria infection
Malaria endemic species: Not stated
Participants
Sample size: 1997. 4 RDTs were not done (reason not reported)
Age: Range: 8 months to 85 years. Mean 20.7 (SD not stated)
Sex: 56.2 male, 43.8 female
Co-morbidities or pregnancy: Patients with other known causes of non malarial febrile
illnesses or serious illness were excluded. Pregnancy status not stated
Study design
Reference standard test(s) used: Microscopy, thick and thin smears
Who performed the reference standard tests, and where? Microscopy assessment was
performed by experienced medical laboratory technicians
How many observers or repeats were used? Slides were also sent for expert microscopy
at The Carter Center in Addis Ababa
Commercial name of the test: ParaScreen Pan/Pf (Zephyr Biomedical systems, Verna,
Goa, India)
Who performed the index test, and where? The ten experienced laboratory technicians
involved in this study were trained on the RDT sampling and evaluation procedures
79
Endeshaw 2012a
(Continued)
Follow-up
Not applicable
Notes
Source of funding: Not stated.

Out of 2000 recruited patients, 1997 febrile cases were examined for malaria parasites
by blood slide microscopy.
Of the 1997 persons tested by slide, 1993 samples were also examined by ParaScreen
RDT at the health centers.

Item
Authors judgement
Description
All tests
Yes
In each health centre the first 200 selfpresenting patients of any age and either
sex who qualified as clinically presumptive
malaria were recruited

All tests
Unclear
Slides were evaluated by trained technicians

at each site and were also sent to a central lab
for expert microscopy. However, number
of microscopic field was not stated

All tests
Yes


All tests
Yes

All tests
Yes
Microscopy was used as reference standard.

All tests
Yes
Although blind procedures for local technicians are not reported, slides were also sent
for expert microscopy at a central lab where
they were examined in blinded fashion

All tests
Yes
Microscopy and ParaScreen Pan/PfH RDT

were done immediately by health centre
technicians

All tests
Unclear
All tests
Yes
Number enrolled in the study was explicitly stated as 2000, 1993 were presented in
the analysis; therefore there were 7 withdrawals. These were explained as 3 who de-
80
Endeshaw 2012a
(Continued)
clined to participate and 4 who did not

have RDT because the technicians had too
much work
Endeshaw 2012b
Presenting signs and symptoms: Clinically presumptive malaria: an axillary temperature greater than or equal to 37.5C or history of fever in the previous 48 hours
Country: Ethiopia
Participants
Study design
Goa,India)
Follow-up
Not applicable
Notes

81
Endeshaw 2012b
(Continued)
Item
Authors judgement
Description
All tests
Yes

All tests
Unclear

of microscopic fields was not stated

All tests
Yes


All tests
Yes

All tests
Yes
Microscopy was used as a reference standard.

All tests
Yes

All tests
Yes

technicians

All tests
Unclear
All tests
Yes
the analysis; therefore there were 7 withdrawals. These were explained as 3 who declined to participate and 4 who did not
much work
82
Endeshaw 2012c
Country: Ethiopia
Participants
Co-morbidities or pregnancy: patients with other known causes of non malarial febrile
Study design
Goa, India)
Follow-up
Not applicable
Notes


Item
Authors judgement
Description
83
Endeshaw 2012c
(Continued)
All tests
Yes
In each health centre, the first 200 selfpresenting patients of any age and either

All tests
Unclear

of microscopic field have not been stated

All tests
Yes


All tests
Yes

All tests
Yes

All tests
Yes

All tests
Yes

technicians

All tests
Unclear
All tests
Yes
much work
84
Endeshaw 2012d
Country: Ethiopia
Participants
Study design
Goa, India)
Follow-up
Not applicable
Notes


Item
Authors judgement
Description
85
Endeshaw 2012d
(Continued)
All tests
Yes
In each health centre, the first 200 selfpresenting patients of any age and either

All tests
Unclear

for expert microscopy. However, the number of microscopic fields was not stated

All tests
Yes


All tests
Yes

All tests
Yes

All tests
Yes

All tests
Yes

technicians

All tests
Unclear
All tests
Yes
much work
86
Endeshaw 2012e
Country: Ethiopia
Participants
Study design
Goa,India)
Follow-up
Not applicable
Notes


Item
Authors judgement
Description
87
Endeshaw 2012e
(Continued)
All tests
Yes

All tests
Unclear


All tests
Yes


All tests
Yes

All tests
Yes

All tests
Yes

All tests
Yes

technicians

All tests
Unclear
All tests
Yes
much work
88
Endeshaw 2012f
Country: Ethiopia
Participants
Study design
Goa,India)
Follow-up
Not applicable
Notes


Item
Authors judgement
Description
89
Endeshaw 2012f
(Continued)
All tests
Yes

All tests
Unclear


All tests
Yes


All tests
Yes

All tests
Yes

All tests
Yes

All tests
Yes

technicians

All tests
Unclear
All tests
Yes
much work
90
Endeshaw 2012g
Country: Ethiopia
Participants
Study design
Goa,India)
Who performed the index test, and where? The 10 experienced laboratory technicians
Follow-up
Not applicable
Notes

by blood slide microscopy

Item
Authors judgement
Description
91
Endeshaw 2012g
(Continued)
All tests
Yes

All tests
Unclear


All tests
Yes


All tests
Yes

All tests
Yes

All tests
Yes

All tests
Yes

technicians

All tests
Unclear
All tests
Yes
much work
92
Endeshaw 2012h
Country: Ethiopia
Participants
Study design
Goa,India)
Follow-up
Not applicable
Notes


Item
Authors judgement
Description
93
Endeshaw 2012h
(Continued)
All tests
Yes

All tests
Unclear


All tests
Yes


All tests
Yes

All tests
Yes

All tests
Yes

All tests
Yes

technicians

All tests
Unclear
All tests
Yes
much work
94
Endeshaw 2012i
Country: Ethiopia
Participants
Study design
Goa,India)
Follow-up
Not applicable
Notes


Item
Authors judgement
Description
95
Endeshaw 2012i
(Continued)
All tests
Yes

All tests
Unclear


All tests
Yes


All tests
Yes

All tests
Yes

All tests
Yes

All tests
Yes

technicians

All tests
Unclear
All tests
Yes
much work
96
Endeshaw 2012j
Country: Ethiopia
Participants
Study design
Goa, India)
Follow-up
Not applicable
Notes


Item
Authors judgement
Description
97
Endeshaw 2012j
(Continued)
All tests
Yes

All tests
Unclear


All tests
Yes


All tests
Yes

All tests
Yes

All tests
Yes

All tests
Yes

technicians

All tests
Unclear
All tests
Yes
much work
98
Fernando 2004
Presenting signs and symptoms: Fever or history of fever

Previous treatment for malaria: No exclusions because of prior antimalarial use, and
no data presented on the frequency of recent antimalarial use in the participants
Clinical setting: A malaria research station and a malaria clinic
Country: Sri Lanka
Malaria endemic species: P. vivax (70%) and P. falciparum
Participants
Sample size: 328

Age: All ages above 5 years eligible; mean age 28.3 years (range 5 to 72 years)
Sex: Both males and females eligible; 64% of the participants were males
Co-morbidities and pregnancy: No exclusion criteria based on co-morbidities or pregnancy. No details of the frequency of these conditions in the participant population is
presented
Study design

Reference standard: Microscopy thick and think blood films
Who performed the reference standard tests, and where? Trained microscopists at the
clinics and in a laboratory
How many observers or repeats were used? 2 independent readers; 1 at the clinics and
another in a laboratory
How were discrepancies between observers resolved? There were no discrepancies
between the 2 microscopists

species only
Transport and storage conditions: Stored and used at room temperature which often
exceeds 30C
Person(s) performing RDT: The researchers
RDT setting: At the clinics
Follow-up
Not applicable
Notes
Source of funding: National Science Foundation, Sri Lanka

Item
Authors judgement
Description
All tests
Yes

people attending clinics with fever or history of fever
99
Fernando 2004
(Continued)

All tests
Yes
2
independent
trained
microscopists viewed 400 high power fields
before declaring a slide negative

All tests
Yes


All tests
Yes

All tests
Yes

reference standard.

All tests
Unclear

All tests
Unclear

All tests
Unclear

All tests
Yes

Harani 2006
Presenting signs and symptoms: Clinical symptoms of malaria and history of fever
over 37.5C. People with known causes of fever other than malaria were excluded
Previous treatment for malaria: Patients who had been treated for malaria in the previous 4 weeks were excluded from the study
Clinical setting: Outpatient department of a reference hospital
Country: Pakistan
Participants
Sample size: 560

Age: All age groups eligible; actual age range of included participants 2 to 73 years
Sex: Both males and females eligibles. Participants included 339 males and 221 females
Co-morbidities and pregnancy: Not mentioned, either as an inclusion criteria or characteristic of included participants
Study design
Enrolment was prospective. The sampling method was not described. 1 RDT was tested
100
Harani 2006
(Continued)

Reference standard: Microscopy thick and thin blood films
Who performed the reference standard tests, and where? Senior technologist and
principle author in the
Department of Pathology and Microbiology, Aga Khan University
How many observers or repeats were used? Unclear, 2 microscopists were used but
how they divided the work between them was not described
How were discrepancies between observers resolved? Not applicable
Commerical name of RDT: ICT Malaria Pf/Pv (Binax Inc. Portland, Maine, USA)
species only
Person(s) performing RDT: The second author
RDT setting: Microbiology section of Aga Khan University
Follow-up
Not applicable
Notes

Item
Authors judgement
Description
All tests
Unclear
All participants were presenting at an outpatients department with symptoms of

malaria and history of fever, but the sampling method was not described

All tests
Unclear
2 microscopists at a University laboratory

viewed 200 high power fields before declaring a slide negative; however, it is unclear
how the 2 microscopists worked together

All tests
Yes


All tests
Yes

All tests
Yes

reference standard.

All tests
Yes
The microscopists were unaware of the

microscopy results.
101
Harani 2006
(Continued)

All tests
Yes
These results were read by the second author who was blind to the microscopy results

All tests
Unclear
The number of participants originally enrolled in the study was clearly stated, and
corresponds with the number presented in
the analysis; therefore there were no exclusions due to invalid results
All tests
Yes
corresponds with the number presented in
the analysis; therefore there were no withdrawals due to invalid results
Kolaczinski 2004
Presenting signs and symptoms: Suspected malaria or febrile illness

Previous treatment for malaria: No exclusion criteria based on previous use of antimalarials, and no data on previous antimalarial use of the participants was presented
Clinical setting: Basic health units within an Afghan refugee camp
Country: Pakistan (North West Frontier Province)
Malaria endemic species: 80% P. vivax, 20%P. falciparum
Participants
Sample size: 499

Age: All age groups eligible for inclusion; actual age range of the participants not stated
Sex: Both males and females eligible for inclusion; actual age range of the participants
not stated
Co-morbidities and pregnancy: No exclusions based on co morbidities or pregnancy,
and no data presented on the frequency of these conditions in the study population
Study design
Enrolment was consecutive and prospective. 1 RDT was tested.

Reference standard: Microscopy thick and think blood films
Who performed the reference standard tests, and where? Microscopists in the basic
health units within an Afghan refugee camp and HNIs reference laboratory in Peshawar
How many observers or repeats were used? 2, 1 at the BHU and 1 at the reference
laboratory
How were discrepancies between observers resolved? Unclear all of the smears
checked by the microscopist at each BHU were cross checked at HNIs reference laboratory at Pashawar
102
Kolaczinski 2004
(Continued)

species only
Person(s) performing RDT: Microscopists
RDT setting: Basic health units
Follow-up
Not applicable
Notes

Item
Authors judgement
Description
All tests
Yes
Participants were a consecutive series of patients attending a basic health units with
suspected malaria

All tests
Yes
2 microscopists, 1 working in a central laboratory, viewed at least 100 high power

fields before declaring a slide negative

All tests
Yes


All tests
Yes

All tests
Yes

reference standard.

All tests
No
The index test and reference test were undertaken by the same person

All tests
No
The index test and reference test were undertaken by the same person

All tests
Unclear
corresponded to the number presented in
the analysis: therefore there were no exclusions due to invalid test results
All tests
Yes
103
Kolaczinski 2004
(Continued)

the analysis: therefore there were no withdrawals
Kosack 2013
Presenting signs and symptoms: Fever or a history of fever in the prior 24 hours
Previous treatments for malaria: Not reported
Clinical setting: 2 primary care clinics
Country: Myanmar
Malaria endemic species: P. falciparum, P. vivax
Participants
Sample size: 2585

Age: Mean 10.9 years (SD not reported), range 0.1 to 94 years
Sex: 51.3% male, 48.7% female
Co-morbidities or pregnancy: Pregnant women were not included
Study design
Target condition and reference standard(s) Type(s) of malaria parasite tested for: Multi-species malaria
Reference standard test(s) used: Microscopy thick and thin smears.
Who performed the reference standard tests, and where? A laboratory technician
performed the reference test. Location not reported, presumably on site
If microscopy was used, how many high power fields were looked at? At least 200
fields
How many observers or repeats were used? Slides were sent to a malaria research centre
in Thailand, for external quality control
How were discrepancies between observers resolved? Not reported
Commercial name of the test: SD Bioline Malaria Ag P.f/Pan 05FK60 (Standard Diagnostics, Kyonggi, Republic of Korea),
Parasite species the test is designed to detect: P. falciparum or mixed infection, nonfalciparum species
Batch numbers: Not reported
Who performed the index test, and where? Not reported. As patients with fever or
history of fever in the past 24 hours were immediately tested, presumable the RDTs were
performed at the clinics
Follow-up
Not applicable
Notes
Source of funding: Source of funding not reported
104
Kosack 2013
(Continued)
Item
Authors judgement
Description
All tests
Yes
All non-pregnant patients visiting primary

care clinics with fever or a history of fever
in the prior 24 hours were included

All tests
No
It is reported that the program follows the

WHO Malaria Microscopy Quality Assurance recommendation (reference provided)
. 1 technician read the slide on site. 900
(450 negative and 450 positive) of 2585
slides were sent to a malaria research unit
in Thailand for external control

All tests
Yes
All participants had their RDT results verified by microscopic reference test

All tests
Yes
Microscopy was used for all samples.
All tests
Yes
Microscopy was used for all samples.

All tests
Yes
The laboratory technician was not aware of

the RDT result when examining the smear

All tests
Yes
RDT was performed immediately. The

slide for microscopic evaluation was prepared after the RDT was performed

All tests
Unclear
All tests
Yes
were no withdrawals
105
Mekonnen 2010
Presenting signs and symptoms: Febrile, clinically suspected for malaria

Previous treatment for malaria: No exclusions based on previous treatment, and no
relevant data presented
Clinical setting: Outpatient department of a health centre
Country: Ethiopia (Jimma, South-West) - 300 km south-west of Addis Ababa, 1760 m
above sea level
Malaria endemicity: Not stated: transmission takes place throughout the year
Participants
Sample size: 240

Age: Eligible age range not stated. Actual age range of participants was 1 to 60 years,
with a mean age of 25 years
Sex: Both males and females eligible. 57.5% of the study participants were male, 42.5%
female
Co-morbidities and pregnancy: Not mentioned, either as an exclusion criteria or characteristic of the included participants
Study design

Person(s) performing microscopy: Experienced malaria technicians
Microscopy setting: Not stated
Number of high power fields examined before declaring negative: 300
Number of observer or repeats: Discordant results between RDTs and slides were
repeated.
Resolution of discrepancies between observers: Not described.
Commerical name of RDT: CareStart Malaria Pf/Pv Combo (Access Bio Inc, Monmouth Junction, New Jersey, USA)
Parasite(s) designed to detect: P. falciparum and P. vivax
Transport and storage conditions: Stored according to the guidelines of the manufacturer and quality of package desiccant was checked before use
Person(s) performing RDT: Experienced malaria technicians
Follow-up
Not applicable
Notes
Source of funding: Recieved financial support from the School of Laboratory Studies
of the Jimma Univeristy and the VLIR-IUC program between Flanders and Jimma
Univeristy. Access Bio Ltd donated the CareStart Malaria Pf/Pv Combo test kit

Item
Authors judgement
Description
106
Mekonnen 2010
(Continued)
All tests
Unclear
All participants were attending a clinic with

fever and suspected malaria, but the sampling method was not described

All tests
Yes
Experienced technicians independently

viewed 300 high power fields before declaring a slide negative. Discordant results was
repeated independently

All tests
Yes


All tests
Yes

All tests
Yes

reference standard.

