Modelling the incremental benefit of introducing malaria to antenatal care in Africa

Walker, Patrick, Cairns, Matt, Slater, Hannah, Gutman, Julie, Kayentao, Kassoum, Williams, John E, O Coulibaly, Sheick, Khairallah, Carole, Taylor, Steve, Meshnick, Steven R, Hill, Jenny ORCID: https://orcid.org/0000-0003-1588-485X, Mwapasa, Victor, Kalilani-Phiri, Linda, Bojang, Kalifa, Kariuki, Simon, Tagbor, Harry, Griffin, Jamie T, Madanista, Mwayi, Ghani, Azra CH, Desai, Meghna and terKuile, Feiko ORCID: https://orcid.org/0000-0003-3663-5617 (2020) 'Modelling the incremental benefit of introducing malaria to antenatal care in Africa'. Nature Communications, Vol 11, p. 3799.

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Abstract

Plasmodium falciparum in pregnancy is a major cause of adverse pregnancy outcomes. We combine performance estimates of standard rapid diagnostic tests (RDT) from trials of intermittent screening and treatment in pregnancy (ISTp) with modelling to assess whether
screening at antenatal visits improves upon current intermittent preventative therapy with sulphadoxine-pyrimethamine (IPTp-SP). We estimate that RDTs in primigravidae at first antenatal visit are substantially more sensitive than in non-pregnant adults (OR=17.2, 95% Cr.I. 13.8-21.6), and that sensitivity declines in subsequent visits and with gravidity, likely driven by declining susceptibility to placental infection. Monthly ISTp with standard RDTs, even with highly effective drugs, is not superior to monthly IPTp-SP. However, a hybrid strategy, recently adopted in Tanzania, combining testing and treatment at first visit with IPTp-SP may offer benefit, especially in areas with high-grade SP resistance. Screening and treatment in the first trimester, when IPTp-SP is contraindicated, could substantially improve pregnancy outcomes.

Item Type:	Article
Subjects:	WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WC Communicable Diseases > Tropical and Parasitic Diseases > WC 750 Malaria WQ Obstetrics > Childbirth. Prenatal Care > WQ 175 Prenatal care
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.1038/s41467-020-17528-3
Depositing User:	Tracy Seddon
Date Deposited:	10 Aug 2020 14:20
Last Modified:	23 Sep 2020 09:15
URI:	https://archive.lstmed.ac.uk/id/eprint/14903

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