Malaria screening

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2], Marjan Khan M.B.B.S.[3]

Overview

Screening of malaria is important in Sub-Saharan refugees and blood donors.^[1]

Screening for malaria infection is important in:^[1]

Sub-Saharan refugees
- A sub-optimal alternative to presumptive therapy is to test newly arriving for malaria infection.
- Studies have demonstrated that a single malaria thick-and-thin blood smear lacks sensitivity for detecting asymptomatic or sub-clinical malaria in these populations.
- Three separate blood films taken at 12 to 24 hour intervals, the standard recommendation for diagnosis of clinical malaria, has a greater sensitivity. However, this approach is rarely feasible for screening newly arriving refugee populations because of cost constraints and the need for multiple visits.
- When a refugee does not receive presumptive therapy they should be monitored for signs or symptoms of disease, particularly during the initial 3 months after arrival, regardless of the post-arrival testing results.

Blood donors
- Studies using PCR test for the screening of malaria in blood donors are being conducted.^[2]

In 1968, the World Health Organization published guidelines for the establishment of a screening program that can be summarized in 10 principles:

The disease should be an important health problem.
The natural history of the disease should be understood adequately.
A latent stage of the disease occurs.
A test for the disease is available.
The test is acceptable to the population.
Treatment for the disease exist.
facilities for diagnosis and treatment are available.
A policy about who to treat has been agreed on.
Case finding costs should be considered in relation to medical expenditure as a whole.
Case finding should be organized as an ongoing process rather than a one-time only project.

These guidelines form the theoretic basis of most screening programs including malaria that are currently in use.