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Clin Infect Dis. 2016 Apr 1;62(7):837-844. doi: 10.1093/cid/civ1198. Epub 2015 Dec 31.

The Performance of a Rapid Diagnostic Test in Detecting Malaria Infection in Pregnant Women and the Impact of Missed Infections.

Author information

Navrongo Health Research Centre, Ghana.
Faculties of Epidemiology and Population Health and Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, United Kingdom.
Medical Research Unit, Fajara, The Gambia.
Department of Community Medicine, Kwame Nkrumah University of Sciences and Technology, Kumasi, Ghana.
Department of Veterinary Disease Biology and Centre for Medical Parasitology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
Department of Clinical Sciences, Liverpool School of Tropical Medicine, United Kingdom.



Intermittent screening and treatment in pregnancy (ISTp) is a potential strategy for the control of malaria during pregnancy. However, the frequency and consequences of malaria infections missed by a rapid diagnostic test (RDT) for malaria are a concern.


Primigravidae and secundigravidae who participated in the ISTp arm of a noninferiority trial in 4 West African countries were screened with an HRP2/pLDH RDT on enrollment and, in Ghana, at subsequent antenatal clinic (ANC) visits. Blood samples were examined subsequently by microscopy and by a polymerase chain reaction (PCR) assay.


The sensitivity of the RDT to detect peripheral blood infections confirmed by microscopy and/or PCR at enrollment ranged from 91% (95% confidence interval [CI], 88%, 94%) in Burkina Faso to 59% (95% CI, 48%, 70% in The Gambia. In Ghana, RDT sensitivity was 89% (95% CI, 85%, 92%), 83% (95% CI, 76%, 90%) and 77% (95% CI, 67%, 86%) at enrollment, second and third ANC visits respectively but only 49% (95% CI, 31%, 66%) at delivery. Screening at enrollment detected 56% of all infections detected throughout pregnancy. Seventy-five RDT negative PCR or microscopy positive infections were detected in 540 women; these were not associated with maternal anemia, placental malaria, or low birth weight.


The sensitivity of an RDT to detect malaria in primigravidae and secundigravidae was high at enrollment in 3 of 4 countries and, in Ghana, at subsequent ANC visits. In Ghana, RDT negative malaria infections were not associated with adverse birth outcomes but missed infections were uncommon.


Ghana; intermittent screening and treatment; malaria in pregnancy; rapid diagnostic test

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