Sensitivity Concordance Between Rapid Diagnostic Tests and Thick Smears for Detecting Malaria at Sultan Cherif Kasser Hospital, N'Djamena Central Health District


Authors : Vourchakbé Joël; Amina Abakar Djato; Mahamat Béchir; Ousmane Issa Abdel Djalil

Volume/Issue : Volume 11 - 2026, Issue 1 - January


Google Scholar : https://tinyurl.com/292zjxys

Scribd : https://tinyurl.com/mvw74x5d

DOI : https://doi.org/10.38124/ijisrt/26jan1410

Note : A published paper may take 4-5 working days from the publication date to appear in PlumX Metrics, Semantic Scholar, and ResearchGate.


Abstract : Malaria is a parasitic infection transmitted to humans by insect bites. It remains the deadliest parasitic disease and is a major public health problem. The objective of this study was to evaluate the sensitivity of a rapid diagnostic test (RDT) compared to thick smear microscopy, considered the gold standard. Blood samples from 427 patients aged 1 to 86 years were examined using both RDTs and thick smears in the laboratory. Of the 427 participants, 382 had identical results, representing an overall concordance of 89.5%, including 182 (42.6%) true negatives (TS- RDT-) and 200 (46.8%) true positives (46.8%) (RDT+ and TS+). In 45 cases of overall discordance, the percentage was 10.5%, divided into 19 cases (4.4%) of false negatives (RDT- and TS+) and 26 (6.1%) of false positives (RDT+ and TS-). The most represented age group was 18–50 years, followed by 1–5 years. The sensitivity of the rapid diagnostic test (RDT) was 91.3%. The specificity of the RDT was 87.5%. The positive predictive value (PPV), representing the probability that a patient who tests positive is actually infected with malaria, was 88.5%, and the negative predictive value (NPV), indicating the probability that a patient who tests negative is actually uninfected, was 90.5%. RDTs and thick smears are diagnostic tools for malaria in Plasmodium patients and for assessing parasitemia in order to provide effective antimalarial treatment to patients. They are the main means of combating malaria. However, thick smears remain essential, particularly for quantifying parasitemia and identifying clinically suspected cases that may be negative on RDT.

Keywords : Malaria, Rapid Diagnostic Test, Thick Smear, Sensitivity, Specificity, Health District, N'Djamena, Chad.

References :

