following

Well, during my days at Caleb University. We were using microscope as our diagnotic tool for malaria and other microbes.

microscopes are effective but depending on the accurate functionality of the tool and the expertise skill of the technician or scientist.

**Disadvantages- are the facts that it is time consuming, and it demands high intellectual understanding of the use of a microscope. Not everyone then could operate a microscope. Before you can view anything under the microscope, you have to prepare the slide and stain to be able to detect microbes while viewing. All these were long processes. Therefore, this may have lower opportunity to be used in rural areas because of its complexity, population size and time factor.

**Advantages- it can also be importantly used in rural areas, because of the accuracy and the ability to detect difficult conscience results than the RDTs.

RDTs are the quickest ways to detect and diagnose malaria. It is something that could be easily operated. It can be home-based for everyone depending you understand the principles of how it works. It is also effective and time management. Therefore, this can be used in rural areas because it will be fast to attend to a large number of people. But it has its own limitations because of the fragility of the equipment. And it might not detect difficult conscience results...

(So, you make your choice I have given you the opportunity aspects that they both incure. And as well as the advantages and disadvantages for both equipments). Good luck.

Thank you very much William Seriki for the detailed explanations.

Dear Nanloh Samuel Jimam

I join you to say many thanks to Willian Seriki for the detailed explanations.

Let's me remember your question:

Microscopes and rapid diagnostics test (RDTs) sets: which is better for used in rural settings within malaria-endemic areas and why? Comments:The use of microscopes and RDTs approaches are recommended for malaria test. Considering the advantages and disadvantages of the two,which one do you think is more suitable for EFFECTIVE identification of presence of malaria parasites by rural health care practitioners .

My answer:

Reference: A preprint= a paper that has not been peer-reviewed

Citation: Preprints deposited in bioRxiv can be cited using their digital object identifier (doi).

Example: Tshima KG. 2019. What is the explanation for Plasmodium vivax malarial recurrence? Experience of Parasitology Unit of Kinshasa University Hospital of 1982-1983 and 2000-2009. bioRxiv doi: 10.1101/537027

Using this preprint that can be downoloaded for free, I will give my humble contribution on which method to choose in different settings:

• In Africa, Asia and South America:

- In rural areas: RDTs +++ , Microscopy ???

- In urban areas:

* if hospital structure (University Hospital): Microscopy +++, RDTs +++

* if research institute : Microscopy, RDTs, PCR

• In Europe and North America: Microscopy, RDTs and PCR.

A.1. A.2.A.3.= Comments on ??? Microscopy use in rural areas highlights the Advantages or interests and disadvantages or limitations of biological diagnosis of malaria access. According to the points A.1., A.2. and A.3. developed below: RDTs are more suitable for EFFECTIVE identification of presence of malaria parasites (only for P.falciparum) by rural health care practitioners

A.1.  Microscopy

ADVANTAGES

• Good sensitivity

• Determination of mixed infections

• Post-treatment evaluation

• Retrospective reading and quality control

DISADVANTAGES

• Qualified staff

• Color quality

A.2. Rapid diagnostic test (HRP-2 / Aldolase / pLDH)

Rapid diagnostic test (HRP-2 / Aldolase / pLDH)

DETECTION OF PARASITIC ANTIGENS

ADVANTAGES (INTERESTS)

• Rapid diagnosis

• Detection even in the event of sequestration

• Therapeutic treatment

DISADVANTAGES (LIMITS)

• No quantification

• Lower sensitivity for P.vivax, P.malariae and P.ovale

• Persistence of HRP-2 antigens after treatment

• Problem of quality control

• Heat

• Less sensitive in stable transmission zone

A.3. Detection of parasite genetic material (PCR)

INTERESTS (ADVANTAGES)

• Sensitive

• Specific

• Differentiation of species

• Diagnosis of re-infection and relapse and possibility of degenotyping

LIMITS (DISADVANTAGES)

• Costly

• Slow

• Contamination

• Specialized equipment

• Specialized staff, not available

• Not yet for routine diagnosis

TAKE HOME MESSAGE:

The reference method for the diagnosis of malaria is microscopy

• But the combination of microscopy and a rapid diagnostic test minimizes the risk of missing a vital diagnosis for the patient

• Biological diagnosis remains an important element for the patient under antimalarial to avoid the phenomenon of resistance.

TO REMEMBER:

What to remember

• Mandatory biological diagnosis for any suspicion of malaria

• More suspected cases in stable transmission but few cases diagnosed with microscopy

• Education of the population for obtaining in all the cases of fever a biological confirmation for a fast, early and adequate therapeutic process.

In ​​terms of public health

- to know the species of malaria in question

- to evaluate the malaria control strategy

- malaria eradication surveillance

- to avoid the misuse of antimalarial drugs Resistance

- Evaluating Efficacy of Treatment

- Cost

- Socio-Cultural Factors

If my answer is not clear, we can discuss more using the preprint that can be downoloaded for free at https://www.biorxiv.org/content/10.1101/537027v1.

In the preprint, I would like to study the environment factor in genetic of populations. I am interested on asian populations living in africa for a long period. I took the example of P.vivax that is more prevalent in Asia than in Africa, I would like to know its prevalence for a ten year period of 2000-2009 and later compare with 2010-2019 using surveillance data.

It is clear for me that I should use microscopy results.

Many thanks for your time.

Sincerely yours,

Guyguy.

Thank you very much Guyguy for your meaningful contribution.

I have learned a lot from it, and this has further opened my thinking into other areas of malaria research, especially in Africa.