Comparison between the Diagnostic Performances of Rapid Diagnostic Test (RDT) using Advantage Malaria Card Pf/Pv Ag, Microscopy, and Polymerase Chain Reaction (PCR) in Malaria Suspected patients at the Merauke Regional General Hospital

Abstract

Malaria prevalence in Indonesia is still high, especially in eastern Indonesia, namely Papua, reaching a peak of 16%, for example, in Merauke. The diagnosis of Malaria is conducted according to the gold standard, using the microscopy method. However, it is still limited, raising the need for a Rapid Diagnostic Test (RDT) examination. This study aims to evaluate the diagnostic performances of Immunochromatography (ICT) based RDT (using Advantage Malaria Card Pf/Pv Ag), compared to the diagnostic performances of microscopy and Polymerase Chain Reaction (PCR).This cross-sectional observational study took all fever patients of outpatient and inpatient care at the Merauke Regional General Hospital (hereinafter referred to as RSUD Merauke) from June to July 2019 as the samples. The sample population included all malaria patients with positive microscopy results, and the control population included all non-malarial fever patients at RSUD Merauke. Each specimen underwent microscopy (thick and thin preparations), RDT, and Real-Time (RT)-PCR tests using a Rotor Gene-Q (Qiagen) with abTESTM malaria 5qPCR III reagent. The diagnostic performances of RDT were analyzed by calculating its sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV). The study was conducted on 105 samples, namely 55 malaria samples and 50 control samples, who underwent microscopy, RDT, and RT-PCR. RDT sensitivity to microscopy, P. vivax 100%, P. falciparum 89.5%; specificity of P. vivax 95.7%, P. falciparum 97.7%. RDT sensitivity to RT-PCR, P. vivax 53.5%, P. falciparum 48.6%; specificity of P. vivax 100%, P. falciparum 98.5%. The RDT p-value for microscopy and RT-PCR was p=0.000. RDT k-coefficient of microscopy, P. vivax 0.937, P. falciparum 0.871. RDT k-coefficient of PCR, P. vivax 0.427, P. falciparum 0.531. RDT is more sensitive to P. vivax than microscopy. RDT is more specific to P. vivax than RT-PCR. Further studies are suggested to discuss anti-malaria drug resistance and sequencing.