Digital microscopy and artificial intelligence could profoundly contribute to malaria diagnosis in elimination settings
Hans‐Peter Beck · Frontiers in Artificial Intelligence · 2022
Malaria, transmitted by female Anopheles mosquitoes, is caused by the apicomplexan parasite of the genus Plasmodium of which five infect humans, namely Plasmodium falciparum, P. vivax, P. ovale, P, malariae, and P. knowlesi.It is a life threatening disease of tropical countries around the globe, and more than 600,000 deaths occurred in 2020 (WHO, 2021).More than 80 percent of deaths occur in young children in sub-Saharan Africa mostly caused by the life threatening P. falciparum.In general, most deaths from malaria occur in Sub-Saharan Africa (96%) whilst the South-East Asia region accounts for 2.2% of fatal cases and the Eastern European countries for 2.5%.There is also malaria in the Western Pacific region and in the Americas with Brazil having the highest incidence rate (WHO, 2021).Action for malaria elimination is increasing and in 2021 already 40 previously malaria-endemic countries reported no malaria cases , which is a clear indicator of a move forward to malaria elimination.This success has been possible due to a number of factors but mainly due to distribution of bed nets, availability of effective drugs [artemisinin combination therapy (ACT)] and an improvement of diagnosis by the introduction of rapid diagnostic tests (RDTs).WHO defines three pillars on which elimination is based on: vector control, rapid and accurate diagnosis, and the availability of rapidly acting effective drugs.There are numerous strategies and possibilities to control the mosquito population with various degrees of success.There are highly effective drugs available [albeit under threat of the development of reduced susceptibility to the currently used artemisinine-combination therapy (Dondorp et al., 2011;Ouji et al., 2018)] contributing to the significant reduction of malaria in endemic areas over the last decade.These drugs are still effective in Africa (Conrad and Rosenthal, 2019) but partial resistance is occurring (Ward et al., 2022) and might have contributed to the recent increase in deaths in 2020 (WHO, 2021).For diagnosis WHO recommends "prompt parasite-based diagnosis by microscopy or malaria rapid diagnostic test (RDT) in all patients suspected of malaria before antimalarial treatment is administered.Light microscopy entails visualization of the malaria parasites in a thick or thin smear of the patient's blood" (WHO, 2017).https://www.who.int/teams/global-malaria-programme/elimination/countries-and-territories- certified-malaria-free-by-who (accessed last . .).