Use of a Histidine-Rich Protein 2-Based Rapid Diagnostic Test for Malaria by Health Personnel during Routine Consultation of Febrile Outpatients in a Peripheral Health Facility in Yaounde, Cameroon

The role of a rapid diagnostic test (RDT) in the case management of Plasmodium falciparum malaria infections has not been determined in Africa. Our study was conducted during November 2007-January 2008 to assess test accuracy of an RDT in the management of febrile outpatients in a peripheral urban health facility in Cameroon. We found the overall sensitivity to be 71.4% and a specificity of 82.2%; the positive predictive value and negative predictive value were 73.8% and 80.4%, respectively. False-negative and false-positive cases represented 11.8% and 10.5% of all febrile patients. Malaria alone (31.3%) was the first cause of fever; 33.5% of fever cases were of unknown origin. Acute respiratory infections were common among children 0-2 years of age (25.5%) and decreased with age. The risk of having a clinical failure with the presumptive treatment of febrile children was seven times greater than that of the RDT-oriented management (relative risk = 6.8, 95% confidence interval = 0.88-53.4, P = 0.03) because of the delay of appropriate treatment of non-malarial febrile illness. Our results suggest that the RDT may be of limited utility for children greater than five years of age and adults and that diagnosis based on microscopic examination of blood smears should be recommended for these patient populations, as well as in areas of low transmission.