**5. References**

168 Malaria Parasites

**3.3 Provision of centralised rapid diagnostic test centres for more efficient diagnosis**  To ascertain some degree of quality assurance and uniformity of results there is need to develop centralised RDT centres. These centres serve for purchase, transport, storage of RDTs kits as well as provide training for personnel that administer the tests at community level. It could serve as a reference laboratory since there are more highly skilled personnel and results of tests could be ascertained. Church et al (2003), describe such a centre which has supported and facilitated the RDT programme. Bastiaens et al (2011) have described results of researches carried on at such centres which showed improved diagnosis of malaria when government policy changed to implementation of testing before treatment in malaria. However, Derua et al (2011), describe in their study the perception of the users and health service providers which were dissimilar. Whereas the clinicians and patients were satisfied with the overall performance of the labs, the laboratory personnel expressed dissatisfaction over working conditions and some details of laboratory procedures. This signal is worth more investigation across regional centres so that the efforts gained would not be undermined. There is also noted that there is need to integrate these services into

Due to the limitations of the rapid diagnostic tests already noted, the RDTs are not the end in malaria diagnosis. Using Polymerase chain reaction (PCR) techniques some of the limitations have been overcome. Myjak et al (2002), describe PCR techniques that have been utilised to enhance malaria diagnosis in mixed infections and especially in patients with low parasite densities, while Patsoula et al (2003) reported a single step PCR based method to differentiate mixed infections and Ahmet et al ( 2010) have used nested PCR and Real-Time

Reliable enumeration of malaria parasites in thick blood film using digital analysis is also

Some workers have identified some other non malaria haematological indicators of the diagnosis and course of malaria (Ida E et al, 2007). Such include low levels of thrombocyte, leucocytes and coagulation factors II- VII-X as well as raised levels of C-reactive protein, lactate dehydrogenase and bilirubin. It is suggested that these could serve as markers of active disease as well as for monitoring during treatment and especially so when malaria

• There has been tremendous increase in research in malaria diagnosis in the last decade. • There should be an increased awareness and identification of congenital, neonatal and early infancy malaria especially in endemic areas. This also calls for closer monitoring

• Clinical algorithms for malaria diagnosis are not sensitive enough for predicting

existing healthcare services to ensure sustainability in the long run.

**3.5 Other non specific laboratory tests in malaria diagnosis** 

and care of the pregnant woman at risk of malaria infection

**3.4 Newer microscopic techniques** 

PCR for detection of *Plasmodium vivax.*

described by Frean (2009).

parasites are difficult to identify.

morbidity or mortality.

**4. Conclusion**


Current Issues in Clinical and Laboratory Diagnosis in Malaria 171

Mc Guinness, D; Koram, K; Bennett, S; Wagner, G; Nkrumah, F, Riley E. (1998). Clinical case

Mohapatra, M; Padhiary, K; Mishra, D; Sethy, G. (2002). Atypical manifestations of Plasmodium vivax malaria. *Indian Journal of Malariology*, Vol.39, No. 1-2, (Mar-Jun 2002), pp. 18-25 Molyneux, M.(1989) Malaria- clinical features in children. *Journal of the Royal Society* 

Murthy, G; Sahay, R; Srinivasan, V; Upadhaya, A; Shantaram, V; Gayatri, K. (2000). Clinical

Mukhtar, M; Lesi, F; Iroha, E; Egri-Okwaji M& Mafe A. (2006). Congenital malaria among

Myjak P ; Nahorski, W; Pieniazek, N; Pietkiewicz, H. Usefulness of PCR for Diagnosis of

Okwa,O. (2000). The status of malaria among infants aged 0-5 years in Lagos State, Nigeria. *Nigeria Quarterly Journal of Hospital Medicine,*Vol. 10, No.2, (2000), pp. 87-89 Okwa, O.& Ibidapo, A. (2010). The Malaria situation, perception of cause and treatment in a

