Malaria elimination in Ghana:recommendations for reactive case detection strategy implementation in a low endemic area of Asutsuare, Ghana

Background: Progress toward malaria elimination is increasing as many countries near zero indigenous malaria cases. In settings nearing elimination, interventions will be most effective at interrupting transmission when targeted at the residual foci of transmission. These foci may be missed due to asymptomatic infections. To solve this problem, the World Health Organization recommends reactive case detection (RACD). This case study was conducted to identify individuals with asymptomatic malaria, their predisposing risk factors and recommend RACD in Asutsuare, Ghana based on literature review and a cross sectional study. Methods: The study involved a search on PubMed and Google Scholar of literature published between 1st January, 2009–14th August, 2023 using the search terms “malaria” in “Asutsuare”. Furthermore, structured questionnaires were administered to one hundred individuals without symptoms of malaria and screened using rapid diagnostic test (RDT) kits, microscopy and real-time polymerase chain reaction (rt-PCR). Malaria prevalence based on the three diagnostic techniques as well as potential malaria risk factors were assessed through questionnaires in a cross-sectional study. Results: Cumulatively, sixty-four (64) studies (Google Scholar, 57 and PubMed, 7) were reviewed and 22 studies included in the literature on malaria in Asutsuare, Ghana. Significant risk factors were occupation, distance from a house to a waterbody, age group and educational level. Out of the 100 samples, 3 (3%) were positive by RDT, 6 (6%) by microscopy and 9 (9%) by rt-PCR. Ages 5–14.9 years had the highest mean malaria parasite densities of 560 parasites/µl with Plasmodium falciparum as the dominant species in 4 participants. Moreover, in the age group ≥ 15, 2 participants (1 each) harboured P. falciparum and Plasmodium malariae parasites. RDT had a higher sensitivity (76.54%; CI95 66.82–85.54) than rt-PCR (33.33%; CI95 4.33–77.72), while both rt-PCR and RDT were observed to have a higher specificity (92.55; CI95 85.26–96.95) and (97.30; CI95 93.87–99.13), respectively in the diagnosis of malaria. Conclusion: In Asutsuare, Ghana, a low endemic area, the elimination of malaria may require finding individuals with asymptomatic infections. Given the low prevalence of asymptomatic individuals identified in this study and as repleted in the literature review, which favours RACD, Asutsuare is a possible setting receptive for RACD implementation.</p

Performance of Antigen Detection Tests for SARS-CoV-2 in Ghana

&lt;p&gt;&lt;strong&gt;Abstract&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;RT-PCR, the gold standard for SARS-CoV-2 detection, remains expensive and requires highly trained laboratory personnel, which proves to be a challenge in resource-limited settings. Antigen-based rapid diagnostic tests (Ag-RDTs) are cheaper and have a short turnaround time, which is important in providing results for the identification and isolation of infected persons. However, independent evaluation of the holistic diagnostic performance of Ag-RDTs, including detection of variant-specific infection, is limited and necessitates this evaluation. We tested 268 nasopharyngeal specimens using RT-PCR and Ag-RDTs [Flourescence Immunoassay (FIA) and Lateral Flow Immunoassay (LFIA)] to detect SARS-CoV-2 infections, followed by viral load quantification. Variant identification was done using a PCR-based assay. Generally, FIA has higher sensitivity, positive predictive value, and accuracy than LFIA. However, LFIA has a higher specificity and negative predictive value than FIA. There was a strong agreement between the Ag-RDTs and RT-PCR. In asymptomatic cases, FIA has a higher sensitivity, PPV, and accuracy than LFIA. Furthermore, both Ag-RDTs had 100% sensitivity in cases with high viral load (Ct &lt;25). Although sensitivity is reduced at low viral loads (Ct &gt;30), FIA has higher sensitivity than LFIA. In infections associated with the Alpha variant, FIA has better sensitivity than LFIA, and vice versa for Delta variant infections. However, both Ag-RDTs have 100% sensitivity for detecting Omicron infections. Ag-RDTs performed well with respect to the WHO criteria for antigen test usage and offer prospects of increased testing capacity in a pandemic at a relatively low cost. Both Ag-RDTs perform excellently in patients with high viral loads and infections associated with the Omicron variant relative to the other VOCs (Alpha and Delta variants). However, FIA has better sensitivity in asymptomatic patients. Notwithstanding this, results should be interpreted in conjunction with other clinical parameters.&lt;/p&gt