All tests
Yes

All tests
Yes
Results of the CareStart tests were determined prior to microscopic results with
strict blinding to the microscopic examination of the blood film

All tests
Unclear
the analysis: therefore there were no exclusions due to invalid test results
All tests
Yes
the analysis: therefore there were no withdrawals
107
Metzger 2011
Presenting signs and symptoms: Not stated

Previous treatments for malaria: Not mentioned, either as an exclusion criteria or
Clinical setting: Health posts
Country: Venezuela
Malaria endemicity: In 2007, the annual parasite index (API) was 68.4 cases/1000
inhabitants, but hot spots of higher malaria risk were seen in some indigenous ethnic
groups.
Participants
Sample size: 550

Age: Not mentioned either as an inclusion criteria or a characteristic of participants
Study design
No details of the enrolment and sampling method were reported. 1 RDT was evaluated
Reference standard test(s) used: microscopy
Who performed the reference standard tests, and where? Slides were examined by
microscopists in health posts, then all positive and 10% of negative slides were reexamined by microscopists at the Regional Central Laboratory. Slides were then sent to
the National Amazon Centre for Research and Control of Tropical Diseases in Puerto
Ayacucho for re-examination by expert microscopists
If microscopy was used, how many high power fields were looked at? In the health
posts and Regional Central Laboratory 200 fields of thick blood smears, and in the
National Amazon Centre for Research and Control of Tropical Diseases the complete
blood smear was read before being declared negative
Commercial name of the test: OptiMAL-IT (Diamed AG, Cressier sur Morat, Switzerland)
Transport and storage conditions: Samples were transported by messengers using boat,
aeroplane, motorbike, bicycle and foot transportation, sometimes taking up to 4 weeks.
Due to lack of refrigerators or due to electrical power cuts, or both, samples were often
exposed to local ambient conditions (study average temperature of 26.9C, with frequent
peaks up to 40C)
Who performed the index test, and where? Microscopists at health posts and expert
microscopists at the Amazon Centre for Research and Control of Tropical Diseases in
Puerto Ayacucho
Follow-up
Not applicable
108
Metzger 2011
(Continued)
Notes
Source of funding: UNICEF

Item
Authors judgement
Description
All tests
Unclear
No details of the characteristics of the participants were reported

All tests
Yes
3 microscopists read the slides at either 200

fields or the complete smear before declaring a test as negative

All tests
Yes
550 RDTs (OptiMAL-IT) ans concomitant slides originating from the HPs of
Atures municipality were received in the order of their arrival at the RCL in Puerto
Ayacucho

All tests
Yes
All tests
Yes

reference standard.

All tests
Yes
Reported blinding.

All tests
Yes
Reported blinding.

All tests
Unclear
Number enrolled in the study was explicitly stated and corresponded to the number presented in the analysis; therefore no
withdrawals due to invalid results
All tests
Yes
36 tests had to be excluded because coding

was lost during transport and/or because
they could not be clearly allocated
109
Moges 2012
Presenting signs and symptoms: Suspected malaria: fever, headache, fatigue, sweating/
chills/rigors, vomiting, splenomegaly, myalgia and arthralgia, anaemia, hypoglycaemia
Previous treatments for malaria: Patients who had received anti-malarial drugs during
the past 4 weeks were excluded
Clinical setting: Medical and paediatric out-patient departments of a health centre
Country: Ethiopia
Malaria endemic species: P. vivax and P. falciparum
Participants
Sample size: 254

Age: Mean 21.4 (SD14.76), range 0.4 to 75 years
Sex: 61% male, 39% female
Co-morbidities or pregnancy: Co-morbities are not reported. However, critically ill
patients who were unable to give blood were excluded from the study
Study design
Who performed the reference standard tests, and where? The tests were performed by
an experienced laboratory technician at the health centre and an experienced microscopist
at a university hospital laboratory
If microscopy was used, how many high power fields were looked at? 200 fields
How many observers or repeats were used? 2 observers
How were discrepancies between observers resolved? A third of discordant results, a
third expert reader was used. This third readers results were considered final
Commercial name of the test: CareStart Malaria HRP2/pLDH COMBO (Access

Bio Inc., USA)
Parasite species the test is designed to detect: P. falciparum or mixed infection, nonfalciparum species only
Who performed the index test, and where? The index test was performed at the health
centre. Information on the person who performed the test is not reported
Follow-up
Not applicable
Notes
Source of funding: Source of funding not reported. RDT kits were supplied by the
North Gondar Zonal Health Bureau

Item
Authors judgement
Description
All tests
Yes
Subjects with suspected malaria symptoms

were recruited (all symptoms reported)
110
Moges 2012
(Continued)

All tests
Yes
Microscopy evaluations were performed by

2 independent observers (200 fields). Discordant results were referred to a third observer

All tests
Yes
All participants receiving the index test had

their diagnosis verified my microscopy

All tests
Yes
Microscopy was used as reference test for

all samples.
All tests
Yes
The reference standard for all samples was

microscopy.

All tests
Yes
The microscopists were blinded to the

RDT results.

All tests
Unclear
The same finger-prick blood sample used

for microscopy was used to perform the index in parallel

All tests
Unclear

to the number presented in the analysis;
therefore there were no exclusions due to
uninterpretable test results
All tests
Yes

to the number included in the analysis;
Mohon 2012

Clinical setting: Upazila Health Complexes
Country: Bangladesh
Malaria endemicity: Hypo-endemicity
Malaria endemic species: 95% P. falciparum
Participants
Sample size: 372

Age: Median 19.4, range 1.5 to 82 years
Sex: 52.8 male, 47.2% female
Co-morbidities or pregnancy:
Co-morbidities and pregnancy not reported.
111
Mohon 2012
(Continued)
Study design
Target condition and reference standard(s) Type(s) of malaria parasite tested for: P. falciparum, P. vivax
Reference standard test(s) used: Microscopy thick and thin smears, nested PCR.
Who performed the reference standard tests, and where? Microscopy was performed
by experienced microscopists on site and the icddr,b laboratory
If microscopy was used, how many high power fields were looked at? Microscopy was
performed following the standard procedure. Details, not reported(reference provided)
Commercial name of the test: OnSite (Pf /Pan) (CTK Biotech Inc, USA)
Parasite species the test is designed to detect: P. falciparum, non-falciparum, P. vivax
Who performed the index test, and where? The index test was performed at the icddr,
b Parasitology Laboratory
Follow-up
Not applicable
Notes
Source of funding: International Centre for Diarrheal Research Bangladesh (icddr,b)

Item
Authors judgement
Description
All tests
Unclear
Febrile patients were recruited. However,

patients with mixed infections and those
with discordant microscopy/PCR results
were excluded and the numbers excluded
for these reasons are not stated

All tests
Yes
Microscopy was verified with PCR.

All tests
Yes
All participants that received the index test

had their diagnosis verified by reference test

All tests
Yes
PCR adjusted microscopy was used as the

reference test.
All tests
Yes
PCR adjusted microscopy was used as the

reference test.

All tests
Unclear
Blinding not reported.
112
Mohon 2012
(Continued)

All tests
Unclear
Blinding not reported.

All tests
No
therefore it is unclear whether there were
any exclusions due to uninterpretable test
results
All tests
Unclear
any withdrawals
Pattanasin 2003
Presenting signs and symptoms: Fever or history of fever and suspected diagnosis of
uncomplicated malaria
Previous treatment for malaria: No mention of previous treatment for malaria, either
as an exclusion criteria or a characteristic of included participants
Clinical setting: Not stated
Country: Thailand (Mae Sod)
Malaria endemicity: Not stated, peak transmission season
Participants
Sample size: 271

Age: Children aged under 2 years were excluded. The study included participants aged
2 to 81 years; 71% were aged under 15 years
Sex: Male: female ratio was 1.7:1
Co-morbidities and pregnancy: Pregnant women were excluded
Study design
evaluated, the vast majority of participants received both RDTs

Reference standard: Microscopy thick and thin blood film
Person(s) performing microscopy: Not stated
Number of high power fields examined before declaring negative: Not stated
Number of observer or repeats: Not stated
Resolution of discrepancies between observers: Not applicable

Paracheck-Pf (Orchid Biomedical Systems, Goa, India)
OptiMAL-IT (DiaMed, AG, Cressier, Switzerland)
Paracheck-Pf - P. falciparum
113
Pattanasin 2003
(Continued)
OptiMAL-IT - P. falciparum or mixed infection, non-falciparum species only

Designated type:
Paracheck-Pf - Type 1
OptiMAL-IT - Type 4
Transport and storage conditions: Kept at room temperature and opened just before
performing the test to avoid humidity
Follow-up
Not applicable
Notes

Item
Authors judgement
Description
All tests
Unclear
All participants had a fever and suspected

malaria, but the exact clinical setting and
the sampling method were not described

All tests
Unclear
No details of the microscopy process were

given.

All tests
Yes


All tests
Yes

All tests
Yes

reference standard.

All tests
Unclear

All tests
Yes
Test results were recorded without reference

to the microscopy results

All tests
Yes
Doubtful and invalid results were reported

(5 of 271).
All tests
Unclear
Almost all participants were reported to receive the same index and reference tests
(271 participants in total, 266 received
OptMAL, 269 received Paracheck-Pf ); the
numbers presented in the analysis correspond
114
Rakotonirina 2008
Presenting signs and symptoms: Fever over 37.5C or history of fever in the previous
24 hours
Previous treatment for malaria: Participants with recent antimalarial use were not
excluded from the study; 34% of participants declared antimalarial use
Clinical setting: 2 primary health centres
Country: Madagascar (Tsiroanomandidy on the west foothill areas of the Highlands)
Malaria endemicity: Low and predominantly seasonal
Malaria endemic species: P. falciparum (80%) andP. vivax
Participants
Sample size: 313

Age: All age groups were eligible for inclusion; the actual age range of the included
participants was 6 months to 79 years (median age 10 years)
Co-morbidities and pregnancy: Pregnant women were excluded, as were people with
signs of severe or complicated malaria
mean 4104, SD 7894
Study design
Enrolment was consecutive and prospective. 2 RDTs were evaluated, all participants
received both RDTs

Reference standard: PCR

PALUTOP
PALUTOP - P. falciparum, P. vivax and other malaria types
Designated type:
OptiMAL-IT - Type 4
PALUTOP - Type 6
Batch numbers:
OptiMAL-IT - 46110.85.01
PALUTOP - 91014
Transport and storage conditions: Transported and maintained at the study sites (primary health centres) at room temperature and opened just before use to avoid humidity
damage
Person(s) performing RDT: Trained technician
RDT setting: Primary health centres
Follow-up
Not applicable
Notes
Source of funding: Global Fund Project for Madagascar, Round 3
115
Rakotonirina 2008
(Continued)
Item
Authors judgement
Description
All tests
Yes

patients attending primary health centres
with fever or history of fever in the previous
24 hours

All tests
Yes
Reference standard was PCR.

All tests
Yes


All tests
Yes

All tests
Yes

reference standard.

All tests
Yes
Stated that the PCR operator was blind to

the results of the other tests performed

All tests
Yes
Stated that the test readers were blind to

the results of the other tests performed

All tests
Yes
There were no test failures with either RDT.
All tests
Yes

study is clearly stated and corresponds to
the number presented in the analysis
Ratsimbasoa 2007
Presenting signs and symptoms: Fever over 37.5C or history of fever in the previous
24 hours, with typical malaria symptoms. Patients with signs of severe or complicated
malaria were excluded
excluded from the study; 17% of participants reported antimalarial use
Clinical setting: Primary health centres
Country: Madagascar. Rural areas of Mahasolo (western foothills areas of the highlands)
and Saharevo (eastern foothills areas of the highlands)
Malaria endemicity: Low and predominantly seasonal in both areas
Malaria endemic species: Predominantly P. falciparum; someP. vivax
Participants
Sample size: 194

Age: All groups eligible for inclusion not stated; actual age range of the included participants was 1 to 79 years (mean age 15.2 years). 12.9% were under 5 years of age
116
Ratsimbasoa 2007
(Continued)

mean 6564, SD 26,553
Study design
evaluated, all participants received both RDTs

Person(s) performing microscopy: An experienced technician
Number of high power fields examined before declaring negative: 200
Number of observer or repeats: 1
Resolution of discrepancies between observers: Not applicable

CareStart Malaria Pf/Pan (Access Bio Inc., Monmouth Junction, NJ)
SD Malaria Antigen Bioline Pf/Pan (Standard Diagnostics, Suwon City, South
Korea)
Parasite(s) designed to detect: P. falciparum or mixed infection, non-falciparum species
only
Batch numbers:
CareStart Malaria - J25IL, J35IL, J45IL, J55IL
SD Malaria Antigen Bioline - T5001, T5002, T5003, T5004
OptiMAL-IT - 46110.73.01, 46110.74.01, 46110.75.01
Transport and storage conditions: Transported and maintained at the study sites (primary health centres) at room temperature and opened just before use to avoid humidity
damage
Person(s) performing RDT: A technician
Follow-up
Not applicable
Notes
Source of funding: Global Fund Project for Madagascar, Round 3. The manufacturers
supplied the test kits

Item
Authors judgement
Description
All tests
Unclear
All participants were attending primary

health centres with fever and symptoms of
malaria, but the sampling method was not
described
117
Ratsimbasoa 2007
(Continued)

All tests
No
An expert technician viewed 200 high

power fields before declaring a slide negative; however their findings were not verified by a second independent reader

All tests
Yes


All tests
Yes

All tests
Yes

reference standard.

All tests
Yes
Analyzed without reference to the RDT

results.

All tests
Yes
The RDTs were undertaken before the microscopy.

All tests
Unclear

number included in the analysis
All tests
Yes

number included in the analysis
Ratsimbasoa 2008
Presenting signs and symptoms: Fever or fever in the previous 24 hours with typical
malaria symptoms
excluded from the study; 13% of participants declared antimalarial use
Clinical setting: Primary Health Centre
Country: Madagascar (Ampasimpotsy, Central Highlands)
Malaria endemicity: Transmission is low and predominantly seasonal. This study was
carried out in the low season
Malaria endemic species: P. falciparum (approximately 75%) andP. vivax
Participants
Sample size: 200

Age: Eligible age range not stated; actual age range of the included participants was 6
months to 73 years (40% under 5 years, 26.5% 5 to 15 years)
mean 16,757, SD 42,631
118
Ratsimbasoa 2008
(Continued)
Study design
evaluated, all participants received both RDTs

Reference standard: PCR

SD Bioline Malaria Ag Pf (Standard Diagnostics Inc., Suwon City, South Korea)
SD Bioline Malaria Ag Pf/Pan (Standard Diagnostics Inc., Suwon City, South
Korea)
SD Bioline Malaria Ag Pf - P. falciparum
SD Bioline Malaria Ag Pf/Pan - P. falciparum or mixed infection, non-falciparum
species only
Designated type:
SD Bioline Malaria Ag Pf - Type 1
SD Bioline Malaria Ag Pf/Pan - Type 3
Batch numbers:
SD Bioline Malaria Ag Pf - 05FK50
SD Bioline Malaria Ag Pf/Pan - 05FK60
Transport and storage conditions: All tests were kept at room temperature and opened
just before use to avoid humidity damage
Follow-up
Not applicable
Notes
Source of funding: Kozone, representing Standard Diagnostics Inc in Madagascar

Item
Authors judgement
Description
All tests
Unclear
Participants were all attending a health centre with fever and typical symptoms of
malaria, but the sampling method was not
described

All tests
Yes
The reference standard was PCR.

All tests
Yes


All tests
Yes

All tests
Yes

reference standard.
119
Ratsimbasoa 2008
(Continued)

All tests
Yes
PCR was carried out by technicians blind

to the results of RDT testing

All tests
Yes
RDTs were undertaken before the results

of PCR were known

All tests
Yes
Uninterpretable results are reported and excluded from the analysis. There were 2 invalid results for Bioline Pf and 1 for Bioline
Pf/Pan
All tests
No
There was 1 participant missing from the

analysis from Bioline Pf/Pan, with no explanation
Samane 2010
Presenting signs and symptoms: Suspected malaria with symptoms including fever or
chills of several days, or both
Previous treatments for malaria: Not mentioned, either as an exclusion criteria or
Clinical setting: Health centres
Country: Iran
Participants
Sample size: 250

Age: Not mentioned either as an inclusion criteria or a characteristic of participants
Study design
Target condition and reference standard(s) Type(s) of malaria parasite tested for: P. falciparum andP. vivax
Reference standard test(s) used: Microscopy
performed the test, it is not stated where this was done
Commercial name of the test: BIOTEC Malaria Pv/Pf Rapid Device

Parasite species the test is designed to detect: P. falciparum andP. vivax
Designated type: Other type. HRP-2 for P. falciparum and pLDH for P. vivax.
120
Samane 2010
(Continued)
Who performed the index test, and where? Not reported

Follow-up
Not applicable
Notes

Item
Authors judgement
Description
All tests
Unclear
Characteristics of participants not adequately described, although all had symptoms of malaria

All tests
Unclear
2 independent microscopists viewed the

slides, but the number of fields viewed was
not reported

All tests
Yes


All tests
Yes
All tests
Yes

reference test.

