Diagnostic Accuracy of Rapid Diagnostic Tests for Typhoid Fever among Patients in Ga West Municipality, Ghana
Michael Oppong Yeboah
*
Akramaman Health Centre, Ga West Municipal Health Directorate, Amasaman, Accra, Ghana.
Frank Bediako Agyei
Department of Nursing and Midwifery, University of Skills Training and Entrepreneurial Development, Mampong, Ghana.
Omosive Maduka
Department of Preventive and Social Medicine, University of Port Harcourt, Rivers State, Nigeria.
Oscar Vetsi
Department of Public Health, Disease Control Unit, Ghana Health Service, Ada West District, Sege, Ghana.
Samira Mastura Sulleman
Department of Population and Reproductive Health, Mana Mission Hospital, Accra, Ghana.
Jerdu Bin-eranaa Nuhu
Department of Public Health, School of Public Health, University of Port Harcourt, Port Harcourt, Nigeria.
John Kwame Agbenyeavu
Department of Public Health, School of Public Health, University of Port Harcourt, Port Harcourt, Nigeria.
Rebecca Tricia Morrison
Department of Population and Reproductive Health, University of Port Harcourt, Port Harcourt, Nigeria.
Boaz Ahulu
Department of Public Health, School of Public Health, University of Port Harcourt, Port Harcourt, Nigeria and Department of Public Health, Community Health Nursing Training College, Akim Oda, Ghana.
Benjamin Kwasi Amoako
Department of Public Health, Disease Control Unit, Assin Fosu Municipal Health Directorate, Assin Fosu, Ghana.
Abubakar Alhassan
Department of Public Health, Federal University of Health Sciences, Azare, Bauchi State, Nigeria.
Porbilla Ewura Ofosu-Apea
Department of Public Health, School of Public Health, University of Port Harcourt, Port Harcourt, Nigeria.
Richard Kwaku Essien
Department of Public Health, Abuakwa South Municipal Health Directorate, Ghana.
Eric Addo Owusu
Department of Population and Reproductive Health, University of Port Harcourt, Port Harcourt, Nigeria.
Dadia Stephen
Department of Public Health, Ghana Health Service, Kpandai District Health Directorate, Kpandai, Ghana.
*Author to whom correspondence should be addressed.
Abstract
Background: Typhoid fever remains a major public health challenge in many low- and middle-income countries, particularly in sub-Saharan Africa, where diagnostic limitations complicate the management of febrile illness. Rapid diagnostic tests (RDTs) are widely used as point-of-care tools in resource-limited settings, but concerns remain about their diagnostic accuracy in endemic settings.
Aim: This study assessed the diagnostic accuracy of RDTs for typhoid fever among febrile patients in Ga West Municipality, Ghana.
Methods: A quantitative cross-sectional design was used to recruit 284 febrile patients from health facilities in Ga West Municipality. Each participant underwent both RDT and blood culture testing, with blood culture serving as the reference standard. We calculated diagnostic accuracy parameters, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), and conducted hypothesis tests to assess diagnostic misclassification.
Results: The RDT showed an observed sensitivity (100%) and a negative predictive value of 100% in the study sample. However, specificity was poor (52.5%), and the positive predictive value was extremely low (5.8%), reflecting a substantial number of false-positive results. The diagnostic misclassification rate was 46.1%, and the reported hypothesis tests rejected all three null hypotheses (P<0.05).
Conclusion: Although the RDT showed high observed sensitivity in this sample, its poor specificity and low PPV make it unreliable for definitive typhoid diagnosis in this setting. The study recommends confirmatory testing for all positive RDT results and supports improvements in diagnostic algorithms to guide clinical decision-making and reduce inappropriate antibiotic use in febrile illness management.
Keywords: Typhoid fever, rapid diagnostic tests, sensitivity and specificity, diagnostic accuracy