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Malaria rapid diagnostic test (mRDT) kit is one of the techniques for diagnosing malaria. Due to its inherent advantages over the microscopy technique, several brands of the kit have flooded malaria endemic countries, without prior in-country evaluation. Two of such mRDT kits are Oscar (India) and Standard Q (Korea Republic). In this study, the performance of Oscar and Standard Q mRDT kits were compared to First Response (India) and CareStart (USA) mRDTs, which have been evaluated and deployed for use approved by the Ministry of Health (MOH). In this comparative study, whole blood samples were collected from patients suspected of malaria. Plasmodium falciparum was detected in each sample using nested polymerase chain reaction (nPCR), microscopy and the four mRDTs. The sensitivities, specificities, accuracies, positive and negative predictive values and accuracies of the mRDTs were determined using nPCR as a reference technique. Kappa statistic was used to determine the level of agreement among the techniques. Two hundred (200) blood samples were analyzed in this study. The overall detection rates of P. falciparum by microscopy, First Response, CareStart, Oscar-PfHRP2, Standard Q mRDT kits and nPCR were 31.5%, 34.5%, 33.5%, 32%, 31% and 43% (x2 = 6.1, p = 0.046), respectively. The accuracies of CareStart and First Response were comparable (90.5% vs. 89.5%). Further, comparing their sensitivities, Oscar-PfHRP2 was 74.4% (95% confidence interval (CI): 63.9–83.2) while that of Standard Q was 72.1% (95% CI: 61.4–81.2), with comparable accuracies (Oscar-PfHRP2–89% and Standard Q -88%). Apart from First Response that was 98.3% specific, the others were 100% specific. Kappa test revealed perfect diagnostic agreement (κ = 0.90–0.98) among the four mRDTs. That notwithstanding, Oscar-PfHRP2 agreed better with CareStart (κ = 0.94) and First Response (κ = 0.92) compared to the agreement between Standard Q and, CareStart (κ = 0.92) and First Response (κ = 0.90). Taken together, the diagnostic performance of the four mRDT kits were statistically similar. That notwithstanding, new mRDT kits should be evaluated prior to deployment for use. [ABSTRACT FROM AUTHOR]

[Display omitted] Ghana has been a pioneer in energy efficiency in the sub-Saharan region, becoming the first country to introduce minimum energy performance standards and energy labelling for lighting, air conditioners and refrigerating appliances in 2008. It also introduced an innovative and not yet widely adopted policy of banning the import of used air conditioners and refrigerating appliances, mostly from Europe. While the impact of this policy package has already been assessed in terms of energy savings in Ghana, it is still unclear whether the import ban on used products makes sense in terms of environmental impact. Ghana's ban may seem surprising given that current European product policies in the context of the Green Deal aim to extend the lifetime of products and encourage their reuse to make them more sustainable. In this paper, different scenarios covering new and used refrigerating appliances as well as different end-of-life management options were examined in a life cycle analysis. The results show that exporting used refrigerators from Europe to West Africa increases their environmental impact per functional unit in many categories, even if it extends the lifetime of the product. The informal end-of-life treatment of refrigerators by open burning has a massive impact on human toxicity. As energy consumption during the use phase is the main determinant of most environmental impacts, energy efficiency policies (minimum energy efficiency performance standards and labelling) combined with an import ban on used refrigerating appliances are the best approach to reduce these impacts. It is therefore recommended that the Ghanaian policy package be replicated in other countries in the region, but also that exporting countries take action, as the fight against environmental dumping is a shared responsibility. • Used refrigerators exported to West Africa increase greenhouse gas emissions. • Energy efficiency reduces the environmental impact of refrigerators. • Import ban on used refrigerating appliances is justified. • Informal end-of-life treatment of refrigerators has a major impact on human toxicity. [ABSTRACT FROM AUTHOR]