All tests
Yes

All tests
Yes

All tests
No
Number enrolled in the study was explicitly stated but did not correspond to the
number presented in the analysis - 250 patients were enrolled but 276 were included
in the analysis
All tests
Unclear
Number enrolled in the study was explicitly stated but did not correspond to the
number presented in the analysis - 250 patients were enrolled but 276 were included
in the analysis
121
Selimuzzaman 2010
Presenting signs and symptoms: Fever with oral temperature 100 F or more or with
convincing history of fever
Previous treatments for malaria: Patients taking anti-malarial drugs for current illness
or providing history of anti-malarial therapy within previous four weeks or taking antimalarial prophylaxis were excluded from the study
Clinical setting: Sick bay of 37 Rifle Battalion Headquarters
Country: Bangladesh
Malaria endemicity: Malaria endemic zone
Participants
Sample size: 271

Age: Ranged from 18 years to 57 years
Sex: Male
Study design
Were participants consecutively enrolled in the study?: Yes

Were they enrolled prospectively?: Yes
If the study evaluated more than one RDT, how were tests allocated to individuals,
or did each individual receive all the tests?
1 RDT was evaluated
Reference standard test(s) used: Microscopy thick and thin blood films
at Armed Forces Medical College in Dhaka examined the slides
How were discrepancies between observers resolved? Only 1 microscopist read each
slide
Commercial name of the test: MALARIGEN MALARIA Pf/Pv Antigen Rapid Test
(Biotest Diagnostic Corp., Denville, NJ, USA)
Parasite species the test is designed to detect: P. falciparum, P. vivax malaria
Designated type: Unclear, HRP-2 antigen of P. falciparum and unspecified monoclonal
antibodies for detection of non-falciparum malarial parasites
Who performed the index test, and where? Experienced microscopists at Armed Forces
Medical College in Dhaka examined the RDT kits
Follow-up
Not applicable
Notes

Item
Authors judgement
Description
122
Selimuzzaman 2010
(Continued)
All tests
Yes
Participants were a consecutive series of patients with clinical signs and symptoms of
malaria

All tests
No
One microscopist read each slide.

All tests
Yes


All tests
Yes

All tests
Yes

reference standards

All tests
Unclear
Described as a single blinded study, but no

further details reported

All tests
Unclear
Described as a single blinded study, but no

further details reported

All tests
Yes
Three out of 271 (1.11%) cases did not

demonstrate control band or become positive only after a long time lag and were
excluded from the study. Thin blood films
of 6 patients (2.21%) were marked by the
microscopist as poor quality and were excluded from the study.
All tests
Yes

study is clearly stated and corresponds to
the number presented in the analysis minus
the number reported to have invalid test
results or incomplete data
Sharew 2009
Presenting signs and symptoms: Febrile patients, clinically suspected for malaria
Previous treatment for malaria: No exclusions based on previous treatment. Information on previous treatment collected, but actual data not provided
Clinical setting: Outpatient departments of 2 health centres
Country: Ethiopia (Southern - Wondo Genet)
Malaria endemicity: Takes place throughout the year
Participants
Sample size: 668

Age: All age groups eligible. Actual age range 6 months to 75 years
123
Sharew 2009
(Continued)
Sex: 361 (54%) males, 307 (46%) females

presented
Study design
Enrolment was consecutive and prospective. 2 different RDTs were evaluated, and each
participant received both tests

Who performed the reference standard tests, and where? Experienced malaria technicians. The microscopy setting was not stated, but in the Wondo Genet area
How many observers or repeats were used? 2 independent technicians, also checked
by the team leader
How were discrepancies between observers resolved? All discordant results between
microscopy and RDTs were repeated

CareStart Malaria Pf/Pv Combo test (Access Bio INc, New Jersey, USA)
Parasite(s) designed to detect: P. falciparum
CareStart Malaria Pf/Pv Combo test - P. falciparum, P. vivax or mixed infection
Designated type:
Paracheck Pf - Type 1
CareStart Malaria Pf/Pv Combo test - Type 5
Transport and storage conditions: As per the instructions of the manufacturer
RDT setting: 2 health centres
Follow-up
Not applicable
Notes
Source of funding: School of Graduate Studies of the Addis Adaba University through
the Graduate Programme in Tropical and Infectious Diseases, Aklilu Lemma Institute
of Pathobiology and from the Federal Ministry of Health of Ethiopia. Federal Ministry
of Health of Ethiopia and Access Bio Inc donated the test kits

Item
Authors judgement
Description
All tests
Yes

febrile patients attending health centres
with suspected malaria
124
Sharew 2009
(Continued)

All tests
Yes
2 experienced microscopists independently

viewed 100 high power fields before declaring a slide negative

All tests
Yes


All tests
Yes

All tests
Yes

reference standard.

All tests
Unclear
Not described.

All tests
Yes
Strict blinding with the results available before microscopy reported

All tests
Yes
If a test was un-interpretable then it was

repeated.
All tests
Yes

study was clearly stated and corresponds to
the number included in the analysis; therefore there were no withdrawals
Singh 2000a
Presenting signs and symptoms: Fever suspected to be malaria

Previous treatment for malaria: There were no exclusions based on previous treatment,
and no information presented; this was an outbreak in a rural area
Clinical setting: Mobile field laboratory
Country: India (forest villages in Chhindwara, central India)
Malaria endemicity: Outbreak situation
Participants
Sample size: 344

Age: All age groups eligible. Actual age range 6 months to 65 years
presented
Study design
125
Singh 2000a
(Continued)

Reference standard: Microscopy thick blood film
Who performed the reference standard tests, and where? Experienced microscopist for
all slides; expert microscopist for re-examined slides. Setting was a mobile field laboratory
for all slides; Malaria Research Centre at Jabalur for re-examined slides
If microscopy was used, how many high power fields were looked at? Not stated.
However, 200 white blood cells were counted as an alternative indicator; or 500 WBCs
for slides that were re-examined
How many observers or repeats were used? 1, but negative blood smears were reexamined if the patient was having severe symptoms, the corresponding RDT result was
positive or if P. vivax was diagnosed
How were discrepancies between observers resolved? Not described, most likely accepted the findings of second microscopist
Commerical name of RDT: ICT Malaria Pf/Pv (AMRAD, Australia)

only
Person(s) performing RDT: Field laboratory assistants
RDT setting: Mobile field laboratory
Follow-up
Not applicable
Notes
Source of funding: Becton Dickinson provided financial support and supplied the RDTs
free of charge

Item
Authors judgement
Description
All tests
Yes
All participants were attending an ambulatory setting with fever suspected to be

malaria, and enrolment was consecutive

All tests
No
Microscopy was undertaken by 1 microscopist only; and the number of high power
fields viewed was unclear (200 white blood
cells)

All tests
Yes


All tests
Yes

126
Singh 2000a
(Continued)
All tests
Yes

reference standard.

All tests
Yes
Blood films were examined...without reference to the results of ICT

All tests
Yes
All specimens were tested...who were

blinded to the results of the blood smear
tests

All tests
Unclear
The numbers of participants originally enrolled in the study was clearly stated and
the numbers presented in the analysis correspond; therefore there were no exclusions
due to uninterpretable test results
All tests
Yes
the numbers presented in the analysis correspond; therefore there were no withdrawals
Singh 2003

Previous treatment for malaria: No explicit exclusions based on previous treatment,
and no data reported
Clinical setting: Hospital malaria clinic
Country: India, Jabalpur
Malaria endemic species: P. falciparum and P. vivax in roughly equal proportions
Participants
Sample size: 80
Age: All age groups eligible. Adults and children included; mean age 27.7 (SD 16.42)
for males and 29 (SD 12.8) for females
Sex: Both males and females eligible; included 28 males and 18 females
Co-morbidities and pregnancy: No explicit exclusion criteria based on co-morbidities
or pregnancy. No details of the frequency of these conditions in the participant population
is presented
Parasite density of microscopy positive cases: Range 40 to 370,574 parasites per L
for P. falciparum and 318 to 9970 for P. vivax
Study design
Enrolment was prospective. The sampling method was not described. Only 1 RDT was
evaluated

Reference standard: Microscopy thick blood films
Who performed the reference standard tests, and where? Not stated. Setting was a
hospital laboratory
127
Singh 2003
(Continued)
How many observers or repeats were used? If the results of the OptiMAL conflicted
with that of microscopy for any sample, the blood smear was re-examined by a different
technician
How were discrepancies between observers resolved? If the re-examination of discordant results gave a different result to the first examination, the second results was
confirmed by yet another technician
Commerical name of RDT: OptiMAL

only
Person(s) performing RDT: A technician
RDT setting: Hospital clinic or laboratory
Follow-up
Not applicable
Notes

Item
Authors judgement
Description
All tests
Unclear
Participants were all attending a clinic with

fever or history of fever, but the sampling

All tests
Unclear
Discordant results between RDT and microscopy were re-examined; however the
number of high power fields viewed before
declaring a sample negative was not stated

All tests
Yes


All tests
Yes

All tests
Yes

reference standard.

All tests
Unclear

All tests
Yes
Technican were blinded to the results of the

blood smear examination
128
Singh 2003
(Continued)

All tests
Unclear
the numbers presented in the analysis correspond; therefore there were no exclusions
due to uninterpretable test results
All tests
Yes
the numbers presented in the analysis correspond; therefore there were no withdrawals
Singh 2010
Presenting signs and symptoms: Clinical suspicion of malaria

Previous treatments for malaria: Patients were excluded due to recent anti-malarial
intake
Clinical setting: Field clinic
Country: India
Malaria endemicity:
Participants
Sample size: 409

Age: All ages were included. Mean age was 15 (SD 14).
Sex: Both sexes were included, ratio was not reported.
Co-morbidities or pregnancy: Pregnant women were excluded from participating. Comorbidities not mentioned either as an inclusion criteria or a characteristic of participants
Study design
Enrolment was prospective and consecutive. 5 RDTs were evaluated; each participant
received all the tests
Reference standard test(s) used: Microscopy and PCR
Who performed the reference standard tests, and where? Microscopy was conducted
by an experienced microscopist in the laboratory. PCR was also performed in the laboratory, by an independent research assistant
How were discrepancies between observers resolved? All negative slides that test
positive on the RDT/PCR or all positive slides that test negative on the RDT/PCR were
re-examined by another expert technician blinded to the results of microscopy, RDT/
PCR and clinical status of the patients.

Parascreen Device (rapid test for malaria Pan/Pf ) (Zephyer Biomedicals Goa)
Falcivax Device (rapid test for malaria Pv/Pf ) (Zephyer Biomedicals Goa)
Malascan Device (rapid test for malaria Pf/Pan) (Zephyer Biomedicals Goa),
ParaHIT Total (rapid test for Pf & Pan Malaria species) (SPAN Diagnostics Ltd,
Surat)
129
Singh 2010
(Continued)
First Response Malaria Antigen Combo Card test (pLDH/HRP2) (Premier

medical corporation Mumbai)
Parascreen - malaria Pan/Pf
Falcivax - malaria Pv/Pf
Malascan - malaria Pf/Pan
ParaHIT Total - Pf & Pan Malaria species
First Response Malaria Antigen Combo Card test - pLDH/HRP2
Designated type:
Parascreen - Type 3
Falcivax - Type 5
Malascan - Type 2
ParaHIT Total - Type 2
First Response Malaria Antigen Combo Card test - Type 3
Transport and storage conditions: RDTs were stored at 25C on receipt in the study
sites, then allocated to separate groups for storage at 35C & 45C for 90 days, at 60C
for 48 hours, and at -10C for 60 minutes before testing. At the start of the study, the
incubators were stabilized at the required temperature for three days before the RDTs to
be tested were placed inside. RDTs were removed from storage to reach room temperature
for 2 hours before testing and comparisons were made with control RDTs kept at 25C
until use and with microscopy.
Who performed the index test, and where? 2 research assistants tested in the RCTs in
field in 10 villages of Satanwada Primary Health Centre
Follow-up
Not applicable
Notes
Source of funding: WHO Country Office, New Delhi, India

Item
Authors judgement
Description
All tests
Yes
Participants were a consecutive series of patients attending clinics with clinical signs
and symptoms of malaria

All tests
No
Only 1 microscopist used, except in cases

of discordant results between microscopy
and RDT

All tests
Yes


All tests
Yes
All tests
Yes

reference standards
130
Singh 2010
(Continued)

All tests
Yes

All tests
Yes

All tests
Unclear
Number enrolled in the study was explicitly stated and corresponded to the number presented in the analysis; therefore no
withdrawals due to invalid results
All tests
Yes
37 patients (9%) were excluded as not fulfilling the study enrolment criteria due to
recent anti-malarial intake
Tjitra 1999
Presenting signs and symptoms: Symptomatic with a presumptive clinical diagnosis of

malaria: fever or history of fever in the last 24 hours and no other obvious cause of fever
Previous treatment for malaria: Prior use of antimalarials was not an exclusion criteria.
Approximately half of the participants reported use of antimalarials within the previous
4 weeks
Clinical setting: Primary health centre
Country: Indonesia (Laratama sub district, West Sumba, East Nusa Tenggara Province,
Eastern Indonesia)
Malaria endemicity: Infection rate in children 0 to 9 years of 5.1%
Participants
Sample size: 560

Age: All ages eligible. Actual age range of the participants 0 to 80 years
Sex: Males and females eligible; 289 males and 271 females included
Co-morbidities: Not mentioned either as an exclusion criteria or a characteristic of the
included participants
Parasite density of microscopy positive cases: P. vivax mean 7157 parasites per L
Study design

Who performed the reference standard tests, and where? Expert microscopists with
over 20 years experience each. The setting was
one local (exact setting not stated); cross-checking was done in Darwin, Australia
If microscopy was used, how many high power fields were looked at? at least 100
for all slides, at least 200 for those cross-checked
How many observers or repeats were used? 1 observer for the majority of slides;
discordant results between microscopy and RDT and 20% of slides with concordant
results were cross-checked by a 2nd microscopist, blind to the results of 1st microscopy
and RDT
131
Tjitra 1999
(Continued)
How were discrepancies between observers resolved? Not described

Commerical name of RDT: ICT Malaria Pf/Pv

only
Batch numbers: 100088 for the first 393 tests, and 041388 for the remaining 167 tests
Person(s) performing RDT: Performed by trained health workers and read by a study
physician blinded to the microscopy results
RDT setting: Primary health centre
Follow-up
Not applicable
Notes
Source of funding: Financial assistance received from the Northern Territory Government 50th Anniversary of Indonesian Independence Malaria-Tuberculosis Research Fellowships. ICT Pf/Pv kits and some logistical costs were supported by AMRAD-ICT
Sydney, New South Wales, Australia

Item
Authors judgement
Description
All tests
Unclear
Participants were all attending a primary

health care centre with fever and symptoms
of malaria, but the sampling method was
not described

All tests
Yes
All slides were read by an experienced microscopist viewing at least 100 high power
fields, and results discordant with RDT
were re-examined by another, independent
microscopist

All tests
Yes


All tests
Yes

All tests
Yes

reference standard.

All tests
Yes
The microscopist was unaware of the immunochromatographic test result

All tests
Yes
The results were read by a study physician

who was blinded to the microscopy results
132
Tjitra 1999
(Continued)

All tests
Unclear

study was clearly stated and correspond to
the number presented in the analysis; therefore there were no exclusions due to uninterpretable test results
All tests
Yes

to the number included in the analysis;
Trouvay 2013
Presenting signs and symptoms: Febrile patients who consulted for suspected malaria
Previous treatment for malaria: Not reported on, but there were no exclusion criteria
based on antimalarial use
Clinical setting: Not clear
Country: French Guiana
Malaria endemicity: At a low number of focal points on the coast, associated with gold
mining
Malaria endemic species: 31% P. falciparum and 68.5% P. vivax. P. malariae cases are
occasional.
Participants
Sample size: 960

Age: All ages eligible. Actual age range of the participants 1 to 92 years (median age 25.
8 years)
Sex: Males and females eligible; ratio of male to female was 1.2:1
Co-morbidities: Not mentioned either as an exclusion criteria or a characteristic of the
Parasite density of microscopy positive cases: P. vivax mean 0.11%
Study design
Enrolment was prospective, with all eligible participants were included. 1 RDT was
tested

Who performed the reference standard tests, and where? An expert microscopist at
Cayenne Hospital laboratory
If microscopy was used, how many high power fields were looked at? 200 fields in
the thin film
How many observers or repeats were used? 1 observer.
How were discrepancies between observers resolved? Not applicable. However, PCR
was conducted on samples where microscopy and RDT gave different results
Commerical name of RDT: SD malaria Ag Pf/Pan

only
133
Trouvay 2013
(Continued)
Batch numbers: not stated

Transport and storage conditions: Tests were guaranteed to have been stored at the
correct temperature (24 to 28C) and were used within their recommended shelf life
Person(s) performing RDT: Technician
RDT setting: Cayenne Hospital
Follow-up
Not applicable
Notes
Source of funding: French Ministry of Health

Item
Authors judgement
Description
All tests
Yes
All febrile patients who consulted with suspected malaria during a prospective study
were initially included. P. malariae cases
were subsequently excluded, however, only
3 of 960 enrolled participants were excluded for this reason

All tests
No
Only 1 microscopist was used. In case of

discordant results between RDT and microscopy, PCR was used to determine infections and species. However, the PCR results were not used to adjust the microscopy
results

All tests
Yes


All tests
Yes

All tests
Yes

reference standard.

