comparison of pfhrp-2/pldh rdts with light microscopy in a low prevalence setting in southeastern iran, sistan and baluchestan: due to implementation of malaria elimination program

Background: the gold standard for diagnosing malaria in iran is using light microscopy; however, this method requires equip- ment, time and skilled microscopists. in some circumstances, rapid diagnostic test (rdts) can be a proper substitute. assessing the diagnostic performance of rdt relative to microscopy, for the diagnosis of malaria in southeastern iran, sistan and baluchestan, was the purpose of this study. methods: from march to july 2016, which was a peak transmission season in iran, 318 patients with suspected malaria were taken for a blood sample at the health center in saravan, in sistan and baluchestan province. the samples were surveyed instantly by light microscopy and rdt. comparison analysis included: sensitivity, specificity, positive and negative predictive values, and other diagnostic screening performance measures for detecting malaria infections. results: of the 318 malaria cases (6.6%), 21 were identified by a microscopy compared to 22 of 318 (6.9%) by rdt. rdt sensitivity and specificity for the diagnosis of malaria were 95.5% (77.2% - 99.9%, 95% ci) and 100% (98.8% - 100%, 95% ci), respectively, compared to standard microscopy, the sensitivity and specificity for vivax malaria were 100% (79.4-100%, 95% ci) and 99.7% (98.14% - 99.99%, 95% ci), and for falciparum malaria: 80% (28.4% - 99.5%, 95% ci) and 100% (98.8% - 100%, 95% ci). two tests showed an amazing agreement with a kappa estimation of 0.975. conclusions: the study proved that the rdt test performs appropriately for the identification of infections with p. falciparum and p. vivax malaria in cross-border malaria. moreover, the rdt can be a useful instrument for the identification of new clinical cases of malaria in this region.