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

Williams, John E, Cairns, Matthew, Njie, Fanta, Quaye, Stephen Laryea, Awine, Timothy, Oduro, Abraham, Tagbor, Harry, Bojang, Kalifa, Magnussen, Pascal, terKuile, Feiko ORCID: https://orcid.org/0000-0003-3663-5617, Woukeu, Arouna, Milligan, Paul, Chandramohan, Daniel and Greenwood, Brian (2015) 'The Performance of a Rapid Diagnostic Test in Detecting Malaria Infection in Pregnant Women and the Impact of Missed Infections'. Clinical Infectious Diseases, Vol 62, Issue 7, pp. 837-844.

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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.

Item Type:	Article
Uncontrolled Keywords:	malaria in pregnancy, rapid diagnostic test, intermittent screening and treatment, Ghana
Subjects:	WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare WC Communicable Diseases > Tropical and Parasitic Diseases > WC 750 Malaria WC Communicable Diseases > Tropical and Parasitic Diseases > WC 765 Prevention and control WQ Obstetrics > Pregnancy > WQ 200 General works
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.1093/cid/civ1198
Depositing User:	Jessica Jones
Date Deposited:	28 Jan 2016 15:03
Last Modified:	15 Jun 2018 14:47
URI:	https://archive.lstmed.ac.uk/id/eprint/5550

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