All tests
Yes
The microscopic examination was carried

out simultaneously.

All tests
Yes
Interpretation of the test was carried out independently of the microscopic examination

All tests
Yes
No invalid RDTs were observed.
All tests
Yes
There were 3 exclusions post-enrolment,

due to P. malariae infection.
134
Valecha 2003

Previous treatment for malaria: Not mentioned, either as an exclusion criteria or a
Clinical setting: Malaria clinics and village health workers
Country: India (Delhi, Nadiad, Jabalpur and Sonapur)
Malaria endemicity: 4 sites of different endemicities
Participants
Sample size: 699

Age: All ages eligible; age range of included participants 1 to 75 years (mean 22.8)
Sex: Included 395 males and 304 females
Co-morbidities: Not mentioned, either as an exclusion criteria or a characteristic of
Parasite density of microscopy positive cases: P. vivax range 40 to 44,000 parasites/
L, median 1020, P. falciparum range 120 to 68,480 parasites/L, median 2000
Study design

Reference standard: Microscopy
Who performed the reference standard tests, and where? Microscopist. Setting was
not stated
How many observers or repeats were used? 1 for most slides. All results discordant
with RDT results and 20% of concordant results were cross-checked. Negative slides
which tested positive by kit were re-examined by counting up to 2000 WBCs
How were discrepancies between observers resolved? In the case of initially negative
slides looked at in more detail because of discordant results, the second reading was taken
as true

only
Batch numbers: 46050.24.05
Transport and storage conditions: Stored below 30C
RDT setting: At the study sites (clinic and villages)
Follow-up
Not applicable
Notes

Item
Authors judgement
Description
135
Valecha 2003
(Continued)
All tests
Unclear
All participants were all attending clinics

or approaching village health workers with
fever or history of fever, but the sampling

All tests
Unclear
Microscopists viewed 100 high power fields

before declaring a slide negative, and results
discordant with RDTs were cross-checked.
However, it is not clear whether the person doing the cross-checking was a different microscopist working independently

All tests
Yes


All tests
Yes

All tests
Yes

reference standard.

All tests
Yes
Microscopists were blinded to the rapid

test results.

All tests
Yes
The RDT was done before the microscopy.

All tests
No
any exclusions due to uninterpretable test
results
All tests
Unclear
any withdrawals
136
van den Broek 2006

Presenting signs and symptoms: New episode of suspected malaria, which could include
fever, history or other complaints indicating possible malaria infection
Previous treatment for malaria: Excluded if malaria confirmed (treated or untreated)
within the previous 4 weeks
Clinical setting: Malaria outpatient centre
Country: Colombia
Malaria endemicity: Hypoendemic, annual parasite rate 2 to 5%
Malaria endemic species: P. vivax (54%) P. falciparum (46%)
Participants
Sample size: 896

Age: All ages eligible. Actual numbers of children and adults not stated, although the
report mentions that many workers were included,
Sex: Both males and females eligible. Most of the participants were male (646, 79%)
Co-morbidities and pregnancy: No exclusions criteria based on co-morbidities. No
details of the frequency of these conditions in the participant population is presented
Parasite density of microscopy positive cases: Geometric mean approximately 2300
parasites per L for both P. falciparum and P. vivax
Study design
tested. All individuals received all 3 tests

Person(s) performing microscopy: Well trained, experienced microscopists
Number of high power fields examined before declaring negative: At least 200
Number of observer or repeats: 1, except for about one third of the slides (especially low
density parasitaemias and mixed infections). In this case, another microscopist viewed
the slide and discordant results between microscopists or between slides and RDTs were
sent to the University of Antioquia for external cross-checking
Resolution of discrepancies between observers: Disagreements between the internal
and external results were sent to a third laboratory, of the National Health Institute in
Bogota. In cases where both external laboratories disagreed with the internal laboratory,
results were corrected accordingly

OptiMAL-IT (Diamed AG, Switzerland)
NOW Malaria ICT (Binax, Portland, USA)
NOW Malaria ICT - P. falciparum or mixed infection, non-falciparum species
only
Designated type:
Paracheck Pf - Type 1
Parascreen - Type 3
OptiMAL - Type 4
137
van den Broek 2006
(Continued)

Person(s) performing RDT: A bacteriologist. Where the result was ambiguous, 2 bacteriologists read the test results
RDT setting: At the malaria centre
Follow-up
Not applicable
Notes
Source of funding: Medicins Sans Frontires, Holland, and its donors. The American
Society of Tropical Medicine and Hygiene assisted with publication expenses

Item
Authors judgement
Description
All tests
Unclear
All participants were patients presenting

with suspected malaria, but the sampling

All tests
No
Microscopists viewed at least 200 high

power fields before declaring a slide negative; however the findings were only verified by a second independent reader for a
third of slides

All tests
Yes


All tests
Yes

All tests
Yes

reference standard.

All tests
Yes
Report states that microscopists were

blinded to the results of RDTs

All tests
Yes
Report states that RDTs were blinded to

the results of microscopy

All tests
Yes
There were no uninterpretable results; and

weak lines were scored as positive
All tests
Unclear
therefore it was not possible to assess
whether there were any withdrawals
138
Wongsrichanalai 2003
Presenting signs and symptoms: Oral temperature over 38C, headache or a history of
fever in the previous 72 hours
Previous treatment for malaria: No exclusions based on previous episodes or treatment
for malaria; no data presented on recent antimalarial use in the children
Clinical setting: Malaria clinics
Country: Thailand (Maesod)
Malaria endemic species: P. falciparum andP. vivax.
Participants
Sample size: 246

Age: Inclusion criteria stipulated over 20 years old
Sex: Both males and females were eligible
Co-morbidities and pregnancy: Not mentioned, either as an exclusion criteria or characteristic of the included participants
Study design

at the
Armed Forces Research Institute of Medical Sciences
How many observers or repeats were used? 2 independent observers, blinded to each
others findings
How were discrepancies between observers resolved? Resolved by a third expert microscopist, whose reading was accepted as final. Where there was species discrepancy
between microscopy and NOW ICT, PCR was done
Commerical name of RDT: NOW ICT Malaria Pf/Pv

only
Batch numbers: 030611
Person(s) performing RDT: Technician
RDT setting: Armed Forces Research Institute of Medical Sciences
Follow-up
Not applicable
Notes
Source of funding: US Army Medical Material Development Activity

Item
Authors judgement
Description
139
(Continued)
All tests
Unclear
All participants were attending malaria

clinics with temperature over 38C,
headache or a history of fever in the previous 72 hours, but the sampling method
was not adequately described

All tests
Yes
2 independent microscopists at a research

laboratory viewed at least 200 high power
fields before declaring a slide negative

All tests
Yes


All tests
Yes

All tests
Yes

reference standard.

All tests
Yes
read by two microscopists blinded to...the

NOW ICT results

All tests
Yes
The RDT was carried out before microscopy.

All tests
Yes
The RDTs had to be repeated in 39 of 285

assays. A successful test was eventually completed for each sample
All tests
Yes

with the number included in the analysis,
indicating no withdrawals
Xiaodong 2013
Presenting signs and symptoms: Suspected malaria

Previous treatments for malaria: Not reported.
Clinical setting: TengChong CDC, China and Health Unlimited clinic in Myanmar
(China-Myanmar border)
Country: China, Myanmar
Malaria endemicity: Endemic
Malaria endemic species: P. falciparum,P. vivax
Participants
Sample size: 241

Age: Mean 29.62 (11.21), range 3 to 58 years
Sex: 78.01% male, 21.99% female
140
Xiaodong 2013
(Continued)
Study design
Reference standard test(s) used: Microscopy (thick and thin blood smears) corrected
by PCR assays
Who performed the reference standard tests, and where? The microscopic evaluation
was done by experienced microscopists. Place not reported. Not reported for PCR
How many observers or repeats were used? 2 independent microscopists. Also, a
double-blind cross reading of a random 50 blood slides was performed by a senior
microscopist
How were discrepancies between observers resolved?
In the case of discordant results between microscopy and PCR, the results of PCR were
used as the standard method
Commercial name of the test: CareStart malaria HRP2/pLDH (Pf/pan) combo test
Parasite species the test is designed to detect: Multi species
Batch numbers: C201R
Transport and storage conditions: Not reported.
Who performed the index test, and where? 3 health worker-observers. Place not reported.
Follow-up
Not applicable
Notes
Source of funding: Source of funding not reported. CDC (Chinese Center for Disease
Control and Prevention). It is stated that individual biodata and malaria history in the
previous 1 year were documented from each suspected case. However, co-morbidities
and treatment history have not been reported. Index test was performed by 3 health
worker-observers: the first observer performed readings at 20 minutes (recommended by
the manufacturer) and the other 2 observers, within the next 10 minutes

Item
Authors judgement
Description
All tests
Yes
Consecutive
patients
with
suspected malaria were enrolled. Then all
patients who were positive for malaria by
microscopy and a random sample of negative samples were included in the analysis

All tests
Yes
Microscopy was undertaken by 2 independent experienced microscopists (100

fields) and species identifications was conformed PCR assays
141
Xiaodong 2013
(Continued)

All tests
Yes
All participants receiving the index tests

had their diagnosis verified by reference
standard

All tests
Yes
Microscopy was used as a reference standard for all samples, regardless of index test
All tests
Yes
Microscopy and PCR was used.

All tests
Unclear
Blinding of microscopists not reported.

All tests
Yes
The 3 observers were blinded to each others

readings and to the results of microscopy
and PCR assay

All tests
Unclear
were no withdrawals due to invalid results.
In case the index test result was considered
invalid, the test was repeated
All tests
Yes
were no withdrawals
Yan 2013
Presenting signs and symptoms: Suspected uncomplicated malaria, fever with axillary
temperature above 37.5C at the time of examination
Clinical setting: Local malaria clinics and hospitals at the Laiza township.
Country: Myanmar (China-Myanmar border)
Malaria endemicity: Endemic. Seasonal; mostly in the rainy season from April to
November
Malaria endemic species:
Predominantly P. falciparum and P. vivax
Participants
Sample size: 606

Age: Median 20.3 years, range 6 months to 88 years.
Sex: ~ 50% male 50% female
142
Yan 2013
(Continued)
Study design
Participants prospectively enrolled, not reported whether participants consecutively enrolled. All 606 samples were evaluated microscopically and by One Step Malaria Pf/Pan
test. A subset of 350 were also evaluated by Malaria Pv/Pf test device
Target condition and reference standard(s) Type(s) of malaria parasite tested for: Multiple species; falciparum and non-falciparum.
Reference standard test(s) used: Microscopy thick and thin blood smears and PCR
Who performed the reference standard tests, and where? The reference standard was
performed by experienced microscopists. Location not reported. Not reported for PCR
How many observers or repeats were used? 2 independent microscopists
How were discrepancies between observers resolved? The results were combined

One Step Malaria Pf/Pan test (Wondfo, China)
Malaria Pv/Pf test device (Tycolpharm Co., Limited, UK)
One Step Malaria Pf/Pan test: P. falciparum and all human Plasmodium species
Malaria Pv/Pf test device: P. falciparum and P. vivax
Designated type:
One Step Malaria Pf/Pan test: Type 3
Malaria Pv/Pf test device: HRP-2 antigen for P. falciparum and pLDH antigen for
P. vivax
Who performed the index test and where? Not reported.
Follow-up
Not applicable
Notes
Source of funding: The National Institute of Allergy and Infectious Diseases, National
Institutes of Health (U19 AI089672)

Item
Authors judgement
Description
All tests
Unclear
Patients with suspected malaria, having

fever with axillary temperature above 37.
5C were included in the study. Sampling
method was not reported, only a subsample
received Pf/Pv test and sampling method
for this not described

All tests
Yes
Microscopy was performed by 2 independent microscopists. 100 fields. PCR was

also done

All tests
Yes
All participants receiving the index tests

had their diagnosis verified by the reference
143
Yan 2013
(Continued)
test
All tests
Yes
The same reference test was used.
All tests
Yes
The reference test was microscopy and

PCR.

All tests
Yes
The microscopists were blinded to the results of additional diagnostic tests

