Evaluating the potential of using urine and saliva specimens for malaria diagnosis in suspected patients in Ghana
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Malaria Journal Open Access
RESEARCH
Evaluating the potential of using urine and saliva specimens for malaria diagnosis in suspected patients in Ghana Enoch Aninagyei1* , Joseph Abraham2, Paul Atiiga2, Shadrach Duodu Antwi2, Stephen Bamfo2 and Desmond Omane Acheampong2*
Abstract Background: This study aimed at detecting PfHRP2 and pLDH malaria antigens in urine and salivary specimens of suspected malaria patients using RDT kits, and identifying factors influencing the detection of these antigens. Methods: Malaria rapid test kit (SD Bioline RDT kit) was used to detect malaria antigens, PfHRP2 and pLDH, in blood, urine and saliva samples received from patients suspected of malaria. Subsequently, malaria parasitaemia was determined. From the same patients, body temperature readings and haemoglobin concentrations were recorded. Also, micro-haematuria and saliva occult blood were determined. Relative to blood, the sensitivities and the performance of urine and saliva as alternative samples were evaluated. Results: A total of 706 suspected malaria patients provided all three specimens. Prevalence of malaria by microscopy and RDT was 44.2% and 53.9%, respectively. Compared to blood, the sensitivities of urine and saliva were 35.2% and 57.0% respectively. Haemoglobin concentration 38.7 °C and occult blood influenced the detection of malaria antigens in both urine and saliva. Furthermore, the antigens were not detected in urine and saliva when parasitaemia was 12.5 g/dL, PfHRP2/ pLDH antigens were detected in 170 (44.6%) and 79 (20.7%) blood specimens. Over half of the salivary specimens were found to contain occult blood (52.2%), while only 29.4% of the urine samples were micro-haematuric. The overall mean temperature of the patients was 38.6 ± 0.72 °C. The distribution of the clinical findings among the four study sites are presented in Table 3. Sensitivities and specificities of urine and salivary specimens for detecting malaria antigens
Table 4 represents the diagnostic performance of urine and salivary specimens for diagnosing malaria. Compared to blood specimen, urine specimen was 35.2%
Table 2 Sample related prevalence of Plasmodium falciparum antigens in the study sites Sample type
Microscopy
Positive n (%)
Negative n (%)
Positive samples Kotoku (n = 161) n (%)
Mayera (n = 107) n (%)
Oduman (n = 250) n (%)
Pokuase (n = 188) n (%)
69 (42.8)
67 (62.6)
103 (41.2)
73 (38.8)
312 (44.2)
394 (55.8)
Total PfHRP2/pLDH detected
381 (53.9)
325 (46.0)
94 (58.4)
71 (66.4)
127 (50.8)
89 (47.3)
Only PfHRP2 detected
362 [95.0]a
89 [94.7]a
67 [94.3]a
120 [94.4]a
86 [96.6]a
Both PfHRP2/pLDH detected
19 [5.0]a
5 [5.3]a
4 [5.6]a
7 [5.5]a
3 [3.7]a
Rapid diagnostic test (blood)
Rapid diagnostic test (urine) Total PfHRP2/pLDH detected
134 (18.9)
27 (16.7)
31 (29.0)
39 (15.6)
37 (19.7)
Only PfHRP2 detected
119 [88.8]a
572 (81.1)
27 [100.0]a
27 [87.1]a
32 [82.0]a
33 [89.2]a
Both PfHRP2/pLDH detected
15 [11.2]a
0 [0.0]a
4 [12.9]a
7 [18.0]a
4 [10.8]a
Rapid diagnostic te
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