Project Lead(s): Isaac Bogoch
Despite intensified control efforts, an estimated of 438,000 people died of malaria in 2015 with 90% of these deaths occurring in sub-Saharan Africa, and the others in South-East Asia and South America.
The World Health Organization (WHO) announced a “T3: Test, Treat, Track” initiative on World Malaria Day in 2012, with the goal of scaling up diagnostic, treatment and surveillance systems in malaria-endemic countries.
A central tenet of this initiative revolves around universal access to quality malaria diagnostics, with both rapid diagnostic tests (RDTs) and microscopy.
Unlike RDTs, microscopy has the capability to speciate and quantify malaria diagnoses, but issues surround the general lack of availability, poor maintenance of microscopes and training of microscopists in malaria-endemic zones.
Handheld light microscopy, using compact optics and mobile phones, may improve the quality of healthcare in resource-constrained settings by enabling access to prompt and accurate diagnostic tools.
The goal of the project was to use handheld and mobile phone microscopes for the diagnoses of malaria, schistosomiasis and intestinal protozoa infections, and to test in ‘real world’, public health settings.
The aim was to provide portable, quality laboratory testing in rural, remote or under-serviced settings, rather than transferring ill individuals or specimens to distant reference laboratories.
Local laboratory technicians were trained to operate two handheld diagnostic devices (the Newton Nm1 microscope with an attached mobile phone and a clip-on version of the mobile phone-based Cell Scope).
The Newton Nm1 with a mobile phone attachment was compared to conventional light microscopy for the detection of Plasmodium falciparum in a cross-sectional study in rural Côte d’Ivoire.
Single Giemsa-stained thick blood film from 223 individuals were prepared and read by local laboratory technicians on both microscopes under 1,000× magnification with oil. Of the 223 samples, 162 (72.6%) were P. falciparum positive. Sensitivity and specificity were 80.2% and 100% respectively.
The study demonstrated that the Newton Nm1 handheld microscope with a mobile phone attachment has excellent operating characteristics, as used by Ivorian laboratory technicians with a half-day of training.
The team was able to train these technicians on how to use these devices to make diagnoses without support from the research team.
The local laboratory technicians felt that they would be able to implement the use of these devices in their day-to-day work; the handheld microscope with a mobile phone attachment could be integrated into routine use for a community-based malaria screening program to provide accurate diagnoses.
Knowledge of the project has been published and the team has applied for further funding to carry out further validation studies.