All tests
Yes
The readers of RDTs were blinded to the

results of microscopy and PCR

All tests
Unclear
All tests
Yes
were no withdrawals
Characteristics of excluded studies [ordered by study ID]
Study
Reason for exclusion
A-Elgayoum 2009
Not a study of RDTs (compared usual with expert microscopy).
Abeku 2008
No data presented on non-falciparum malaria.
Abul Faiz 2000
Participants had cerebral malaria.
Ademowo 2012
P. falciparum malaria only.
Adesanmi 2011
Afzaal 2001
Review or narrative.
Ahmad 2003
Report does not contain enough information to assess eligibility
Ahmed 2010
Case-control study.
Albertini 2012
Not a DTA study.
144
(Continued)
Allen 2011
Anonymous 2005
Ansah 2008
Ansah 2010
Araz 2000
Some participants did not have symptoms of malaria.
Arcanjo 2007
Non-English language.
Ardic 2012
Arora 2003
Participants have severe or complicated malaria.
Arrspide 2004a
Most participants had no symptoms of malaria.
Arrspide 2004b
Arrspide 2006
Ashley 2009
Not able to extract or calculate absolute numbers of true positives, false positives, false negatives and true
negatives
Aslan 2001
Participants were hospital inpatients.
Assal 1999
Not immunochromatographic RDTs.
Avila 2002
Participants were travellers returning from an endemic to a non-endemic region
Ayeh-Kumi 2011
Azazy 2004
Only participants with malaria positive blood films by microscopy received the RDT
Azikiwe 2012
Babacar 2008
Not a DTA study.
Baiden 2012
Baltzell 2013
Not a DTA study.
Banchongaksorn 1996
Banchongaksorn 1997
145
(Continued)
Barber 2013
Only participants with malaria positive blood films by microscopy were included
Bartoloni 1998
Single case study.
Bassene 2009
Not a DTA study.
Bassett 1991
Not a DTA study.
Batwala 2011
Beadle 1994
Most participants did not have symptoms of malaria.
Bechem 1999
Did not present sufficient data to enable extraction of the numbers of true positives, false positive, true
negatives and false positives
Beg 2005
All participants were positive for malaria by microscopy.
Belizario 2005
Participants were recruited by active case finding.
Bell 2005
Not a consecutive sample: excluded a random sample of participants who were negative for malaria by
microscopy
Bell 2006
Bellagra 1998
Participants were travellers returning from an endemic to a non-endemic area
Bendezu 2008
Unable to extract or calculate absolute numbers of true positives, false positives, false negatives and true
negatives
Berens-Riha 2009
Subjects were dead.
Bhandari 2008
Bhat 2012
Recruited from a tertiary care hospital.
Bhatt 1994
Birku 1999
Participants had severe or complicated malaria.
Bisoffi 2009a
Not a DTA study.
Bisoffi 2009b
Bisoffi 2011
Not a DTA study.
Biswas 2004
Not a DTA study.
146
(Continued)
Biswas 2006
Not an immunochromatographic test.
Bjorkman 2011
Bojang 1999
Bouchaud 2000
Participants were travellers returning from endemic to non-endemic areas
Bouyou Akotet 2013
Unable to extract raw data.
Brenier-Pinchart 2000
Bruxvoort 2008
Bualombai 2003
Bualombai 2008
Buchachart 2004
Participants are hospital in-patients.
Buhalata 2011
Bujanover 2002
Not a DTA study.
Cabezas 2004
Not a DTA study (comparing field and laboratory RDT results)
Caraballo 1996
Carmona Fonseca 2010
Cavallo 1997
Participants were travellers returning from endemic to non-endemic countries
Chaijaroenkul 2011
Included participants without symptoms of malaria.
Chatterjee 2008
Report did not contain enough information to assess eligibility
Cheng 2006
Chilton 2006
Not a DTA study.
Chinkhumba 2010
Chinkhumba 2012
Chiodini 1998
147
(Continued)
Chiodini 2005
Not a DTA study.
Chitkara 2004
Cho 2001
Not undertaken in a malaria endemic area.
Cho 2011
Case-control study in travellers returning from an endemic to a non-endemic area
Cnops 2011
Samples not collected in a malaria endemic area.
Coleman 2002a
Coleman 2002b
Cong le 2002
Cooke 1999
Craig 1997
Tested blood films with artificially cultured and diluted malaria parasites
Craig 2002
The participants were positive for malaria by microscopy.
Cropley 2000
Cuadros 2007
Davoodian 2011
Not enough information presented to judge eligibility.
Dawoud 2008
de Carsalade 2009
de Dominguez 1996
Not a DTA study.
De Monbrison 2004
de Oliveira 2007
Delaunay 2008
Deletoille 1987
Not commercially available RDTs.
Devi 2002
Di Perry 1997
Di Santi 2011
Positive and negative blood samples selected for the study.
148
(Continued)
Diarra 2012
negatives for individual malaria species
Dietze 1995
Drakeley 2009
Dubarry 1990
Not evaluating an immunochromatographic RDT.
Durand 2005
Durand 2007
Durrheim 1998
Dyer 2000
Dzakah 2013
Eisen 2000
El-Moamly 2007
Participants were travellers returning from a malaria endemic to a non endemic area
Elmardi 2009
Not a DTA study.
Endeshaw 2008
Endeshaw 2010
Unable to extract raw data for 2 x 2 table.
Existe 2010
Falade 2013
Fan 2000
Fancony 2013
Included assymptomatic individuals (population survey).
Farcas 2003
Farcas 2004
Ferro 2002
Participants were travellers returning from an endemic area to an non-endemic area
Figueiredo Filho 2003
Fogg 2008
149
(Continued)
Forney 2001
Forney 2003
Fryauff 1997
Fryauff 2000
Participants did not have symptoms of malaria.
Funk 1999
Garavelli 2002
Garcia 1996
Gatti 2002
Gatti 2007
Gaye 1998
Gaye 1999
Gelaglie 2010
Gerstl 2009
Ghanchi 2009
Not a DTA study.
Ghosh 2000
Ghouth 2012
Gillet 2009a
Gillet 2009b
Not a DTA study.
Gillet 2009c
Gillet 2011
Not a DTA study: patients negative by reference standard standard were excluded
Gogtay 1999
Gogtay 2003
Participants were all positive for malaria by blood smear.
Goh 2013
Does not evaluate an RDT.
150
(Continued)
Gomes 2013
Selected positve and negative samples by reference test.
Gonzles-Cern 2005
Grobusch 1999
Grobusch 2002
Grobusch 2003a
Grobusch 2003b
Gupta 2001
Some participants had severe or complicated malaria.
Guthmann 2002
Gutierrez 2005
Not a DTA study.
Hada 2011
negatives for individual malaria species
Haditsch 2004
Hance 2005
Happi 2004
Harchut 2013
Hashizume 2006
Participants were displaced people from mainly very low endemicity areas
Hawkes 2009
Not a DTA study.
Hernandes 2001
Holmberg 1992
Not a DTA study.
Hopkins 2007
Hopkins 2008
Hossain 2008
Houmsou 2011
Houz 2009
151
(Continued)
Houz 2011
Humar 1997
Huong 2002
Not based on a consecutive sample; included a group malaria positive by microscopy and an asymptomatic
malaria negative control group
Hnscheid 1999
Iqbal 2000
Not a consecutive sample: participants were selected to have a high risk of rheumatoid factor
Iqbal 2001
Iqbal 2002
Iqbal 2003
Iqbal 2004
Ishengoma 2011
Jang 2013
Jelinek 1996
Does not evaluate an immunochromatographic RDT for malaria.
Jelinek 1999
Jelinek 2000
Jelinek 2001
Jeurissen 1999
John 1998
Joshi 2004
Not evaluating an immunochromatographic RDT.
Kaewsonthi 1996
Not a DTA study.
Kahama-Maro 2008
Kahama-Maro 2011
Kakkilaya 2003
Kamugisha 2008
152
(Continued)
Kar 1998
Karbwang 1996
Karimov 2011
Kashif 2013
Katakai 2011
Kattenberg 2011
Kaur 2000
All participants had cerebral malaria.
Kaushal 1995
Tested for P. knowlesi infection in monkeys.
Kaushal 1997
Kawai 2009
Tested for P. knowlesi infection in monkeys.
Keating 2009
Khairnar 2009
Khan 2004
Kilian 1997
negatives
Kilian 1999
Kim 2008
Includes a symptomatic group with malaria infection identified by microscopy, and an asymptomatic
group with no malaria infection by microscopy
Kim 2011
Only participants with malaria positive blood films by microscopy received the RDT
Kim 2013
Includes a symptomatic group with malaria infection identified by microscopy, and an asymptomatic
group with no malaria infection by microscopy
Knappik 2002
Kodisinghe 1997
Koita 2012
Kumar 1996
153
(Continued)
Kumar 2000
Participants were migrants from a very low endemicity area.
Kumar 2004
Kumar 2012
Not a DTA study.
Kumar 2013
Not a diganostic test accuracy study.
Kweka 2011
Kyabayinze 2008
Labb 2001
Lee 1999
Lee 2008
Participants were soldiers usually residing in non-endemic areas
Lee 2011
Lema 1999
Some participants were attending for follow-up of a previously diagnosed and treated case of malaria
Lepre 2004
Not a DTA study.
Lim 2001
Half the participants had malaria confirmed by microscopy before enrolment
Llanos Zavalaga 2000
Not a DTA study.
Llanos-Zavalaga 2002
Mahajan 2000
Makler 1998
Makler 2009
Malik 2004
Study was based at a tertiary referral centre with a high percentage of patients with complicated malaria
Mankhambo 2002
Mason 2002
Mawili-Mboumba 2010
Mayxay 2004
negatives
154
(Continued)
Mboera 2006a
McCutchan 2008
McMorrow 2010
Meena 2009
Participants were all hospital inpatients.
Menan 1996
Not a study of malaria RDTs.
Mendiratta 2006
Mendoza 2007
Mendoza 2013
Mengesha 1999
negatives
Mens 2007
Mens 2010
RDT evaluated is not an immunochromatographic test.
Metzger 2008
Metzger 2009
Not a DTA study.
Mharakurwa 1997a
Participants had all been recently treated for malaria.
Mharakurwa 1997b
Miantuasila 2012
Mikhail 2011
Miller 2001
Letter.
Miller 2008
negatives
Mills 1999
Mills 2007
Mills 2010
Mills 2010a
155
(Continued)
Minja 2012
Not all participants had symptoms of malaria: prospective cohort of pregnant women
Minodier 2005
Mishra 1999
Not a consecutive sample; comprised a malaria positive group by microscopy and negative control groups
Mishra 2007
Mohanty 1999
Mohapatra 1996
Montoya 2008
Moody 2000
Moody 2002a
Moody 2002b
RDTs tested on artificially cultured blood samples.
Moonasar 2007
Not a DTA study.
Moonasar 2009
Morankar 2011
Moulin 2009
Msellem 2009
Mtove 2011
Mueller 2007
Participants not representative of people presenting to ambulatory care setting with symptoms of malaria
Muhindo 2012
Munier 2009
Murahwa 1999
Murray 2003
Murray 2008
Mwanza 2005
Myjak 2004
156
(Continued)
Naing 2002a
Nema 2005
Neumann 2008
Nicastri 2009a
Nigussie 2008
Nkrumah 2010
RDT evaluated is not an immunochromatographic test.
Nkrumah 2011
P. falciparum malaria only: Only 2 cases of non-falciparum malaria (263 study participants)
Nour 2011
Not enough information presented to extract numbers of true postives, false positives, true negatives and
false negatives
Nwuba 2001
Nyunt 2013
Not a DTA study: all participants had positive blood slide for P. falciparum
Ochola 2006
Omar 1999
OMS 1999
Not a DTA study.
Onile 2005
Osman 2010
Less than one percent of the malaria detected was P. vivax.
Ouattara 2011
negatives for individual malaria species (mainly P. falciparum but numbers not provided).
Ozbilge 2006
Pabon 2007
Pakalapati 2013
Unable to extract data on numbers of true positives, false positive, true negatives and false negatives
Palmer 1998
Palmer 1999
Palmer 2003
Pammenter 1988
157
(Continued)
Pandey 1995
Pandya 2001
Park 2003
Not a consecutive sample; included a known malaria group and negative control group by microscopy
Park 2006
Written in Korean only.
Parra 1991
Not a DTA study.
Peng 2012
Penhalbel 2005
Not a consecutive sample; included a known malaria group and negative control group by microscopy
Peyron 1999
Phommanivong 2010
Not a DTA study.
Pica 2005
Pieroni 1998
Pinto 1999
All participants had previous tested negative for malaria and had symptoms that meant complicated
malaria could not be ruled out
Piper 1999
Half the participants lived in non-endemic areas.
Pividal 1994
Not a DTA study.
Planche 2001
Playford 2002
Popov 2000
Popov 2004
Premji 1994
Prou 1988
Proux 2001
Majority of participants did not have symptoms of malaria.
Prez 2007
Quintana 1998
158
(Continued)
Rabinovich 2006
Radrianasolo 2007
Rahim 2002
Rajendran 2006
Ramutton 2012
Participants had severe malaria.
Ratnawati 2008
Many participants were recruited by active case finding.
Ratsimbasoa 2012
Rehlis 2004
Reyburn 2007
Not a DTA study.
Ricci 2000
Richardson 2002
Richter 2004a
Richter 2004b
Rimn 2003
Roche 1995
Rodrguez-Iglesias 2005
Rodulfo 2007
Some of the participants did not have symptoms of malaria.
Rolland 2006
Not a DTA study.
Rosenthal 2012
Not a DTA study: editorial.
Rubio 2001
Runsewe-Abiodun 2012
Not enough information presented to absolute numbers of true positives, true negatives, false positives
and false negatives
Ryan 2002
Not a DTA study.
Samal 1998
159
(Continued)
Saranya 2003
Sayang 2009
Schachterle 2011
P. falciparum only.
Schmidt 2003
Schmidt 2011
Only participants with positive P. falciparum malaria slides were included.
Seidahmed 2008
Not a DTA study.
Senn 2012
Not a diagnostic test accuracy study: blood slide was performed to assess treatment outcome
Sezibera 2009
Not a DTA study.
Shah 2004
Shaikh 2013
Does not differentiate malaria parasitiaemia by species.
Shakya 2012
negatives
Shamsi 1999
Sharma 1999
Sharma 2008
She 2007
Shenoi 1996
Shiff 1993
Shillcutt 2008
Not a DTA study.
Shirayama 2008
Not a DTA study.
Shujatullah 2006
Shujatullah 2009
Singer 2004
Singh 1997a
160
(Continued)
Singh 1997b
Singh 2000b
Singh 2000c
Singh 2001
Singh 2002a
Singh 2002b
Singh 2004a
Singh 2005a
Singh 2005b
negatives
Singh 2005c
Singh 2007
Singh 2013
Participants selected through active case detection.
Skarbinski 2009
Not a DTA study.
Smego 2000
Sotimehin 2007
Soto Tarazona 2004
negatives
Srinivasan 2000
Stauffer 2005
Participants were refugees from an endemic to a non-endemic country
Stauffer 2006
Stauffer 2009
Participants were all travellers returning from an endemic to a non-endemic area
Stephens 1999
Stow 1999
161
(Continued)
Strm 2013
No cases of non-falciparum malaria.
Strenburg 2009
Surpur 2010
Data not presented for P. falciparum and P. vivax separately.
Susi 2005
Swarthout 2007
Tagbo 2007
Tagbor 2008
Tahar 2013
P. falciparum malaria only: only 4 cases of non-falciparum malaria (179 participants)
Tarimo 2001
negatives
Taylor 2002
Tekeste 2012
Tham 1999
Thepsamarn 1997
Tietche 1996
Not a DTA study.
Tjitra 2001a
Tjitra 2001b
Trachsler 1999
Not a DTA study.
Uguen 1995
Uneke 2008a
Uneke 2008b
Not a DTA study.
Uzochukwu 2009
Valecha 1998
Valecha 2002
162
(Continued)
Vala 2009
Van den Ende 1998
Van der Palen 2009
Van Dijk 2009
van Hellemond 2009
Not a DTA study.
VanderJagt 2005
Most participants had no symptoms of malaria.
Venkatesh 2007
Verl 1996
Voller 1993
Waltz 2007
Wang J-Y 2007
Not a commercial test kit.
Wanji 2008
WHO 1996
Wiese 2006
Willcox 2009
Williams 2008
Not a DTA study.
Wilson 2013
Win 2001
Wolday 2001
Woyessa 2013
Participants recruited through active case detection (population survey)
Wu 2005
Not an immunochromatographic RDT kit.
163
(Continued)
Yadav 1997
Yadav 2012
Not enough information presented to assess eligibility (not clear where participants presented with symptoms)
Yavo 2002
Zakai 2003
Zerpa 2007
Not able to extract or calculate absolute numbers of true positives, false positives, false negatives and true
negatives
Zheng 1999
Zhu 1998
Zikusooka 2008
Not a DTA study.
Zurovac 2008
Not a DTA study.
164
DATA
Presented below are all the data for all of the tests entered into the review.
Tests. Data tables by test
Test
1 Non-falciparum species only,
microscopy, Type 2, ICT
Combo Cassette
microscopy, Type 2, ICT
Malaria Pf/Pv
microscopy, Type 2, NOW
Malaria ICT
microscopy, Type 2, Malascan
microscopy, Type 2, VIKIA Ag
Pf/Pan
microscopy, Type 2 (All)
microscopy, Type 3, Parascreen
microscopy, Type 3, CareStart
Pf/Pan
microscopy, Type 3, SD
Malaria Antigen Bioline
microscopy, Type 3, First
Response Malaria Combo
microscopy, Type 3, One Step
Malaria Pf/Pan
microscopy, Type 4, OptiMAL
14 Non-falciparum species
only, microscopy, Type 4,
OptiMAL-IT
microscopy, Type 4, Carestart
No. of
studies
No. of
participants
2383
3151
246
372
727
11
6879
14
5407
3544
3769
663
606
23
11234
1843
1987
195
10
3831
165

microscopy, Other Type,
Malariagen Malaria
PCR, Type 3, CareStart Pf/Pan
PCR, Type 3, Parascreen
PCR, Type 3, One Step Malaria
Pf/Pan
PCR, Type 3, SD Malaria
Antigen Bioline
PCR, Type 3 (All)
PCR, Type 4, OptiMAL (All)
24 P. vivax, microscopy, Pf HRP-2
and Pv pLDH, Carestart Pf/Pv
(All)
and Pv pLDH, Biotech Malaria
Pf/Pv
and Pv pLDH, Falcivax
27 P. vivax, microscopy, Pf HRp-2
and Pv pLDH, Onsite Pf/Pv
and Pv pLDH, Pf/Pv Malaria
Device
and Pv pLDH (All)
30 P. vivax, PCR, Pf HRP-2 and
Pv pLDH, Falcivax
Pv pLDH, OnSite Pf/Pv
Pv pLDH, Pf/Pv Malaria
Device
Pv pLDH (All)
34 P. vivax, PCR, Type 6,
PALUTOP (All)
262
178
659
606
196
1639
313
2000
250
710
710
350
3682
338
338
350
688
313
166
Test 1. Non-falciparum species only, microscopy, Type 2, ICT Combo Cassette.

Rapid diagnostic tests for diagnosing uncomplicated non-falciparum or Plasmodium
Review:
Test:
vivax malaria in endemic countries
1 Non-falciparum species only, microscopy, Type 2, ICT Combo Cassette
Study
Ashton 2010
TP
FP
FN
TN
Sensitivity
Specificity
209
85
37
2052
0.85 [ 0.80, 0.89 ]
0.96 [ 0.95, 0.97 ]
Sensitivity
0.2
0.4
0.6
Specificity
0.8
0.2
0.4
0.6
0.8
Test 2. Non-falciparum species only, microscopy, Type 2, ICT Malaria Pf/Pv.

