Overview of diagnostic testing

Early and accurate diagnosis of malaria is essential for effective disease management and malaria surveillance. High-quality malaria diagnosis is important in all settings as misdiagnosis can result in significant morbidity and mortality.

WHO recommendations

WHO recommends prompt parasitological confirmation of diagnosis either by microscopy or malaria rapid diagnostic test (RDT) in all patients with suspected malaria before treatment is administered. The choice of method depends on local circumstances, including patient case-load, epidemiology of malaria, and availability of skilled laboratory technicians.

Parasite-based diagnostic testing of malaria improves the management of patients with febrile illnesses, particularly by helping to identify patients who do not have malaria and need different treatment. It may also help reduce the emergence and spread of drug resistance by reserving antimalarials for those who actually have malaria.

The benefit of parasitological diagnosis is dependent on health-care providers adhering to the test results in managing the patient. Where quality-assured parasitological diagnosis is promptly available, and in the absence of signs of severe disease, antimalarial treatment should be limited to test-positive cases while negative cases should be assessed for other causes of fever.

Rising number of suspected malaria cases receive diagnostic tests

The number of countries that have adopted and implemented policies for the parasite-based diagnosis of malaria is increasing. In 2013, 94 of 97 malaria-endemic countries reported that they had adopted the WHO recommendation to provide parasitological diagnosis for all age groups.

The volume of RDT sales to the public and private sectors of endemic countries increased from 46 million in 2008 to 319 million in 2013. The number of patients tested by microscopic examination increased to 197 million in 2013, with India accounting for over 120 million slide examinations.

Last updated: 25 March 2015

Key documents