{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T22:46:30Z","timestamp":1780094790843,"version":"3.54.0"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2021,1,28]],"date-time":"2021-01-28T00:00:00Z","timestamp":1611792000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,9,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Integrated community case management (iCCM) of malaria complements public health services to improve access to timely diagnosis and treatment of malaria. ICCM relies on standardized test-and-treat algorithms implemented by community health workers using malaria rapid diagnostic tests (RDTs). However, due to a changing epidemiology of fever causes in Africa, positive RDT results might not correctly reflect malaria. In this study, we modeled diagnostic predictive values for all malaria-endemic African regions as an indicator of the programmatic usefulness of RDTs in iCCM campaigns on malaria.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Positive predictive values (PPVs) and negative predictive values (NPVs) of RDTs for clinical malaria were modeled. Assay-specific performance characteristics stem from the Cochrane Library and data on the proportion of malaria-attributable fevers among African febrile children aged &amp;lt;5 years were used as prevalence matrix.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Average country-level PPVs vary considerably. Ethiopia had the lowest PPVs (histidine-rich protein II [HRP2] assay, 17.35%; parasite lactate dehydrogenase [pLDH] assay, 39.73%), and Guinea had the highest PPVs (HRP2 assay, 95.32%; pLDH assay, 98.46%). On the contrary, NPVs were above 90% in all countries (HRP2 assay, \u226594.87%; pLDH assay, \u226593.36%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>PPVs differed considerably within Africa when used to screen febrile children, indicating unfavorable performance of RDT-based test-and-treat algorithms in low-PPV settings. This suggests that the administration of antimalarials alone may not constitute causal treatment in the presence of a positive RDT result for a substantial proportion of patients, particularly in low-PPV settings. Therefore, current iCCM algorithms should be complemented by information on other setting-specific major causes of fever.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciaa1942","type":"journal-article","created":{"date-parts":[[2021,1,4]],"date-time":"2021-01-04T20:34:42Z","timestamp":1609792482000},"page":"e1158-e1167","source":"Crossref","is-referenced-by-count":10,"title":["Predictive Performance of Rapid Diagnostic Tests for Falciparum Malaria and Its Modeled Impact on Integrated Community Case Management of Malaria in Sub-Saharan African Febrile Children"],"prefix":"10.1093","volume":"73","author":[{"given":"Johannes","family":"Mischlinger","sequence":"first","affiliation":[{"name":"Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany"},{"name":"German Centre for Infection Research, Partner Site Hamburg-Luebeck-Borstel, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronika","family":"Dudek","sequence":"additional","affiliation":[{"name":"Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany"},{"name":"German Centre for Infection Research, Partner Site Hamburg-Luebeck-Borstel, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Ramharter","sequence":"additional","affiliation":[{"name":"Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany"},{"name":"German Centre for Infection Research, Partner Site Hamburg-Luebeck-Borstel, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,1,28]]},"reference":[{"key":"2021090721191627000_CIT0001","author":"World Health Organization","year":"2009"},{"key":"2021090721191627000_CIT0002","author":"World Health Organization","year":"2012"},{"key":"2021090721191627000_CIT0003","author":"World Health Organization","year":"2012"},{"key":"2021090721191627000_CIT0004","author":"World Health Organization","year":"2015"},{"key":"2021090721191627000_CIT0005","author":"World Health Organization","year":"2019"},{"key":"2021090721191627000_CIT0006","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1111\/tmi.13124","article-title":"Validity and reliability of methods to microscopically detect and quantify malaria 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