Review:
Test:
2 Non-falciparum species only, microscopy, Type 2, ICT Malaria Pf/Pv
Study
TP
FP
FN
TN
Sensitivity
Specificity
Bell 2001a
32
16
300
0.67 [ 0.52, 0.80 ]
0.99 [ 0.98, 1.00 ]
Bell 2001b
25
73
0.81 [ 0.63, 0.93 ]
0.89 [ 0.80, 0.95 ]
Fernando 2004
70
29
227
0.71 [ 0.61, 0.79 ]
0.99 [ 0.97, 1.00 ]
Harani 2006
27
10
520
0.90 [ 0.73, 0.98 ]
0.98 [ 0.97, 0.99 ]
Singh 2000a
34
13
294
0.72 [ 0.57, 0.84 ]
0.99 [ 0.97, 1.00 ]
Tjitra 1999
27
27
497
0.75 [ 0.58, 0.88 ]
0.95 [ 0.93, 0.97 ]
217
74
604
0.75 [ 0.69, 0.79 ]
1.00 [ 0.99, 1.00 ]
van den Broek 2006
Sensitivity
0.2
0.4
0.6
Specificity
0.8
0.2
0.4
0.6
0.8
167
Test 3. Non-falciparum species only, microscopy, Type 2, NOW Malaria ICT.

Review:
Test:
3 Non-falciparum species only, microscopy, Type 2, NOW Malaria ICT
Study
TP
FP
FN
TN
Sensitivity
Specificity
59
178
0.87 [ 0.76, 0.94 ]
1.00 [ 0.98, 1.00 ]
Sensitivity
0.2
0.4
0.6
Specificity
0.8
0.2
0.4
0.6
0.8
Test 4. Non-falciparum species only, microscopy, Type 2, Malascan.

Review:
Test:
4 Non-falciparum species only, microscopy, Type 2, Malascan
Study
Singh 2010
TP
FP
FN
TN
Sensitivity
Specificity
39
18
308
0.68 [ 0.55, 0.80 ]
0.98 [ 0.95, 0.99 ]
Sensitivity
0.2
0.4
0.6
Specificity
0.8
0.2
0.4
0.6
0.8
0.8
Test 5. Non-falciparum species only, microscopy, Type 2, VIKIA Ag Pf/Pan.

Review:
Test:
5 Non-falciparum species only, microscopy, Type 2, VIKIA Ag Pf/Pan
Study
Eibach 2013
TP
FP
FN
TN
Sensitivity
Specificity
716
0.80 [ 0.28, 0.99 ]
0.99 [ 0.98, 1.00 ]
Sensitivity
0.2
0.4
0.6
Specificity
0.8
0.2
0.4
0.6
168
Test 6. Non-falciparum species only, microscopy, Type 2 (All).

Review:
Test:
6 Non-falciparum species only, microscopy, Type 2 (All)
Study
TP
FP
FN
TN
Sensitivity
Specificity
209
85
37
2052
0.85 [ 0.80, 0.89 ]
0.96 [ 0.95, 0.97 ]
Bell 2001a
32
16
300
0.67 [ 0.52, 0.80 ]
0.99 [ 0.98, 1.00 ]
Bell 2001b
25
73
0.81 [ 0.63, 0.93 ]
0.89 [ 0.80, 0.95 ]
716
0.80 [ 0.28, 0.99 ]
0.99 [ 0.98, 1.00 ]
Fernando 2004
70
29
227
0.71 [ 0.61, 0.79 ]
0.99 [ 0.97, 1.00 ]
Harani 2006
27
10
520
0.90 [ 0.73, 0.98 ]
0.98 [ 0.97, 0.99 ]
Singh 2000a
34
13
294
0.72 [ 0.57, 0.84 ]
0.99 [ 0.97, 1.00 ]
Singh 2010
39
18
308
0.68 [ 0.55, 0.80 ]
0.98 [ 0.95, 0.99 ]
Tjitra 1999
27
27
497
0.75 [ 0.58, 0.88 ]
0.95 [ 0.93, 0.97 ]
217
74
604
0.75 [ 0.69, 0.79 ]
1.00 [ 0.99, 1.00 ]
59
178
0.87 [ 0.76, 0.94 ]
1.00 [ 0.98, 1.00 ]
Ashton 2010
Eibach 2013
van den Broek 2006

Sensitivity
0.2
0.4
0.6
Specificity
0.8
0.2
0.4
0.6
0.8
169
Test 7. Non-falciparum species only, microscopy, Type 3, Parascreen.

Review:
Test:
7 Non-falciparum species only, microscopy, Type 3, Parascreen
Study
TP
FP
FN
TN
Sensitivity
Specificity
Ashton 2010
203
96
43
2041
0.83 [ 0.77, 0.87 ]
0.96 [ 0.95, 0.96 ]
Bendezu 2010
64
19
243
0.77 [ 0.67, 0.86 ]
0.98 [ 0.95, 0.99 ]
Elahi 2013
49
270
0.91 [ 0.80, 0.97 ]
0.99 [ 0.97, 1.00 ]
Endeshaw 2012a
190
0.50 [ 0.12, 0.88 ]
0.98 [ 0.95, 0.99 ]
Endeshaw 2012b
32
160
0.89 [ 0.74, 0.97 ]
0.98 [ 0.94, 0.99 ]
Endeshaw 2012c
184
0.55 [ 0.23, 0.83 ]
0.98 [ 0.95, 1.00 ]
Endeshaw 2012d
195
0.50 [ 0.07, 0.93 ]
0.99 [ 0.97, 1.00 ]
Endeshaw 2012e
185
1.00 [ 0.48, 1.00 ]
0.96 [ 0.93, 0.99 ]
Endeshaw 2012f
192
1.00 [ 0.63, 1.00 ]
1.00 [ 0.98, 1.00 ]
Endeshaw 2012g
192
0.60 [ 0.15, 0.95 ]
0.99 [ 0.97, 1.00 ]
Endeshaw 2012h
14
184
0.88 [ 0.62, 0.98 ]
1.00 [ 0.98, 1.00 ]
Endeshaw 2012i
10
186
1.00 [ 0.69, 1.00 ]
0.98 [ 0.95, 0.99 ]
Endeshaw 2012j
12
181
0.25 [ 0.07, 0.52 ]
0.98 [ 0.95, 1.00 ]
44
13
309
0.77 [ 0.64, 0.87 ]
0.98 [ 0.96, 0.99 ]
Singh 2010
Sensitivity
0.2
0.4
0.6
Specificity
0.8
0.2
0.4
0.6
0.8
170
Test 8. Non-falciparum species only, microscopy, Type 3, CareStart Pf/Pan.

Review:
Test:
8 Non-falciparum species only, microscopy, Type 3, CareStart Pf/Pan
Study
TP
FP
FN
TN
Sensitivity
Specificity
Ashton 2010
209
77
37
2060
0.85 [ 0.80, 0.89 ]
0.96 [ 0.96, 0.97 ]
Eibach 2013
718
0.60 [ 0.15, 0.95 ]
0.99 [ 0.99, 1.00 ]
Moges 2012
20
38
192
0.34 [ 0.22, 0.48 ]
0.98 [ 0.95, 0.99 ]
Xiaodong 2013
59
115
0.91 [ 0.81, 0.97 ]
1.00 [ 0.97, 1.00 ]
Sensitivity
0.2
0.4
0.6
Specificity
0.8
0.2
0.4
0.6
0.8
0.8
Test 9. Non-falciparum species only, microscopy, Type 3, SD Malaria Antigen Bioline.

Review:
Test:
9 Non-falciparum species only, microscopy, Type 3, SD Malaria Antigen Bioline
Study
TP
FP
FN
TN
Sensitivity
Specificity
Dev 2004
23
0.71 [ 0.29, 0.96 ]
1.00 [ 0.85, 1.00 ]
454
26
133
1972
0.77 [ 0.74, 0.81 ]
0.99 [ 0.98, 0.99 ]
11
175
0.73 [ 0.45, 0.92 ]
0.98 [ 0.94, 0.99 ]
111
18
828
0.86 [ 0.79, 0.92 ]
1.00 [ 0.99, 1.00 ]
Kosack 2013
Ratsimbasoa 2007
Trouvay 2013
Sensitivity
0.2
0.4
0.6
Specificity
0.8
0.2
0.4
0.6
171
Test 10. Non-falciparum species only, microscopy, Type 3, First Response Malaria Combo.
Review:
Test:
10 Non-falciparum species only, microscopy, Type 3, First Response Malaria Combo
Study
TP
FP
FN
TN
Sensitivity
Specificity
Bharti 2008
34
15
235
0.83 [ 0.68, 0.93 ]
0.94 [ 0.90, 0.97 ]
Singh 2010
48
11
304
0.84 [ 0.72, 0.93 ]
0.97 [ 0.94, 0.98 ]
Sensitivity
0.2
0.4
0.6
Specificity
0.8
0.2
0.4
0.6
0.8
0.8
Test 11. Non-falciparum species only, microscopy, Type 3, One Step Malaria Pf/Pan.
Review:
Test:
11 Non-falciparum species only, microscopy, Type 3, One Step Malaria Pf/Pan
Study
TP
FP
FN
TN
Sensitivity
Specificity
Yan 2013
51
22
528
0.70 [ 0.58, 0.80 ]
0.99 [ 0.98, 1.00 ]
Sensitivity
0.2
0.4
0.6
Specificity
0.8
0.2
0.4
0.6
172

Review:
Test:
Study
TP
FP
FN
TN
Sensitivity
Specificity
Ashton 2010
209
77
37
2060
0.85 [ 0.80, 0.89 ]
0.96 [ 0.96, 0.97 ]
Bendezu 2010
64
19
243
0.77 [ 0.67, 0.86 ]
0.98 [ 0.95, 0.99 ]
Bharti 2008
34
15
235
0.83 [ 0.68, 0.93 ]
0.94 [ 0.90, 0.97 ]
Dev 2004
23
0.71 [ 0.29, 0.96 ]
1.00 [ 0.85, 1.00 ]
Eibach 2013
718
0.60 [ 0.15, 0.95 ]
0.99 [ 0.99, 1.00 ]
49
270
0.91 [ 0.80, 0.97 ]
0.99 [ 0.97, 1.00 ]
Endeshaw 2012a
190
0.50 [ 0.12, 0.88 ]
0.98 [ 0.95, 0.99 ]
Endeshaw 2012b
32
160
0.89 [ 0.74, 0.97 ]
0.98 [ 0.94, 0.99 ]
Endeshaw 2012c
184
0.55 [ 0.23, 0.83 ]
0.98 [ 0.95, 1.00 ]
Endeshaw 2012d
195
0.50 [ 0.07, 0.93 ]
0.99 [ 0.97, 1.00 ]
Endeshaw 2012e
185
1.00 [ 0.48, 1.00 ]
0.96 [ 0.93, 0.99 ]
Endeshaw 2012f
192
1.00 [ 0.63, 1.00 ]
1.00 [ 0.98, 1.00 ]
Endeshaw 2012g
192
0.60 [ 0.15, 0.95 ]
0.99 [ 0.97, 1.00 ]
Endeshaw 2012h
14
184
0.88 [ 0.62, 0.98 ]
1.00 [ 0.98, 1.00 ]
Endeshaw 2012i
10
186
1.00 [ 0.69, 1.00 ]
0.98 [ 0.95, 0.99 ]
Endeshaw 2012j
12
181
0.25 [ 0.07, 0.52 ]
0.98 [ 0.95, 1.00 ]
Kosack 2013
454
26
133
1972
0.77 [ 0.74, 0.81 ]
0.99 [ 0.98, 0.99 ]
Moges 2012
20
38
192
0.34 [ 0.22, 0.48 ]
0.98 [ 0.95, 0.99 ]
Ratsimbasoa 2007
11
175
0.73 [ 0.45, 0.92 ]
0.98 [ 0.94, 0.99 ]
Singh 2010
44
13
309
0.77 [ 0.64, 0.87 ]
0.98 [ 0.96, 0.99 ]
111
18
828
0.86 [ 0.79, 0.92 ]
1.00 [ 0.99, 1.00 ]
Xiaodong 2013
59
115
0.91 [ 0.81, 0.97 ]
1.00 [ 0.97, 1.00 ]
Yan 2013
51
22
528
0.70 [ 0.58, 0.80 ]
0.99 [ 0.98, 1.00 ]
Elahi 2013
Trouvay 2013
Sensitivity
0.2
0.4
0.6
Specificity
0.8
0.2
0.4
0.6
0.8
173
Test 13. Non-falciparum species only, microscopy, Type 4, OptiMAL.

Review:
Test:
13 Non-falciparum species only, microscopy, Type 4, OptiMAL
Study
TP
FP
FN
TN
Sensitivity
Specificity
Chayani 2004
23
204
0.88 [ 0.70, 0.98 ]
0.99 [ 0.97, 1.00 ]
Dev 2004
26
111
0.90 [ 0.73, 0.98 ]
1.00 [ 0.97, 1.00 ]
142
23
328
0.86 [ 0.80, 0.91 ]
0.98 [ 0.97, 1.00 ]
Ratsimbasoa 2007
15
175
0.88 [ 0.64, 0.99 ]
0.99 [ 0.96, 1.00 ]
Singh 2003
22
57
1.00 [ 0.85, 1.00 ]
0.98 [ 0.91, 1.00 ]
173
16
13
497
0.93 [ 0.88, 0.96 ]
0.97 [ 0.95, 0.98 ]
Kolaczinski 2004
Valecha 2003
Sensitivity
0.2
0.4
0.6
Specificity
0.8
0.2
0.4
0.6
0.8
0.8
Test 14. Non-falciparum species only, microscopy, Type 4, OptiMAL-IT.

Review:
Test:
14 Non-falciparum species only, microscopy, Type 4, OptiMAL-IT
TP
FP
FN
TN
Sensitivity
Specificity
Andrade 2010
Study
84
14
213
1.00 [ 0.96, 1.00 ]
0.94 [ 0.90, 0.97 ]
Metzger 2011
52
30
426
0.63 [ 0.52, 0.74 ]
0.99 [ 0.97, 0.99 ]
Pattanasin 2003
56
29
179
0.66 [ 0.55, 0.76 ]
0.99 [ 0.96, 1.00 ]
256
36
598
0.88 [ 0.83, 0.91 ]
0.99 [ 0.98, 1.00 ]
van den Broek 2006
Sensitivity
0.2
0.4
0.6
Specificity
0.8
0.2
0.4
0.6
174
Test 15. Non-falciparum species only, microscopy, Type 4, Carestart.

Review:
Test:
15 Non-falciparum species only, microscopy, Type 4, Carestart
Study
Ratsimbasoa 2007
TP
FP
FN
TN
Sensitivity
Specificity
12
175
0.80 [ 0.52, 0.96 ]
0.97 [ 0.94, 0.99 ]
Sensitivity
0.2
0.4
0.6
Specificity
0.8
0.2
0.4
0.6
0.8
0.8

Review:
Test:
Study
TP
FP
FN
TN
Sensitivity
Specificity
Andrade 2010
84
14
213
1.00 [ 0.96, 1.00 ]
0.94 [ 0.90, 0.97 ]
Chayani 2004
23
204
0.88 [ 0.70, 0.98 ]
0.99 [ 0.97, 1.00 ]
Dev 2004
26
111
0.90 [ 0.73, 0.98 ]
1.00 [ 0.97, 1.00 ]
142
23
328
0.86 [ 0.80, 0.91 ]
0.98 [ 0.97, 1.00 ]
Metzger 2011
52
30
426
0.63 [ 0.52, 0.74 ]
0.99 [ 0.97, 0.99 ]
Pattanasin 2003
56
29
179
0.66 [ 0.55, 0.76 ]
0.99 [ 0.96, 1.00 ]
Ratsimbasoa 2007
12
175
0.80 [ 0.52, 0.96 ]
0.97 [ 0.94, 0.99 ]
Singh 2003
22
57
1.00 [ 0.85, 1.00 ]
0.98 [ 0.91, 1.00 ]
Valecha 2003
173
16
13
497
0.93 [ 0.88, 0.96 ]
0.97 [ 0.95, 0.98 ]
van den Broek 2006
256
36
598
0.88 [ 0.83, 0.91 ]
0.99 [ 0.98, 1.00 ]
Kolaczinski 2004
Sensitivity
0.2
0.4
0.6
Specificity
0.8
0.2
0.4
0.6
175
Test 17. Non-falciparum species only, microscopy, Other Type, Malariagen Malaria.
Review:
Test:
17 Non-falciparum species only, microscopy, Other Type, Malariagen Malaria
Study
Selimuzzaman 2010
TP
FP
FN
TN
Sensitivity
Specificity
11
12
238
0.92 [ 0.62, 1.00 ]
0.95 [ 0.92, 0.97 ]
Sensitivity
0.2
0.4
0.6
Specificity
0.8
0.2
0.4
0.6
0.8
0.8
0.8
Test 18. Non-falciparum species only, PCR, Type 3, CareStart Pf/Pan.

