Paediatrica Indonesiana
VOLUME 48 July ‡
Original Article
Parascreen as an alternative diagnostic tool
for falciparum malaria
Jenny Ginting, Siska Mayasari, Munar Lubis, Syahril Pasaribu, Chairuddin P. Lubis
Abstract
Background Malaria is a parasitic disease with high morbidity
and mortality. Rapid immunochromatographic are emerging to
detect specific antigens of human plasmodia.
Objective To determine the sensitivity and specificity of Parascreen
for the detection of Plasmodium falciparum in children.
Methods A diagnostic test study was performed in Mandailing
Natal District, Penyabungan, North Sumatera. Subjects were
public health center and hospital patients with symptoms of fever,
pallor, headache, and diarrhea. Blood specimens were obtained for
Parascreen testing. Microscopy of Giemsa-stained blood samples
served as the gold standard.
Results One hundred and four subjects were studied. The sensitiv-
ity and specificity of Parascreen were DQGUHVSHFWLYHO\
3RVLWLYHDQGQHJDWLYHSUHGLFWLYHYDOXHVRIWKHWHVWZHUHDQG
UHVSHFWLYHO\/LNHOLKRRGUDWLRZDVLQILQLWHIRUDSRVLWLYHWHVW
and IRUDQHJDWLYHWHVW
Conclusion Parascreen is a useful and highly specific di-
agnostic tool for P. falciparum malaria [Paediatr Indones
2008;48:220-3].
Keywords: malaria, Plasmodium falciparum,
Parascreen, sensitivity, specificity
M
alaria remains a major health problem for
children in tropical areas of the world,
including Indonesia.(YHU\\HDU
million people are infected with malaria,
resulting in two million deaths. Most malarial
deaths occur in infants and young children.5,6 Malaria
220‡Paediatr Indones, Vol. 48, No. 4, July 2008
NUMBER 4
is caused by one or more of the four plasmodium
species that infect humans: Plasmodium falciparum,
Plasmodium vivax, Plasmodium ovale, and Plasmodium
malariae.7,8 Malaria due to P. falciparum is the most
common and most dangerous due to its ability to
cause fatal cerebral malaria.
Malaria presents a diagnostic challenge to
laboratories in most countries. Prompt and accurate
GLDJQRVLVLVWKHNH\WRHIIHFWLYHGLVHDVHPDQDJHPHQW
therefore, it is one of the main interventions of
the global malaria control strategy. Considered
as the gold standard, microscopic examination of
Giemsa-stained blood films is widely used because
of its efficiency and low cost. However, it is
time consuming and requires proper equipment and
trained personnel. The World Health Organiza-
tion has recognized the need to overcome problems
concerning diagnostic microscopy and supports the
development of non-microscopic alternatives.
Several diagnostic methods have been developed for
detection of the P. falciparum malaria disease process.
From the Department of Child Health, Medical School, University of
North Sumatera, H. Adam Malik Hospital, Medan, Indonesia.
Reprint requests to: Jenny Ginting, MD, Department of Child Health,
Medical School, University of North Sumatera, H.Adam Malik Hospital,
-O %XQJD /DX QR  0HGDQ ,QGRQHVLD 7HO  
)D[
 Jenny Ginting et al: Parascreen as an alternative diagnostic tool for falciparum malaria
Immunological methods for this purpose have been
found to be convenient and easy. Parascreen is an
immunochromatographic test (ICT) used for the
rapid diagnosis of malaria which has been marketed
for several years. However, the performance of
this test in the detection of P. falciparum malaria in
Indonesian children has not been established. This
study aims to determine the sensitivity and specific-
ity of Parascreen for the detection of P. falciparum in
children in Mandailing Natal District, Penyabungan,
North Sumatera.
Methods
A diagnostic test study was conducted in Mandailing
Natal District, Penyabungan, North Sumatera from
2FWREHUWR1RYHPEHU7KHVWXG\ZDVDSSURYHG
by the Health Reseatch Ethics Committee of the
A diagnosis of P. falciparumZDVPDGHLIWKH+53
line was visible, with or without the pan-malarial
antigen line.
'DWDZDVDQDO\]HGXVLQJ6366IRU:LQGRZV
(SPSS Inc., Chicago, Illinois, USA). The performance
of the Parascreen test for detection of P. falciparum was
determined by calculating the sensitivity, specificity,
positive and negative predictive values, and positive
and negative likelihood ratios of this test. Test ac-
curacy was defined as the proportion of subjects with
a correct Parascreen result, calculated as the sum of
true positives and true negatives divided by the total
number of subjects.
Results
One hundred and four subjects were recruited in this
study. Fifty-five percent of the subjects were female.
Medical School, University of North Sumatera. 0RVWVXEMHFWVZHUH\HDUVRIDJH7KHPRVW
The required number of subjects based on the FRPPRQFRPSODLQWZDVSDOORUDQGWKHPRVW
VDPSOH VL]H IRUPXOD IRU D GLDJQRVWLF WHVW ZDV  FRPPRQ SK\VLFDO ILQGLQJ ZDV VSOHQRPHJDO\ 
We included patients who came to the public health Subject characteristics are shown in Table 1.
center or hospital with symptoms of fever, pallor,
Table 15WDLGEVEJCTCEVGTKUVKE
headache, and diarrhea. Patients with history of re-
P 
ceiving any antimalarial drug within one week prior 5GZ
to commencement of the study and those who refused (GOCNG  
examination were excluded. Male  
#IG
[GCTU
The Parascreen test were done on all samples.   
Microscopy of Giemsa-stained thick and thin blood    
films were considered the gold standard. Parascreen    
%QORNCKPVU
testing as well as blood film preparation was performed 2CNNQT  
directly from finger-pricked blood samples. Blood films (GXGT  
ZHUHVWDLQHGZLWK*LHPVDVROXWLRQDQGH[DPLQHG *GCFCEJG  
&KCTTJGC  
DWDPDJQLILFDWLRQRI[E\DQH[SHUWPLFURVFRSLVW
2J[UKECNſPFKPIU
The microscopist was unaware of the patient’s diag- ,CWPFKEG  
nosis or Parascreen test result. The initial thick and *GRCVQOGICN[  
thin films were considered positive if parasites were 5RNGPQOGICN[  

