Thanks for these references - plus all the others I receive.

mRDTs are the way forward for improving the accuracy of diagnosis and correct treatment and is becoming even more important with the scale-up of iCCM for pneumonia and other causes of fevers. An area that think needs more research is the use of RDTs for elimination efforts, especially for mapping malaria parasite hotspots, active case detection, investigation and parasite clearance. MACEPA PATH are doing good work in Zambia on this - other places include the GIS work in South Africa. RDTs can be used even in endemic areas to focus malaria control investments in locations with highest malaria - e.g. 95% of malaria limited geographically to 5% of a district - so concentrate investments in this 5% makes sense!

The question is to what extent can RDTs help to find parasites in low prevalence settings? I suspect they would be very useful, especially with expanding CHW programs in many African countries. but there is still confusion - the Burkina Faso study in your list suggests it is better to do presumptive treatment during the none-transmission season.

The other gray area is too what extent to RDTs miss very low density "latent" parasite infections. PCR apparently shows that RDT negative people, can still be infected and therefore contribute to transmission - either at these low levels or during recrudescence

Note the latest paper in Malaria Journal where PCR tests are done on used RDTs to test the accuracy of ersults - at: http://www.malariajournal.com/content/12/1/106/abstract

The other question I have is: in typical rural settings which is more accurate at diagnosing malaria: RDTs or microscopy? A review is needed. I lean towards RDTs doing better than microscopy in the majority of areas in Africa.


Best regards,
Rory Nefdt