Review:
Test:
18 Non-falciparum species only, PCR, Type 3, CareStart Pf/Pan
Study
Xiaodong 2013
TP
FP
FN
TN
Sensitivity
Specificity
59
113
0.91 [ 0.81, 0.97 ]
1.00 [ 0.97, 1.00 ]
Sensitivity
0.2
0.4
0.6
Specificity
0.8
0.2
0.4
0.6
Test 19. Non-falciparum species only, PCR, Type 3, Parascreen.

Review:
Test:
19 Non-falciparum species only, PCR, Type 3, Parascreen
TP
FP
FN
TN
Sensitivity
Specificity
Bendezu 2010
Study
67
21
241
0.76 [ 0.66, 0.85 ]
0.99 [ 0.96, 1.00 ]
Elahi 2013
49
270
0.91 [ 0.80, 0.97 ]
0.99 [ 0.97, 1.00 ]
Sensitivity
0.2
0.4
0.6
Specificity
0.8
0.2
0.4
0.6
176
Test 20. Non-falciparum species only, PCR, Type 3, One Step Malaria Pf/Pan.
Review:
Test:
20 Non-falciparum species only, PCR, Type 3, One Step Malaria Pf/Pan
Study
TP
FP
FN
TN
Sensitivity
Specificity
Yan 2013
51
15
20
520
0.72 [ 0.60, 0.82 ]
0.97 [ 0.95, 0.98 ]
Sensitivity
0.2
0.4
0.6
Specificity
0.8
0.2
0.4
0.6
0.8
Test 21. Non-falciparum species only, PCR, Type 3, SD Malaria Antigen Bioline.
Review:
Test:
21 Non-falciparum species only, PCR, Type 3, SD Malaria Antigen Bioline
Study
Ratsimbasoa 2008
TP
FP
FN
TN
Sensitivity
Specificity
14
173
0.64 [ 0.41, 0.83 ]
0.99 [ 0.97, 1.00 ]
Sensitivity
0.2
0.4
0.6
Specificity
0.8
0.2
0.4
0.6
0.8
177
Test 22. Non-falciparum species only, PCR, Type 3 (All).

Review:
Test:
22 Non-falciparum species only, PCR, Type 3 (All)
Study
TP
FP
FN
TN
Sensitivity
Specificity
Bendezu 2010
67
21
241
0.76 [ 0.66, 0.85 ]
0.99 [ 0.96, 1.00 ]
Elahi 2013
49
270
0.91 [ 0.80, 0.97 ]
0.99 [ 0.97, 1.00 ]
Ratsimbasoa 2008
14
173
0.64 [ 0.41, 0.83 ]
0.99 [ 0.97, 1.00 ]
Xiaodong 2013
59
113
0.91 [ 0.81, 0.97 ]
1.00 [ 0.97, 1.00 ]
Yan 2013
51
15
20
520
0.72 [ 0.60, 0.82 ]
0.97 [ 0.95, 0.98 ]
Sensitivity
0.2
0.4
0.6
Specificity
0.8
0.2
0.4
0.6
0.8
0.8
Test 23. Non-falciparum species only, PCR, Type 4, OptiMAL (All).

Review:
Test:
23 Non-falciparum species only, PCR, Type 4, OptiMAL (All)
Study
Rakotonirina 2008
TP
FP
FN
TN
Sensitivity
Specificity
15
290
0.88 [ 0.64, 0.99 ]
0.98 [ 0.96, 0.99 ]
Sensitivity
0.2
0.4
0.6
Specificity
0.8
0.2
0.4
0.6
178
Test 24. P. vivax, microscopy, Pf HRP-2 and Pv pLDH, Carestart Pf/Pv (All).
Review:
Test:
24 P.
vivax, microscopy, Pf HRP-2 and Pv pLDH, Carestart Pf/Pv (All)
Study
TP
FP
FN
TN
Sensitivity
Specificity
Chanie 2011
25
1063
1.00 [ 0.86, 1.00 ]
1.00 [ 0.99, 1.00 ]
Mekonnen 2010
61
176
0.95 [ 0.87, 0.99 ]
1.00 [ 0.98, 1.00 ]
155
503
0.99 [ 0.96, 1.00 ]
0.98 [ 0.97, 0.99 ]
Sharew 2009
Sensitivity
0.2
0.4
0.6
Specificity
0.8
0.2
0.4
0.6
0.8
0.8
Test 25. P. vivax, microscopy, Pf HRP-2 and Pv pLDH, Biotech Malaria Pf/Pv.
Review:
Test:
25 P.
vivax, microscopy, Pf HRP-2 and Pv pLDH, Biotech Malaria Pf/Pv
Study
Samane 2010
TP
FP
FN
TN
Sensitivity
Specificity
110
138
0.98 [ 0.94, 1.00 ]
1.00 [ 0.97, 1.00 ]
Sensitivity
0.2
0.4
0.6
Specificity
0.8
0.2
0.4
0.6
179
Test 26. P. vivax, microscopy, Pf HRP-2 and Pv pLDH, Falcivax.

Review:
Test:
26 P.
vivax, microscopy, Pf HRP-2 and Pv pLDH, Falcivax
Study
TP
FP
FN
TN
Sensitivity
Specificity
Alam 2011
19
316
0.90 [ 0.70, 0.99 ]
1.00 [ 0.98, 1.00 ]
Singh 2010
45
23
301
0.66 [ 0.54, 0.77 ]
0.99 [ 0.97, 1.00 ]
Sensitivity
0.2
0.4
0.6
Specificity
0.8
0.2
0.4
0.6
0.8
0.8
Test 27. P. vivax, microscopy, Pf HRp-2 and Pv pLDH, Onsite Pf/Pv.

Review:
Test:
27 P.
vivax, microscopy, Pf HRp-2 and Pv pLDH, Onsite Pf/Pv
Study
TP
FP
FN
TN
Sensitivity
Specificity
Alam 2011
19
313
0.90 [ 0.70, 0.99 ]
0.99 [ 0.97, 1.00 ]
Mohon 2012
71
295
0.97 [ 0.90, 1.00 ]
0.99 [ 0.97, 1.00 ]
Sensitivity
0.2
0.4
0.6
Specificity
0.8
0.2
0.4
0.6
180
Test 28. P. vivax, microscopy, Pf HRP-2 and Pv pLDH, Pf/Pv Malaria Device.
Review:
Test:
28 P.
vivax, microscopy, Pf HRP-2 and Pv pLDH, Pf/Pv Malaria Device
Study
TP
FP
FN
TN
Sensitivity
Specificity
Yan 2013
45
16
284
0.74 [ 0.61, 0.84 ]
0.98 [ 0.96, 0.99 ]
Sensitivity
0.2
0.4
0.6
Specificity
0.8
0.2
0.4
0.6
0.8
Test 29. P. vivax, microscopy, Pf HRP-2 and Pv pLDH (All).

Review:
Test:
29 P.
vivax, microscopy, Pf HRP-2 and Pv pLDH (All)
Study
TP
FP
FN
TN
Sensitivity
Specificity
Alam 2011
19
316
0.90 [ 0.70, 0.99 ]
1.00 [ 0.98, 1.00 ]
Chanie 2011
25
1063
1.00 [ 0.86, 1.00 ]
1.00 [ 0.99, 1.00 ]
Mekonnen 2010
61
176
0.95 [ 0.87, 0.99 ]
1.00 [ 0.98, 1.00 ]
Mohon 2012
71
295
0.97 [ 0.90, 1.00 ]
0.99 [ 0.97, 1.00 ]
Samane 2010
110
138
0.98 [ 0.94, 1.00 ]
1.00 [ 0.97, 1.00 ]
Sharew 2009
155
503
0.99 [ 0.96, 1.00 ]
0.98 [ 0.97, 0.99 ]
Singh 2010
45
23
301
0.66 [ 0.54, 0.77 ]
0.99 [ 0.97, 1.00 ]
Yan 2013
45
16
284
0.74 [ 0.61, 0.84 ]
0.98 [ 0.96, 0.99 ]
Sensitivity
0.2
0.4
0.6
Specificity
0.8
0.2
0.4
0.6
0.8
181
Test 30. P. vivax, PCR, Pf HRP-2 and Pv pLDH, Falcivax.

Review:
Test:
30 P.
vivax, PCR, Pf HRP-2 and Pv pLDH, Falcivax
Study
Alam 2011
TP
FP
FN
TN
Sensitivity
Specificity
20
312
0.77 [ 0.56, 0.91 ]
1.00 [ 0.99, 1.00 ]
Sensitivity
0.2
0.4
0.6
Specificity
0.8
0.2
0.4
0.6
0.8
0.8
0.8
Test 31. P. vivax, PCR, Pf HRP-2 and Pv pLDH, OnSite Pf/Pv.

Review:
Test:
31 P.
vivax, PCR, Pf HRP-2 and Pv pLDH, OnSite Pf/Pv
Study
Alam 2011
TP
FP
FN
TN
Sensitivity
Specificity
20
309
0.77 [ 0.56, 0.91 ]
0.99 [ 0.97, 1.00 ]
Sensitivity
0.2
0.4
0.6
Specificity
0.8
0.2
0.4
0.6
Test 32. P. vivax, PCR, Pf HRP-2 and Pv pLDH, Pf/Pv Malaria Device.
Review:
Test:
32 P.
vivax, PCR, Pf HRP-2 and Pv pLDH, Pf/Pv Malaria Device
Study
TP
FP
FN
TN
Sensitivity
Specificity
Yan 2013
43
30
270
0.59 [ 0.47, 0.70 ]
0.97 [ 0.95, 0.99 ]
Sensitivity
0.2
0.4
0.6
Specificity
0.8
0.2
0.4
0.6
182
Test 33. P. vivax, PCR, Pf HRP-2 and Pv pLDH (All).

Review:
Test:
33 P.
vivax, PCR, Pf HRP-2 and Pv pLDH (All)

TP
FP
FN
TN
Sensitivity
Specificity
Alam 2011
Study
20
309
0.77 [ 0.56, 0.91 ]
0.99 [ 0.97, 1.00 ]
Yan 2013
43
30
270
0.59 [ 0.47, 0.70 ]
0.97 [ 0.95, 0.99 ]
Sensitivity
0.2
0.4
0.6
Specificity
0.8
0.2
0.4
0.6
0.8
Test 34. P. vivax, PCR, Type 6, PALUTOP (All).

Review:
Test:
34 P.
vivax, PCR, Type 6, PALUTOP (All)
Study
Rakotonirina 2008
TP
FP
FN
TN
Sensitivity
Specificity
19
292
0.90 [ 0.70, 0.99 ]
1.00 [ 0.99, 1.00 ]
Sensitivity
0.2
0.4
0.6
Specificity
0.8
0.2
0.4
0.6
0.8
183
ADDITIONAL TABLES
Table 1. Types of malaria RDTs by antigen combination and parasite species detected
Type of test
Antigen combinations
Possible results
Type 1
HRP-2 (P. falciparum specific)
No Pf; Pf; invalid
Type 2
HRP-2 (P. falciparum specific) and aldolase (pan-specific) No malaria; Pf or mixed; Pv, Pf, or Pm; invalid
Type 3
HRP-2 (P. falciparum specific) and pLDH (pan-specific)
No malaria; Pf or mixed; Pv, Pf, or Pm; invalid
Type 4
pLDH (P. falciparum specific) and pLHD (pan-specific)
No malaria; Pf or mixed; Pv, Pf, or Pm; invalid
Type 5
pLDH (P. falciparum specific) and pLHD (P. vivax-spe- No malaria; Pf; Pv; Pf and Pv; invalid
cific)
Type 6
HRP-2 (P. falciparum specific), pLHD (pan-specific) and No malaria; Pf and Pv Po and/or Pm; Pf Po and/or
pLDH (P. vivax specific)
Pm; Pv Po or Pm; Po or Pm; invalid
Type 7
Aldolase (pan-specific)
Other
HRP-2 (P. falciparum specific) and pLDH (P. vivax spe- No malaria; Pf; Pv; Pf and Pv; invalid
cific)
No malaria; Pf, Pv, Po,or Pm; invalid
Table 2. Malaria zones by endemic parasite species and type of test appropriate for each
Zone
Endemic malaria parasites
Geographic area
Appropriate test type
P. falciparum only or other species almost Most of sub-Saharan Africa; lowland Tests using HRP-2 to detect P. falcialways as a mixed infection
Papua New Guinea
parum only
(Type 1)
Both P. falciparum and P. vivax, most Asia and the Americas; Ethiopian high- Combination RDTs which detect all
commonly as a single species
lands
species and distinguish between P. falciparum and P. vivax
(Types 2 to 6)
Non-falciparum only
Vivax-only areas of East Asia and Cen- Pan-specific or vivax-specific RDTs

tral Asia; some highland areas elsewhere (Type 7; Pan-pLDH only; vivax-pLDH
only)
184
Table 3. Number of studies by RDT type and reference standard
Type of RDT
Number of study cohorts (test evaluations) by reference standard

Microscopy
PCR
Non-falciparum species in the absence of P. falciparum

Type 2
11 (11)
0 (0)
Type 3
23 (25)
5 (5)
Type 4
10 (11)
1 (1)
Other type
1 (1)
0 (0)
Pf HRP2 and Pv pLDH
8 (9)
2 (3)
Type 6
0 (0)
1 (1)
P. vivax
Table 4. False negatives for non-falciparum and P. vivax by RDT type
Study
Test
Number of false nega- % false negatives indi- % false negatives inditives

cating no malaria
cating P. falciparum
Ashton 2010
ICT Combo
37
22
78
Bell 2001a
ICT Malaria trial 1
16
13
88
Bell 2001b
ICT Malaria trial 2
67
33
Fernando 2004
ICT Malaria Pf/Pv
29
100
Harani 2006
ICT Malaria Pf/Pv
67
33
Singh 2000a
ICT Malaria Pf/Pv
13
62
38
Singh 2010
Malascan
18
67
33
Tjitra 1999
ICT Malaria Pf/Pv
75
25
van den Broek 2006
NOW malaria ICT
72
67
33
ICT Malaria Pf/Pv
67
33
Type 2 tests
185
van den Broek 2006
OptiMAL-IT
34
(Continued)
74
26
Median (range)
67 (13 to 100)
33 (0 to 88)
Pooled estimate (95% CI)*
65 (43 to 81)
35 (19 to 57)
Type 3 tests
Ashton 2010
Carestart
37
22
78
Ashton 2010
Parascreen
43
14
86
Bendezu 2010
Parascreen
19
84
16
Bharti 2008
First response
100
Dev 2004
Diamed OptiMAL
100
Eibach 2013
CareStart
100
Elahi 2013
Parascreen
60
40
Kosack 2013
SD Bioline
133
89
11
Moges 2012
Carestart
38
89
11
Ratsimbasoa 2007
SD Malaria Antigen Bio- 4

line
100
Singh 2010
Parascreen
13
54
46
Singh 2010
First response
33
67
Singh 2010
ParaHIT Total
48
92
Trouvay 2013
SD Malaria Ag Pf/Pan
18
78
22
Yan 2013
Pf/Pan Device
24
25
75
Median (range)
84 (14 to 100)
16 (0 to 86)
Pooled estimate (95% CI)
74 (52 to 88)
26 (12 to 48)
Type 4 tests
Andrade 2010
OptiMAL-IT
Chayani 2004
OptiMAL
100
186
(Continued)
Dev 2004
SD Malaria
100
Kolaczinski 2004
OptiMAL
23
100
Metzger 2011
OptiMAL-IT
30
100
Pattanasin 2003
OptiMAL-IT
26
65
35
Ratsimbasoa 2007
OptiMAL-IT
100
Ratsimbasoa 2007
Carestart Malaria
33
67
Singh 2003
OptiMAL (field)
Soto Tarazona 2004
OptiMAL
100
Valecha 2003
OptiMAL
13
77
23
Median (range)
100 (0 to 100)
0 (0 to 67)
Pooled estimate (95% CI)
87 (79 to 92)
13 (8 to 21)
*The pooled estimates of the percentage of false negatives indicating no malaria and the percentage of false negatives indicating
P. falciparum were computed by using a random effects logistic regression model for Type 2 and Type 3. A fixed effects logistic
regression model was used for Type 4.
This table shows participants with non-falciparum malaria monoinfection identified by microscopy who were negative by non-falciparum monoinfection by RDT, by whether the RDT incorrectly identified the participant as not having malaria, or as having P.
falciparum malaria.
Table 5. Non-falciparum infections by RDT types verified by microscopy
RDT Type
Study cohort
Participants
Malaria cases
Pooled sensitivity
(95% CI) (%)
Pooled specificity
(95% CI) (%)
Test1
Type 2
11
6879
958
78 (73 to 82)
99 (97 to 99)
P = 0.008
Type 3
23
11,234
1537
78 (69 to 85)
99 (98 to 99)
Type 4
10
3831
986
90 (79 to 95)
98 (97 to 99)
Other type
262
12
92 (62 to 100)
95 (92 to 98)
Likelihood ratio test for evidence of a difference in sensitivity or specificity, or both, between Types 2, 3, and 4.
*Only one test brand (randomly selected) from each cohort is included in the analysis of each type.
187
Table 6. Comparisons of RDT types for non-falciparum infections verified by microscopy
Ratio of sensitivity
(95% CI),
P value for comparison
Ratio of specificity
(95% CI),
P value for comparison
Type 2
Type 3
Studies (participants)
11 (6879)
23 (11,234)
Studies (participants)
Sensitivity (95% CI)