VHHQLQDWOHDVWKLJKSRZHUILHOGV
3DUDVFUHHQ3DQ3IWHVW=HSK\U%LRPHGLFDO6\V- Results of the Parascreen test and blood slide
WHPV9HUQD*RD,QGLDZLWK—ORIILQJHUSULFNHG
capillary blood was performed according to the
manufacturer’s instructions by well-trained person-
nel. The results were read by designated physicians
who were blinded to the microscopy results. The
test was considered positive if the control line was
visible in accordance with the specific histidine-rich
PLFURVFRS\ZHUHXVHGWRFRQVWUXFWD[WDEOHTable
2). Based on microscopy results, the prevalence of P.
falciparumPDODULDZDV7KHVHQVLWLYLW\VSHFLILF-
ity, PPV, and NPV of the Parascreen test to detect
3 IDOFLSDUXP ZHUH    DQG 
UHVSHFWLYHO\7KHDFFXUDF\RIWKHWHVWZDV7KH
OLNHOLKRRGUDWLRZDVLQILQLWHIRUDSRVLWLYHWHVWDQG
SURWHLQ+53DQGRUSDQPDODULDODQWLJHQOLQH for a negative test.

Paediatr Indones, Vol. 48, No. 4, July 2008‡221

 Jenny Ginting et al: Parascreen as an alternative diagnostic tool for falciparum malaria

Table 2%QORCTKUQPDGVYGGP2CTCUETGGPCPFOKETQUEQR[TGUWNVU
/KETQUEQR[
P
2QUKVKXG 0GICVKXG
2QUKVKXG   
2CTCUETGGP
0GICVKXG   
P   

