Accuracy of immunochromatography diagnostic test versus microscopy in the diagnosis of malaria among clinically suspected patients in Jazan area, KSA

Background Malaria has been documented as a major health problem in Saudi Arabia, and it is highly endemic especially in the Southwest (Jazan and Asir). Its control is considered a challenge; hence proper diagnosis is essential for implementation of successful control programs. Accordingly, the diagnostic test used should be easy, rapid, and reliable, besides it must be accurate and cost effective. Objective This work aims to study reliability and diagnostic accuracy of an immunochromatographic test (ICT) using BinaxNOW ® malaria test compared to microscopical examination of blood film as gold standard for malaria diagnosis among clinically suspected patients in Jazan area, KSA. Methods A cross sectional prospective designed study was done for 200 patients with prolonged fever attending Jazan general hospitals. Venous blood samples were collected for both microscopic examination of Giemsa-stained thick and thin blood and rapid ICT (BinaxNOW ® ). Results Microscopic examination of Giemsa-stained blood smears revealed 64 out of 200 cases (32%) positive for Plasmodium spp.; 43 out of 64 (67.2%) were positive for P. falciparum ; 12 (18.7%) had mixed infection including P. falciparum ; and 9 (14.1%) belonged to other Plasmodium spp. of which 8 (12.5%) were P. vivax and one case (1.6%) was P. ovale . ICT showed 66 out of 200 (33%) cases with positive results for Plasmodium spp. and one sample gave an invalid result. The overall sensitivity and specificity of ICT were 97% and 96%, respectively. While for single P. falciparum infection sensitivity and specificity were 96.7% and 78%, respectively. Regarding Plasmodium spp. other than P. falciparum sensitivity was 91.6% and specificity was 100%. Conclusion The use of ICT complement to microscopy is of great value particularly in Jazan, KSA, where P. falciparum and P. vivax are the most prevalent Plasmodium spp. These methods help in expanding laboratory based diagnosis, and minimize malaria associated morbidity and mortality.