Specificity (95% CI)
78 (73 to 82)
99 (97 to 99)
78 (69 to 84)
99 (98 to 99)
Type 2
11 (6879)
78 (73 to 82)
99 (97 to 99)
Type 3
23 (11,234)
78 (69 to 84)
99 (98 to 99)
1.00 (0.89 to 1.12), P = 1.00

1.00 (0.99 to 1.01), P =
0.87
Type 4
10 (3831)
90 (79 to 95)
98 (97 to 99)
0.87 (0.78 to 0.96), P = 0.87 (0.76 to 0.99), P =

0.01
0.03
1.00 (0.99 to 1.02), P = 1.01 (1.00 to 1.02), P =
0.52
0.29
We computed the ratio of sensitivities and specificities by division of the sensitivity and specificity for the column by the sensitivity
and specificity for the row. If the ratio of sensitivities is greater than one, the sensitivity of the test for the column is higher than
that for the row; if less than one, the sensitivity of the test in the row is higher than in the column. The same applies to the ratio of
specificities.
APPENDICES
Appendix 1. Search strategy
Search set
MEDLINE
EMBASE
Exp Malaria[MeSH]
Exp Malaria [Emtree]
Exp Plasmodium [MeSH]
Exp Plasmodium [Emtree]
Malaria ti, ab
Malaria ti, ab
1 or 2 or 3
1 or 2 or 3
188
(Continued)
Exp Reagent kits, diagnostics [MeSH]
Exp Diagnostic procedures [Emtree]
rapid diagnos* test* ti, ab
rapid diagnos$ test$ ti, ab
RDT ti, ab
RDT ti, ab
Dipstick* ti, ab
Dipstick$ ti, ab
Rapid diagnos* device* ti, ab
Rapid diagnos$ device$ ti, ab
10
MRDD ti, ab
MRDD ti, ab
11
OptiMal ti, ab
OptiMal ti, ab
12
Binax NOW ti, ab
Binax NOW ti, ab
13
ParaSight ti, ab
ParaSight ti, ab
14
Immunochromatograph* ti, ab
Immunochromatography [Emtree]
15
Antigen detection method*
Antigen detection method$
16
Rapid malaria antigen test*
Rapid malaria antigen test$
17
Combo card test* ti, ab
Combo card test$ ti, ab
18
Immunoassay [MeSH]
Immunoassay [Emtree]
19
Chromatography [MeSH]
Chromatography [Emtree]
20
Enzyme-linked immunosorbent assay [MeSH]
Enzyme-linked immunosorbent assay [Emtree]
21
Rapid test* ti, ab
Rapid test$ ti, ab
22
Card test* ti, ab
Card test$ ti, ab
23
Rapid AND (detection* or diagnos*) ti, ab
Rapid AND (detection$ or diagnos$) ti, ab
24
5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or
16 or 17 or 18 or 19 or 20 or 21 or 22 or 23
16 or 17 or 18 or 19 or 20 or 21 or 22 or 23
25
4 and 19
4 and 19
26
Limit 20 to Humans
Limit 20 to Human
189
Appendix 2. Data extraction: characteristics of included studies
Study ID
First author, year of publication.
Presenting signs and symptoms, previous treatments for malaria, clinical setting
Participants
Sample size, age, sex, comorbidities or pregnancy, country and locality, P. falciparum malaria endemicity, endemic malaria species, average parasite density in microscopy positive cases
Study design
Were consecutive patients enrolled retrospectively or prospectively?

Whether the sampling method was consecutive or random, or whether the method was not described
but consecutive sampling was most probable
If the study evaluated more than one RDT, how were tests allocated to individuals, or did each
individual receive all the tests?
Target condition
Malaria parasitaemia.
Reference standard
The reference standard test(s) used.

If microscopy was used, who performed it, and where?
If microscopy was used, how many high power fields were looked at?
If microscopy was used, how many observers or repeats were used?
If microscopy was used, how were discrepancies between observers resolved?
Index tests
The parasite species the test was designed to detect, the commercial name, and the type of test. Batch
numbers if provided. Transport and storage conditions. Details of the test operators, including any
special training provided
Notes
Source of funding.
Appendix 3. Data extraction and criteria for judgement: methodological quality
Quality indicator
Notes
Was the spectrum of patients representative of the spectrum of

Yes if the inclusion criteria clearly stipulated people
patients who will receive the test in practice?
attending an ambulatory healthcare setting with symptoms of
malaria, and the sampling method was consecutive or random.
No if the sample was unrepresentative of people with
uncomplicated malaria in general (for example, if the majority of
participants also had some other presenting health problem,
such as pneumonia). Where a proportion of potential
190
(Continued)
participants were excluded due to recent antimalarial use, well

defined comorbidities or pregnancy, the sample could be classed
as representative because these groups may also be excluded from
testing as normal clinical practice, depending on local policy and
practice.
Unclear if the source or characteristics of participants was
not adequately described; or if the sampling method was not
described.
Is the reference standard likely to correctly identify the target con Yes if microscopy was undertaken by experienced
dition?
microscopists with adequate laboratory facilities. Laboratory
facilities were assumed to be adequate unless the study report
indicated otherwise. Slides were viewed by at least two
independent observers, either for all slides or for those where
there are discordant results between the index and the reference
test. At least 100 microscopic fields were viewed before declaring
a slide negative.
Yes if reference standard was PCR.
No if microscopy was undertaken by insufficiently trained
individuals, by one individual only, or in a situation with
inadequate equipment, or if they viewed less than 100
microscopic fields before declaring negative.
Unclear if insufficient information was provided.
Is partial verification avoided?
Yes if all participants who received the index test also

received the reference test.
No if not all the participants who received the index test
also received the reference test.
Unclear if insufficient information was provided to assess
this.
If not all participants received the reference test, we reported how
many did not
Is differential verification avoided?
Yes if the same reference test was used regardless of the

index test results.
No if different reference tests were used depending on the
results of the index test.
If any participants received a different reference test, we reported
the reasons stated for this, and how many participants were involved
Is incorporation avoided? (the index test does not form part of the This should be Yes for all studies, as the reference standard is
reference standard)
defined in the inclusion criteria as microscopy or PCR
Are the reference standard test results blinded?
Yes if the person undertaking the reference test did not

know the results of the index tests, if the two tests were carried
out in different places, or it was clear that the reference test was
undertaken and the results recorded before the index test.
191
(Continued)
No if the same person performed both tests, or the results

of the index tests were known to the person undertaking the
reference tests.
Are the index test results blinded?
Yes if the person undertaking the index test did not know
the results of the reference tests, or if the two tests were carried
out in different places, or it was clear that the index test was
undertaken and the results recorded before the reference test.
No if the same person performed both tests, or the results
of the index tests were known to the person undertaking the
reference tests.
Were uninterpretable results reported?
Yes if the paper stated whether there were any

uninterpretable or invalid results, and how those were handled;
for example whether they were repeated until a valid result was
obtained, or excluded from the analysis.
No if the number of participants presented in the analysis
did not match the number of participants originally enrolled in
the study, and insufficient explanation was provided for any
discrepancy.
Unclear if uninterpretable or invalid test results were not
mentioned, but the number of participants presented in the
analysis corresponded to the number of participants reported to
be originally recruited into the study, or if insufficient
information was given to permit this judgement; for example if
the original number of participants recruited into the study was
unclear.
We reported how many results were uninterpretable (of the total)
and how these were handled in the analysis
Were any withdrawals explained?
Yes if it was clear that no participants were excluded from

the analysis (the number participants originally enrolled was
clearly stated, and corresponded to the number presented in the
analysis) or if exclusions were adequately described.
No if there were participants missing or excluded from the
analysis and there was no explanation given; usually where the
number of participants reported to have been enrolled and the
number presented in the analysis did not correspond.
Unclear if not enough information was given to assess
whether any participants were excluded from the analysis; for
example if the original number of participants recruited into the
study was unclear.
We reported how many participants were excluded from the analysis
192
Appendix 4. Direct comparisons between test types
Study
Sensitivity (true positives/ DifferP value

malaria cases) (%)
ence (95%
CI) (%)
Specificity (true negatives/ Difference

P value
non-cases) (%)
(95% CI)
(%)
Type 2 versus Type 3

Type 2
Ashton
2010
Type 3
Type 2
85
(209/ 85
(209/ 0 (-6.3 to 6. P = 1.00
246)
246)
3)
Type 3
96 (2052/ 96 (2060/ 0 (-1.5 to 0.8 P = 0.58

2137)
2137)
)
Eibach 2013 80 (4/5)
60 (3/5)
20.0 (-35.4 P = 1.00

to 75.4)
99
722)
(716/ 99
722)
(718/ 0 (-1.1 to 0. P = 0.75

6)
Singh 2010
77 (44/57)
-8.8 (-25.0 P = 0.40

to 7.5)
98
315)
(308/ 98
315)
(309/ 0 (-2.5 to 1. P = 1.00

9)
68 (39/57)

Type 2
Type 4
Type 2
van
den 75
(217/ 88
(256/ -13.1 (-19.4 P < 0.001
Broek 2006 291)
292)
to -6.8)
100
605)
Type 4
(604/ 99
604)
(598/ 0.8 (0 to 1.7) P = 0.07
Dev 2004
Type 3
Type 4
71 (5/7)
90 26/29
80 (12/15)
Ratsimbasoa 73 (11/15)
2007
Type 3
Type 4
-18.2 (-53.5 P = 0.24

to 17.0)
100 (23/23)
100
111)
-6.7 (-36.8 P = 1.0

to 23.5)
98
179)
(175/ 97
180)
(111/ 0 (Not es- Not

timable)
estimable
(175/ 0.50 (-2.7 to P = 1.0
3.8)
We presented the difference in sensitivities and specificities between test types compared within each study as percentages. If a study
evaluated more than one commercial brand of a test type on the same patients against the same reference standard, we randomly selected
one brand for the comparison of test types.
193
Appendix 5. Comparison of microscopy and PCR reference standards for non-falciparum infections
Test type, Microscopy

PCR
RDT brand
Number of NumSensiSpeciNumber of NumSensiSpecistudies
ber of par- tivity (95% ficity (95% studies
ber of par- tivity (95% ficity (95%
ticipants
CI) (%)
CI) (%)
ticipants
CI) (%)
CI) (%)
Type
4
3, CareStart
Pf/Pan
3544
74 (45 to 99 (96 to 1
91)
100)
179
91 (81 to 100 (97 to

97)
100)
Type
3, 14
Parascreen
5407
79 (67 to 98 (98 to 2
88)
99)
659
84 (70 to 99 (97 to
92)
100)
Type
1
3, One Step
Malaria Pf/
Pan
606
70 (58 to 99 (98 to 1
81)
100)
606
72 (60 to 97 (95 to
82)
98)
Type
3, 4
SD Malaria
Antigen Bioline
3769
80 (73 to 99 (98 to 1
85)
100)
196
64 (41 to 99 (97 to
83)
100)
Type 4, Op- 6
tiMAL
1843
90 (85 to 98 (97 to 1
93)
99)
313
88 (64 to 98 (96 to
99)
99)
WHATS NEW
Last assessed as up-to-date: 31 December 2013.
Date
Event
Description
16 April 2015
Amended
Errors in the number of malaria cases were corrected in the Summary of Findings table
194
CONTRIBUTIONS OF AUTHORS
The review authors jointly developed the protocol. Katharine Abba applied inclusion criteria, oversaw the data extractions and entered
the data. Yemisi Takwoingi, Sarah Donegan, Amanda Kirkham and Jon Deeks performed statistical analyses. All review authors
contributed to the final manuscript.
DECLARATIONS OF INTEREST
PG is Director of Evidence Building and Synthesis Research Consortium that receives money to increase the number of evidenceinformed decisions by intermediary organizations, including WHO and national decision-makers that benefit the poor in middleand low-income countries. PG is the coordinator of a WHO Collaborating Centre for Evidence Synthesis for Infectious and Tropical
Diseases; one of the Centres aims is to help WHO in its role as an infomediary in communicating reliable summaries of research
evidence to policy makers, clinicians, teachers, and the public in developing countries.
SOURCES OF SUPPORT
Internal sources
International Medical University, Malaysia.
Research grant ID 134/2007
Liverpool School of Tropical Medicine, UK.
External sources
Department for International Development, UK.
Research Programme Grant
DIFFERENCES BETWEEN PROTOCOL AND REVIEW

In the protocol, we considered RDTs for the detection of P. falciparum and non-falciparum malaria within one Cochrane Review.
However, it became apparent during production of the review that such a publication would be very large. For this reason we decided
to split results for the different target conditions into two separate Cochrane Reviews.
In the protocol, we stated that in the search for eligible studies we would contact test manufacturers to identify any unpublished studies,
handsearch conference proceedings and contact study authors and other experts for information on ongoing and unpublished studies.
However, due to the number of citations returned by our search (over 4000) and the large size of the reviews, we did not have the
resources to undertake any of these additional search methods, and the methods stated in the review reflect this.
Since the publication of the protocol, we added three additional exclusion criteria relating to study eligibility. We excluded studies if
the study authors used active case detection to recruit participants, as we felt the threshold of symptoms leading to testing may be lower
than for a self-selecting sample attending healthcare facilities and that this may influence the findings. We also excluded studies if they
did not present sufficient data to allow us to extract or calculate absolute numbers of true positives, false positives, false negatives and
true negatives, as we considered it would be distracting to the reader to present data on studies that did not contribute to the analyses.
Due to resource constraints, we excluded studies if they were written in non-English languages, or if they did not provide enough
information to enable a full assessment of their eligibility for the review.
195
INDEX TERMS
Medical Subject Headings (MeSH)
Antigens, Protozoan [ analysis]; Cohort Studies; Malaria [ diagnosis; immunology; parasitology]; Malaria, Vivax [ diagnosis; immunology]; Microscopy; Parasitemia [diagnosis]; Plasmodium [ immunology]; Plasmodium vivax [immunology]; Polymerase Chain
Reaction; Reagent Kits, Diagnostic [ parasitology]; Sensitivity and Specificity; Species Specificity
MeSH check words

Humans
196

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Test 26. P. vivax, microscopy, Pf HRP-2 and Pv pLDH, Falcivax. . . . .

[Diagnostic Test Accuracy Review]

Data collection and analysis

PLAIN LANGUAGE SUMMARY

Target condition being diagnosed

Microscopic examination of Giemsa-stained thick and thin blood

missed even by good quality microscopy; the limit of detection of

area; the WHO describes three zones (WHO 2005a) as shown in

Investigation of sources of heterogeneity

Criteria for considering studies for this review

Studies aimed to detect non-falciparum or P. vivax malaria. Where

Search methods for identification of studies

Searching other resources

Data collection and analysis

Data extraction and management

true negatives, false positives and false negatives in the form of

Assessment of methodological quality

Statistical analysis and data synthesis

evaluated on the same patients against the same reference standard,

Results of the search

Figure 1. Study flow diagram.

We therefore included a total of 37 study publications. One of the

Methodological quality of included studies

low in every study that reported this information (maximum 6%).

Pan (one). Sensitivities of the tests ranged from 25% to 100%;

Sensitivities of the tests ranged from 63% to 100%; specificities

Other test types

We summarised the comparison of different RDT types in Figure

Comparison of results verified by microscopy or PCR

Target condition: P. vivax

Eight studies evaluated the performance of Pf HRP-2 and Pv

Two studies evaluated the performance of three different brands of

Sensitivities of tests at different levels of P. vivax

Four studies presented additional data relating to the sensitivity

Three studies presented additional data relating to the sensitivity of

People presenting with symptoms suggestive of uncomplicated malaria

Conventional microscopy, polymerase chain reaction (PCR)

37 unique publications reporting 47 studies (22,862 participants)

specificity Prevalence (%) Consequences in a cohort of 1000

Target condition (reference standard): non-falciparum malaria (microscopy)

78% (73% to 82%)

78% (69% to 84%)

99% (97% to 99%)

99% (98% to 99%)

89% (79% to 95%)

98% (97% to 99%)

Target condition (reference standard): non-falciparum malaria (PCR)

81% (72% to 88%)

99% (97% to 99%)

95% (86% to 99%)

99% (99% to 100%)

Summary of main results