Using the in-country reference standard, 50 samples (19%) were positive.
We evaluated the new dipstick RDT in comparison with an in-country reference standard of culture and/or multiplex PCR.
Of the 50 patients with CSF samples positive by the in-country reference standard and having information on all three classical clinical signs for meningitis (fever, headache and stiff neck), 18 (36%) had all three.
There were 265 CSF samples with either a positive or negative result for both the dipstick RDT and the in-country reference standard (Figure 2), from which we found dipstick RDT sensitivity to be 70% (95%CI 55 82), specificity 97% (95%CI 93 100), PPV 83% (95%CI 69 93) and NPV 93% (95%CI 89 96) (Table 1).
We evaluated the diagnostic performance of this dipstick RDT during an urban outbreak of meningitis caused by N. meningitidis serogroup A in Ouagadougou, Burkina Faso; first against an in-country reference standard of culture and/or multiplex PCR; and second against culture and/or a highly sensitive nested PCR technique performed in Oslo, Norway.
Using an in-country reference standard of culture and/or multiplex PCR, we show that dipstick RDT sensitivity at 70% (95%CI 55 82) was lower and specificity at 97% (95%CI 93 99) was substantially higher than found in an earlier dipstick RDT field evaluation using the same reference standard [89% (95%CI 80 95) and 62% (95%CI 48 75) respectively] [11].
However, the greater risk of contamination during the nested PCR is much higher, so this technique may not be feasible as part of an in-country reference standard, although samples could be transported to a supranational reference laboratory certified for this procedure, as was done in our study.
Innovations and experiences in remote programmes will be documented and made available for country reference and others in the field.
No "plug-and-play" and "end-to-end" NGS solutions exist that provide clinically relevant sequence data from the Mycobacterium tuberculosis complex genome from primary clinical samples (e.g., sputum) in high-burden country reference laboratories, which is where they are most needed.
The omitted country reference category in analyses is the U.S. Having data on each of the items, it provides a point of comparison for country differences across all of the attitudes.
The estimated risk for hospital-acquired infections in developing countries is 2 20× greater than that in industrialized countries (reference 64 in Technical Appendix).
