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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

1
Navrongo Health Research Centre, Ghana.
2
Faculties of Epidemiology and Population Health and Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, United Kingdom.
3
Medical Research Unit, Fajara, The Gambia.
4
Department of Community Medicine, Kwame Nkrumah University of Sciences and Technology, Kumasi, Ghana.
5
Department of Veterinary Disease Biology and Centre for Medical Parasitology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
6
Department of Clinical Sciences, Liverpool School of Tropical Medicine, United Kingdom.

Abstract

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

KEYWORDS:

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

PMID:
26721833
PMCID:
PMC4787605
DOI:
10.1093/cid/civ1198
[Indexed for MEDLINE]
Free PMC Article

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