  1. WHO., (2024). WHO Chad Biennial Report 2022–2023. World Health Organization, Regional Office for Africa. Available at: https://www.afro.who.int [Accessed June 19, 2025].
  2. Mahittikorn A., Masangkay FR., Kotepui., Milanez GD.et Kotepui M. (2021). Quantification of the misidentification of Plasmodium knowlesi as Plasmodium malariae by microscopy: an analysis of 1569 P. knowlesi cases. Malaria. J, 20 : 179.
  3. Kotepui M., Masangkay FR., Kotepui KU., De Jesus Milanez G. (2020). Misidentification of Plasmodium ovale as Plasmodium vivax malaria by a microscopic method: a meta-analysis of confirmed P. ovale cases.  SCI. Rep, 10: 21807.
  4. WHO, (2021). Steps for performing the rapid diagnostic test for Plasmodium falciparum. [Online] Available at: https://www.who.int/fr/teams/global-malaria-programme/case-management/diagnosis/rapid-diagnostic-tests/falciparum-training-videos.
  5. WHO, (2022). Chemoprevention of seasonal malaria with sulfadoxine-pyrimethamine and amodiaquine for children: field guide (2nd ed.). Geneva: WHO, published November 23, 2022.
  6. WHO, (2023). Updated vaccination guidance: WHO recommends R21/Matrix-M vaccine for malaria prevention. Press release, October 2, 2023. Geneva: WHO. Available at: https://www.who.int/fr/news/item/02-10-2023-who-recommends-r21-matrix-m-vaccine-for-malaria-prevention-in-updated-advice-on-immunization.
  7. Dorkenoo A.M., Kouassi K.C., Afanyibo Y.G., Gbada K., Yakpa K., Têko M., Koura A.K., Katawa G., Adams, M. & Merkel, M., (2021). External evaluation of the quality of thick smears/blood smears for the diagnosis of malaria in the health districts of Lomé and Golfe in Togo. Tropical Medicine and International Health, 1(1), S1SQ-3476.
  8. Tembiné I., Sagara I., Sidibé D.M., Konate A., Coulibaly C.A., Zeguime A., Coulibaly M.B., Doucouré M., Sidibé S., Sogodogo B.S., SanogoV., Goïta I.S., Dicko F., and Dolo A., -2023). Performance of microscopists in the diagnosis of malaria at two university community health centers, Mali 2020 to 2021. Mali Public Health, 13(2), pp.73-78.
  9. Ngando L., Kenfack M., Médi Siké C., Ngo Nsintat D., Voundi E., and Same Ekobo A., (2024). Quality assurance of biological diagnostic tools for malaria in laboratories at four healthcare facilities in the city of Yaoundé. Health Sci. Dis., 25 (Suppl 3), pp.46-52. Available at: www.hsd-fmsb.org.
  10. Mercier V., Bailly É., Van Langendonck N., Chevallier E., Bernard L., and Desoubeaux G., (2020). Pitfalls and misuse of rapid diagnostic tests for routine malaria screening. Annales de Biologie Clinique, 78(2), pp.174-176. Available at : https://stm.cairn.info/revue-annales-de-biologie-clinique-2020-2-page-174.
  11. Traoré A., (2021). Epidemiology of severe malaria in children aged 3 months to 15 years in the pediatric ward of Mali Hospital before and after the scaling up of malaria chemoprevention. Doctoral thesis in medicine, University of Science, Technology, and Engineering of Bamako.
  12. Konan K.B., (2014). Evaluation of the FIRST RESPONSE® Malaria Ag. pLDH/HRP2 combo Test for rapid diagnosis of malaria in Abidjan (Ivory Coast). Doctoral thesis in Pharmacy, Félix Houphouët-Boigny University, Abidjan, Côte d'Ivoire. Available at: https://beep.ird.fr/collect/pha/index/assoc/1778-16/1778-16.pdf.
  13. Diallo, I. (2024). Evaluation of a rapid malaria diagnostic test compared to thick smear at the MRTC clinical trial site in Donéguébougou during the high malaria transmission season in 2023 (Thesis). USTTB.
  14. Available at https://fr.scribd.com/document649433037/Paludisme.
  15. PNLP Chad, (2023). Annual Activity Report 2022. Ministry of Public Health and Prevention, Republic of Chad.
  16. Sarrassat S., Toure M., Traore M., Diarra A., Coulibaly H., Arou A.Z., Tangara C.O., Muller G., Beier J.C., Vontas J., Bradley J., Traore S.F., Doumbia S. et Kleinschmidt I. (2025). Strategies to reduce residual malaria transmission in areas with high ITN coverage in southwestern Mali. Malaria Journal, 24 (1), Article PMC12243244.
  17. Kamaliddin C., Le Bouar M., Berry, A., Fenneteau O., Gillet P., Godineau N., Candolfi E. & Houzé S. (2020). Assessment of diagnostic methods for imported malaria in mainland France. Médecine et Maladies Infectieuses, 50(2), 141–160. DOI: 10.1016/j.medmal.2019.07.007.
  18. Ba H., Ahouidi A.D., Duffy C.W., Deh Y.B., Diedhiou C., Tandia A., Diallo, M.Y., Assefa, S., Lô B.B., Elkory M.B., and Conway D.J., (2017). Evaluation of the OptiMal-IT® pLDH rapid malaria diagnostic test at the edge of Plasmodium falciparum distribution in Mauritania. Bulletin de la Société de Pathologie Exotique, 110 (1), 31–37. https://doi.org/10.1007/s13149-017-0541-y.
  19. Touré O., (2020). Malaria infection in women giving birth and use of malaria prevention strategies during pregnancy in SAN. Doctoral thesis in medicine and doctorate in medicine. 19. 19. Magassa G., (2022). Study of the sensitivity and specificity of a diagnostic test (SD Bioline Malaria Ag Pf) in a low malaria transmission setting in Sirakorola, Mali. Doctoral thesis in pharmacy, University of Science, Technology, and Engineering of Bamako. [Online] Available at: <https://www.bibliosante.ml/handle/123456789/5374> [Accessed June 9, 2025].
  20. Zeleke M.T., Gelaye K.A., Hirpa A.A., Teshome, M.B., Guma, G.T., Abate B.T. (2023). Diagnostic performance of PfHRP2/pLDH malaria rapid diagnostic tests in élimination setting, northwest Ethiopia. PLOS Global Public Health, 3(7), e0001879. https://doi.org/10.1371/journal.pgph.0001879.
  21. Teou D.C., Dorkenoo A.M., Ataba E., Alidou S., Yakpa K., Abdou-Kerim A., Maman I., Agbonon A. (2023). Evaluation of the performance of Advantage P.f. Malaria Card® and Advantage Malaria Pan + Pf Card®, two rapid diagnostic tests for parasitological confirmation of malaria cases in Field situation in Togo. Parasites & Vectors, 16(1), 444. https://doi.org/10.1186/s13071-023-06062-y.
  22. Feleke D.G., Alemu Y.A. & Yemanebirhane N., (2021). Performance of rapid diagnostic tests, microscopy, loop-mediated isothermal amplification (LAMP) and PCR for malaria diagnosis in Ethiopia: a systematic review and meta-analysis. Malaria Journal, 20(1), p.380. doi :10.1186.
  23. Çulha G., Önlen Y., Çabalak M., Kaya T. & Küçükeser B. (2024). Investigation of Sensitivity of Rapid Diagnosis Tests in Patients with Suspected Malaria. Turkiye Parazitol Derg, 48(1), pp.1–7. DOI: 10.4274/tpd.galenos.2024.3835.
  24. Houngbedji c.A., N’Guessan R., Djohan V., Diakité s., Traoré K. et Bamba L., (2024). Evaluation of malaria microscopy diagnostic performance at 40 publique Health Facilities in Abidjan, côte d’ivoire in 2020.
  25. Sambe B.S., Zobrist S, Sheahan W., Soni D., Diagne A., Sarr I., Diatta AS., Diaw SOM., Golden A., Slater H., Jang IK., Roa N., Pal S., Sarr FD., Faye J., Vigan-Womas I., Dieye Y., Cisse M., Domingo GJ., Niang M. (2025). Performance and usability evaluation of three LDH-based malaria rapid diagnostic tests in Kédougou, Senegal. Parasites & Vectors, 18 :280. doi :10.1186/s13071-025-06914 Santé.
  26. Ogunfowokan O., Ogunfowokan B.A., Nwajei A.I. (2020). Sensitivity and specificity of malaria rapid diagnostic test (mRDT CareStat™) compared with microscopy amongst under five children attending a primary care clinic in southern Nigeria. African Journal of Primary Health Care & Family Medicine, 12 (1). Doi :10.4102/phcfm. v12i1.2212. License CC BY 4.0.
  27. Bruneel F., (2025). Malaria treatment. University Diploma in Anti-Infective Therapies, Grenoble Alpes University, March 19, 2025. Intensive Care and Resuscitation Department, Versailles Hospital. Available at: https://www.infectiologie.com/UserFiles/File/formation/du/grenoble/f-bruneel-versailles-paludisme-du-tai-grenoble-2024-2025.pdf.
  28. Domingo GJ., Niang M. (2025). Performance and usability evaluation of three LDH-based malaria rapid diagnostic tests in Kédougou, Senegal. Parasites & Vectors, 18 :280. doi :10.1186/s13071-025-0691.