2010), pp. 213-222 Available from: http://www.interesjournals.org/JMMS Olowu, A; Sowunmi, A & Abohweyere, A. (2000). Congenital malaria in a hyperendemic area: a revisit. *African Journal of Medicine & Medical Science, Vol.* 29, (2000), pp. 211–213 Orogade, A; Falade, C; Okafor, H; Mokuolu, O; Mamman, A; Tagbo, A; Ogunkunle, O; Ernest,

Orogade, A; Ogala, W & Aikhionbare, H. (2002) Asymptomatic Malaria Parasitaemia- a

Patsoula, E; Spanakos,G; Sofianatou, D; Parara, M;& Vakalis N. (2003). A single step, PCR –

Rougemont, P; Brenner, M; Moret, M; Breslow, N; Dumbo, M; Dolo, A; Soula, G; & Perrin

*Diseases, Vol. 21,* (2002), pp. 215–218 DOI 10.1007/s10096-001-0690-0 Ngasala, B; Mubi, M; Warsame, M; Petzold, M; Massele, A; Gustafsson, L; Tomson, G;

Vol. 92, No.5, (1998), pp. 527-531

52, (2006), pp. 19–23

*ofMedicine,* Vol. 82, Supplement No. 17, (1989), pp. 35

*Association,* Vol. 98, No. 4, (Apr 2000), pp. 160-162, 169.

*Malaria Journal,(* 2008), **7**:199 doi:10.1186/1475-2875-7-199

*Annals of African Medicine,* Vol. 3, No. 4, (2004), pp. 170 – 173

*Paediatrics*., Vol. 29, No.2, (July 2010), pp. 23-26

pp. 1292-1295

definitions for malaria: clinical malaria associated with very low parasite rates in African infants. *Transactions of The Royal Society Of Tropical Medicine And Hygiene,*

profile of falciparum malaria in a tertiary care hospital. *Journal of the Indian Medical* 

inborn babies at a tertiary centre in Lagos. *Nigeria Journal of Tropical Pediatrics,* Vol.

Imported Malaria in Poland. *European Journal of Clinical Microbiology & Infectious* 

Premji, Z.& Bjorkman A. (2008). Impact of training in clinical and microscopy diagnosis of childhood malaria on antimalarial drug prescription and health outcome at primary health care level in Tanzania: A randomized controlled trial.

Nigerian University. *Journal of Medicine and Medical Sciences,*Vol. 1, No.6, (July

K; Callahan, M.& Hamer, D. (2008). Clinical and laboratory features of congenital malaria in Nigeria. *Journal of Pediatric Infectious Diseases, Vol.* 3, (2008), pp. 181–187 Orogade, A. (2006). Malaria in febrile under six months old children in North Western Nigeria. *Proceedings of 27th African Health Congress,* Durban, South Africa,2006 Orogade, A. (2004). Neonatal Malaria in a mesodermic Malaria area of Northern Nigeria.

suitable index for evaluating Malaria Vector Control measures. *Nigerian Journal of* 

based method for detection and differenciation of Plasmodium vivax and P. Falciparum. *Annals of Tropical Medicine & Parasitology*, Vol. 97, No. 1, pp. 15-21 Rehlis, N. & Kurczewska M. (2001). Analysis of different clinical critaeria in malaria patients

in Papua New Guinea. *Wiadomości Parazytologiczne,*Vol.47, No.3, (2001), pp. 371-376

M. (2003). Epidemilogical basis for clinical diagnosis of childhood malaria in endemic zone in West Africa. *The Lancet,* Vol. 338, Issue 8778, (23 November 1991),


Falade, C; Mokuolu, O; Okafor H, Orogade,A et al. (2007).Epidemiology of

Gay- Andrieu, F; Adehossi, E; Lacroix, Veronique; Gagara, M; Ibrahim, L; Kourna, among

Gatti, S; Gramegna, M; Bisoffi, Z; Raglio, A; Gulletta, M; Klersy, C; Bruno, A; Maserati,

Gwer, S; Newton C. & Berkley J. (2007). Overdiagnosis and co-morbidities of severe malaria

Hussain, N; Echoga, A.& Iwarere O.(2009). Pattern of malaria presentation and treatment at

