Performance of HRP2-based rapid test in children attending the health centre compared to asymptomatic children in the community.

Background: The Democratic Republic of the Congo (DRC) is one of the five countries carrying half of global malaria burden with children 0-5 years old being most at risk. Rapid diagnostic tests (RDTs) are currently routinely used for the detection of Plasmodium infection in health centres and may be a useful tool for population-based survey.

Methods: This study assessed, in a stable transmission zone of Kinshasa, whether a HRP2-based RDT matches the selection criteria of the National Malaria Control Programme (NMCP), DRC and assessed the most relevant fever threshold in this context.

Results: RDTs and microscopy were concordant in 84.3% and 83.4% children in the health centre and at the community level, respectively. The sensitivity was high (>95%), but the specificity was too low and lower in the community (66.9%; 95%CI: 58.5-75.2) compared to the HC (79.4%; 95%CI: 75.7-83.2). The estimated parasitic threshold of 5,414 parasites/μl was with a sensitivity of 63.3% and a specificity of 71.8% not very discriminative, and thus not a threshold.

Conclusion: HRP-based RDT gives a satisfactory proxy to estimate and monitor malaria endemicity, but the low specificity, far below the selection criteria of the NMCP, DRC is problematic for use in a clinical setting.