We calculated the sensitivity of the Parascreen —/VLPLODUWRWKHILQGLQJVRI.DNNLOD\D A study by

test at different levels of P. falciparum parasitemia Aslan et al4 showed that the colour intensity of a rapid
(Table 3). The test was not sensitive for parasitemia diagnostic test dipstick is induced by the parasitemia
OHVVWKDQ—O6HQVLWLYLW\LQFUHDVHGZLWKLQFUHDVLQJ level.
OHYHOVRISDUDVLWHPLDDQGUHDFKHGDWSDUDVLWHPLD In this study, we found that the Parascreen test
DERYH—O KDGDVHQVLWLYLW\RIDQGVSHFLILFLW\RI,Q
India, SinghIRXQGWKDW,&7PDODULD3I3YDQRWKHU
Table 35GPUKVKXKV[QHVJG2CTCUETGGPVGUVCVFKHHGTGPVNGXGNUQH2 rapid diagnostic test for malaria, had a sensitivity of
HCNEKRCTWORCTCUKVGOKC DQGVSHFLILFLW\RI3DOPHU similarly evalu-
.GXGNQHRCTCUKVGOKC
0WODGTQH ated the OptiMAL test, which had a sensitivity of
RQUKVKXG DQGVSHFLILFLW\RI,Q6XPED,QGRQHVLD

PWODGTQHRCTCUKVGU P 5GPUKVKXKV[
RGTz.DNQQF
2CTCUETGGP Tjitra found the sensitivity and specificity of ICT
VGUVU
PDODULD3I3YWREHDQGUHVSHFWLYHO\,Q
Ō   
    the same district as the present study, Desrinawati
Ō    HYDOXDWHG,&7PDODULD3I3YDQGIRXQGDVHQVLWLYLW\
Ō    RI  DQG VSHFLILFLW\ RI  -HOLQHN compared
OptiMAL with ICT malaria Pf using PCR as the gold
VWDQGDUGWKLVVWXG\IRXQGDVHQVLWLYLW\RIDQG
Discussion VSHFLILFLW\RIIRU,&7PDODULD3IDQGDVHQVLWLYLW\
RIDQGVSHFLILFLW\RIIRU2SWL0$/,Q:HVW
2IWKHSDWLHQWVZKRPHWWKHFDVHGHILQLWLRQIRU Nusa Tenggara, Arum et al found the sensitivity and
FOLQLFDO PDODULD  ZHUH IHPDOH 7KH DJH UDQJH VSHFLILFLW\RI,&7PDODULD3I3YWREHDQG
ZDVWR\HDUVPRVWVXEMHFWVZHUHWR\HDUV respectively.
old. In Nias, North Sumatera, Marletta et al found In this study, we found an increase of sensitivity
PDODULDWREHPRVWSUHYDOHQWLQWKHDJHJURXSRI ZLWKLQFUHDVLQJSDUDVLWHPLDOHYHOVUHDFKLQJLQ
years. The difference in malaria morbidity rates across SDUDVLWHPLD !—O ,Q 7KDLODQG &ROHPDQ et al
gender and age groups is caused by factors such as UHSRUWHG WKDW WKH VHQVLWLYLW\ RI ,&7 PDODULD 3I3Y
occupation, education, environment, population ZDVLQSDUDVLWHPLD•—OEXWRQO\LQ
migration, and immunity.9 SDUDVLWHPLD—O7MLWUDet al obtained a sensitiv-
The diagnosis of malaria is based on anamnesis, LW\RILQSDUDVLWHPLD!—OEXWRQO\LQ
physical examination, and laboratory findings. The SDUDVLWHPLD—O
gold standard for laboratory diagnosis of malaria is Sensitivity and specificity are constant indices of
detection of parasites on microscopic examination of diagnostic test performance uninfluenced by disease
thick and thin blood smears. However, this method prevalence and are used to derive likelihood ratios.
has several shortcomings, such as the need of a light In this study, the Parascreen test had a reasonably
microscope and a trained examiner. According to a good sensitivity and a high specificity, resulting in an
recent survey of laboratories in West Nusa Tenggara, infinite likelihood ratio for a positive test.
,QGRQHVLDRQO\RIWKHDQDO\VWVHYDOXDWHGZHUH :H FRQFOXGH WKDW ZLWK D VHQVLWLYLW\ RI 
able to read the blood smear properly. DQG VSHFLILFLW\ RI  3DUDVFUHHQ FDQ EH XVHG
In this study, false negative results were mostly as an alternative diagnostic tool for P. falciparum
IRXQGLQVXEMHFWVZLWKORZSDUDVLWHPLDOHYHOV malaria.

222‡Paediatr Indones, Vol. 48, No. 4, July 2008

 Jenny Ginting et al: Parascreen as an alternative diagnostic tool for falciparum malaria
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Paediatr Indones, Vol. 48, No. 4, July 2008‡223