|Malaria Diagnosis: New Perspectives (WHO - OMS, 2000, 57 p.)|
Prompt and accurate diagnosis is the key to effective disease management, one of the main interventions of the Global Malaria Control Strategy (1). It is thus of concern that poor diagnosis continues to hinder effective malaria control. This is due to a combination of factors, including non-specific clinical presentation of the disease, high prevalence of asymptomatic infection in some areas, lack of resources and insufficient access to trained health care providers and health facilities, and widespread practice of self-treatment for clinically suspected malaria.
One major contributing factor, however, is that the laboratory diagnosis of malaria has up to now relied nearly exclusively on microscopy, a valuable technique when performed correctly but unreliable and wasteful when poorly executed. A better utilization of microscopy and the development of alternative diagnostic techniques could substantially improve malaria control (2). Such objectives prove particularly relevant to the Roll Back Malaria initiative, a global movement that emphasizes better application of existing tools and the development of new ones.
Of great interest in this context is the development during the past ten years of rapid diagnostic tests (RDTs) for malaria using immunochromatographic test strips, which might offer a valid alternative to or complement microscopy (3). Various RDTs have been tested in clinical and field situations. Test kits have been marketed and have found limited use in some malaria control programmes, as well as in special situations such as complex emergencies, epidemics and the diagnosis of malaria in returning travellers. The overall results have been encouraging, and several manufacturers are currently developing improved kits and offering them on the global market. The strong market presence of such kits is illustrated by the fact that one manufacturer alone reports having introduced 3-6 million tests to date.
The time has thus come for serious consideration of how RDTs can most effectively be applied to the very diverse situations in which malaria occurs. To that effect, an informal consultation was convened in Geneva on 25-27 October 1999, bringing together the developers, manufacturers and potential users of RDTs, and representatives of other interested agencies, to discuss future actions to ensure their optimal deployment to control malaria.