Ibhanesebhor, S. (1995). Clinical characteristics of neonatal malaria. *Journal of Tropical* 

Ida, E; Lasse, S; Vestergaard, Kirsten, M; Antia, M. & Bygbjerg I. (2007). Laboratory

Ikeh, E; Teclaire, N. (2008). Prevalence of malaria parasitaemia and associated factors in

Kamwendo, D; Dzinjalamala, F; Snounou, G. et al.(2002). Plasmodium falciparum: PCR

Khan, A; Mekan, S; Abbas, Z & Smego, R. (2005). Concurrent malaria and enteric fever in Pakistan. *Singapore Medical Journal,* Vol. 46, No.11, *(*2005), pp. 635-638 Lamikanra, O. (1993). A study of malaria parasitaemia in pregnant women, placentae, cord

Lehner, J; & Andrews, C. (1988). Congenital malaria in Papua New Guinea. *Transactions of The Royal Society Of Tropical Medicine And Hygiene,* Vol.82, (1988), pp. 822–826. Lowe, B; Jeffa, N; New, L; Pedersen, C; Engbaek, K& Marsh, K (1996). Acridine orange

Mc Gregor, I. (1986). Congenitally acquired malaria. *Post Graduate Doctor, Vol.* 2, (1986), pp. 52-56

Nigeria. *Nigeria Postgraduate Medical Journal, Vol.* 15, No. 2, pp.65-69 John, A. (2009). Reliable enumeration of malaria parasites in thick blood films using digital image analysis. In: *Malaria Journal,* (2009), 8:218 doi:10.1186/1475-2875-8-218 Keiser, J; Utzinger, J; Premji, Z; Yamagata, Y & Singer B. (2002). Acridine Orange for

children in Niamey, Niger. In: *Malaria Journal.* Available at:

*Hygiene,* Vol.77, No. 6, Suppl, (December 2007), pp. 6-13

*Research,* Vol. 27, No.1, (2009), pp. 120-127, ISSN1450-216X

*Health,* Vol. 12, No. 11,( 2007), pp.1-9

(2007), pp.195–204

12, (1993), pp. 213–217.

http://www.malariajournal.com/content/4/1/10

*Paediatrics,* Vol. 41, (1995), pp. 330–333

*Infectious Diseases,* Vol. 39, (2007), pp. 707-713

*Medicine and Parsitology,* Vol. 96, No. 7, pp. 643-654

*Tropical Medicine And Hygiene,* Vol. 96, (2002), pp. 145–149.

*Tropical Medicine And Hygiene,* Vol. 90, No.1, (1996), pp. 34-36

congenitalmalaria in Nigeria: a multicentre study. *Tropical Medicine and International* 

H;Boureima, H. (2005).Epidemiological, clinical and Biological features of malaria

R;Madama, S; Scaglia, M.& THE GISPI STUDY GROUP. (2007). A comparison of three diagnostic techniques for malaria: a rapid diagnostic test (NOWH Malaria), PCR and microscopy. *Annals of Tropical Medicine & Parasitology,* Vol. 101, No. 3,

in African children: a guide for clinicians. *American Journal of Tropical Medicine and* 

Obiesan Naval Medical Centre, Lagos- Nigeria. *European Journal of Scientific* 

indicators of the diagnosis and course of imported Malaria. *Scandinavian Journal of* 

febrile under-5 children seen in Primary Health care centres in Jos, North Central

malaria, the Diagnosis: its diagnostic performance; its promotion and implementation in Tanzania and implications for malaria control. *Annals of Tropical* 

detection and genotyping of isolates from peripheral, placental, and cord blood of pregnant Malawian women and their infants. *Transactions of The Royal Society Of* 

blood and newborn babies in Lagos, Nigeria. *West African Journal of Medicine,* Vol.

fluorescence techniques as alternatives to traditional Giemsa staining for the diagnosis of malaria in developing countries. *Transactions of The Royal Society Of* 


**Part 5** 

**Malaria Immunology** 


http://www.malariajournal.com/content/9/1/240