Malaria is a parasitic infection transmitted to humans by insect bites. It remains the deadliest parasitic disease and is a major public health problem. The objective of this study was to evaluate the sensitivity of a rapid diagnostic test (RDT) compared to thick smear microscopy, considered the gold standard. Blood samples from 427 patients aged 1 to 86 years were examined using both RDTs and thick smears in the laboratory. Of the 427 participants, 382 had identical results, representing an overall concordance of 89.5%, including 182 (42.6%) true negatives (TS- RDT-) and 200 (46.8%) true positives (46.8%) (RDT+ and TS+). In 45 cases of overall discordance, the percentage was 10.5%, divided into 19 cases (4.4%) of false negatives (RDT- and TS+) and 26 (6.1%) of false positives (RDT+ and TS-). The most represented age group was 18–50 years, followed by 1–5 years. The sensitivity of the rapid diagnostic test (RDT) was 91.3%. The specificity of the RDT was 87.5%. The positive predictive value (PPV), representing the probability that a patient who tests positive is actually infected with malaria, was 88.5%, and the negative predictive value (NPV), indicating the probability that a patient who tests negative is actually uninfected, was 90.5%. RDTs and thick smears are diagnostic tools for malaria in Plasmodium patients and for assessing parasitemia in order to provide effective antimalarial treatment to patients. They are the main means of combating malaria. However, thick smears remain essential, particularly for quantifying parasitemia and identifying clinically suspected cases that may be negative on RDT.

Keywords : Malaria, Rapid Diagnostic Test, Thick Smear, Sensitivity, Specificity, Health District, N'Djamena, Chad.

Paper Submission Last Date
28 - February - 2026

SUBMIT YOUR PAPER CALL FOR PAPERS
Video Explanation for Published paper

Never miss an update from Papermashup

Get notified about the latest tutorials and downloads.

Subscribe by Email

Get alerts directly into your inbox after each post and stay updated.
Subscribe
OR

Subscribe by RSS

Add our RSS to your feedreader to get regular updates from us.
Subscribe