Harnessing Molecular Biotechnology to Optimize Malaria Diagnosisin Resource-Limited Settings

Authors

  • Jerome Nyhalah Dinga Michael Gahnyam Gbeugvat Foundation, Buea, Cameroon & Biotechnology Unit, University of Buea, Buea, Cameroon & Department of Biochemistry and Molecular Biology, University of Buea, Cameroon Author
  • Akum Yvonne Tita Department of Biochemistry and Molecular Biology, University of Buea, Cameroon Author
  • Marius Tincho Department of Biochemistry and Molecular Biology, University of Buea, Cameroon Author
  • Dieudonne Lemuh Njimoh Biotechnology Unit, University of Buea, Buea, Cameroon and Department of Biochemistry and Molecular Biology, University of Buea, Cameroon Author
  • Stanley Dobgima Gamua Department of Biochemistry and Molecular Biology, University of Buea, Cameroon Author
  • Vincent PK Titanji Biotechnology Unit, University of Buea, Buea, Cameroon and Department of Biochemistry and Molecular Biology, University of Buea, Cameroon Author

DOI:

https://doi.org/10.47363/JFMPM/2025(2)116

Keywords:

Malaria, RDT, Diagnosis, Microscopy, ELISA, PCR

Abstract

Background: Malaria remains a major cause of morbidity and mortality, particularly among children under five in endemic areas. It is caused by different species of the Plasmodium genus. The World Health Organization recommends thick blood smear microscopy as the standard diagnostic tool, but its sensitivity is limited, especially in cases of low parasitaemia, non-falciparum infections, and when performed by unskilled personnel. Misdiagnosis is common in endemic areas, complicating disease management. Early and accurate diagnosis is essential to prevent progression, reduce deaths, and limit transmission. This study aimed to compare the diagnostic accuracy of microscopy, rapid diagnostic tests (RDTs), ELISA, and PCR, using PCR as the reference standard.

Methods: A total of 274 participants were recruited from three health centers. Samples were tested using microscopy, RDT, ELISA, and PCR. Diagnostic performance metrics—including sensitivity, specificity, predictive values, likelihood ratios, kappa statistics, and accuracy—were calculated. Subgroup analyses were stratified by gender, age, body temperature, symptom status, and collection site.

Results: ELISA reported the highest malaria prevalence, followed by RDT, microscopy, and PCR, with statistically significant differences across methods (p = 0.0001). Microscopy showed good sensitivity (82.8%) and specificity (80.6%), with moderate agreement with PCR (κ = 0.60). RDT demonstrated the best diagnostic agreement with PCR (κ = 0.73), high specificity (93.7%), and strong positive predictive value (85.1%). It also showed the highest positive likelihood ratio (PLR = 12.21), making it reliable for confirming malaria cases. ELISA exhibited the highest sensitivity (98.9%) and negative predictive value (96.9%), but its low specificity (56.0%) indicates a risk of overestimating cases due to antibody persistence. Its low negative likelihood ratio (NLR = 0.02) supports its utility for ruling out infection.

Conclusion: RDT emerged as the most diagnostically balanced method, offering high agreement with PCR and strong specificity. Microscopy remains valuable in skilled settings, while ELISA is better suited for surveillance than acute diagnosis due to low specificity. An integrated diagnostic approach leveraging the strengths of each method can enhance malaria control strategies in endemic areas like Buea, Cameroon.

Author Biographies

  • Jerome Nyhalah Dinga, Michael Gahnyam Gbeugvat Foundation, Buea, Cameroon & Biotechnology Unit, University of Buea, Buea, Cameroon & Department of Biochemistry and Molecular Biology, University of Buea, Cameroon

    Jerome Nyhalah Dinga, Michael Gahnyam Gbeugvat Foundation, Buea, Cameroon & Biotechnology Unit, University of Buea, Buea, Cameroon & Department of Biochemistry and Molecular Biology, University of Buea, Cameroon

  • Akum Yvonne Tita, Department of Biochemistry and Molecular Biology, University of Buea, Cameroon

    Akum Yvonne Tita, Department of Biochemistry and Molecular Biology, University of Buea, Cameroon

  • Marius Tincho, Department of Biochemistry and Molecular Biology, University of Buea, Cameroon

    Marius Tincho, Department of Biochemistry and Molecular Biology, University of Buea, Cameroon

  • Dieudonne Lemuh Njimoh, Biotechnology Unit, University of Buea, Buea, Cameroon and Department of Biochemistry and Molecular Biology, University of Buea, Cameroon

    Dieudonne Lemuh Njimoh, Biotechnology Unit, University of Buea, Buea, Cameroon and Department of Biochemistry and Molecular Biology, University of Buea, Cameroon 

  • Stanley Dobgima Gamua, Department of Biochemistry and Molecular Biology, University of Buea, Cameroon

    Stanley Dobgima Gamua, Department of Biochemistry and Molecular Biology, University of Buea, Cameroon 

  • Vincent PK Titanji, Biotechnology Unit, University of Buea, Buea, Cameroon and Department of Biochemistry and Molecular Biology, University of Buea, Cameroon

    Vincent PK Titanji, Biotechnology Unit, University of Buea, Buea, Cameroon and Department of Biochemistry and Molecular Biology, University of Buea, Cameroon

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Published

2025-07-27

Issue

Vol. 2 No. 3 (2025): Volume 2 Issue 3

Section

Articles