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J Infect Dis. 2015 May 1;211(9):1476-83. doi: 10.1093/infdis/jiu655. Epub 2014 Nov 26.

Mass screening and treatment on the basis of results of a Plasmodium falciparum-specific rapid diagnostic test did not reduce malaria incidence in Zanzibar.

Author information

Department of Microbiology and Tumor and Cell Biology.
Zanzibar Malaria Elimination Programme, Ministry of Health.
Global Health Group, University of California-San Francisco.
US President's Malaria Initiative and Centers for Disease Control and Prevention Tanzania Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
Swiss Tropical and Public Health Institute University of Basel, Switzerland.
RTI International, Dar es Salaam, Tanzania.
Department of Microbiology and Tumor and Cell Biology Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm Centre for Clinical Research Sörmland, Uppsala University, Sweden.



Seasonal increases in malaria continue in hot spots in Zanzibar. Mass screening and treatment (MSAT) may help reduce the reservoir of infection; however, it is unclear whether rapid diagnostic tests (RDTs) detect a sufficient proportion of low-density infections to influence subsequent transmission.


Two rounds of MSAT using Plasmodium falciparum-specific RDT were conducted in 5 hot spots (population, 12 000) in Zanzibar in 2012. In parallel, blood samples were collected on filter paper for polymerase chain reaction (PCR) analyses. Data on confirmed malarial parasite infections from health facilities in intervention and hot spot control areas were monitored as proxy for malaria transmission.


Approximately 64% of the population (7859) were screened at least once. P. falciparum prevalence, as measured by RDT, was 0.2% (95% confidence interval [CI], .1%-.3%) in both rounds, compared with PCR measured prevalences (for all species) of 2.5% (95% CI, 2.1%-2.9%) and 3.8% (95% CI, 3.2%-4.4%) in rounds 1 and 2, respectively. Two fifths (40%) of infections detected by PCR included non-falciparum species. Treatment of RDT-positive individuals (4% of the PCR-detected parasite carriers) did not reduce subsequent malaria incidence, compared with control areas.


Highly sensitive point-of-care diagnostic tools for detection of all human malaria species are needed to make MSAT an effective strategy in settings where malaria elimination programs are in the pre-elimination phase.


Plasmodium falciparum; Plasmodium malariae; Plasmodium ovale; Plasmodium vivax; Zanzibar; diagnostic tests; malaria elimination; mass screening and treatment; molecular methods; subpatent

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