The performance of a rapid diagnostic test in detecting malaria infection in pregnant women and the impact of missed infections.


Williams, JE; Cairns, M; Njie, F; Laryea Quaye, S; Awine, T; Oduro, A; Tagbor, H; Bojang, K; Magnussen, P; ter Kuile, FO; Woukeu, A; Milligan, P; Chandramohan, D; Greenwood, B; (2016) The performance of a rapid diagnostic test in detecting malaria infection in pregnant women and the impact of missed infections. Clinical infectious diseases , 62 (7). pp. 837-44. ISSN 1058-4838 DOI: 10.1093/cid/civ1198

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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.<br/> 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.<br/> 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.<br/> 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.<br/>

Item Type: Article
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Disease Control
Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Faculty of Infectious and Tropical Diseases
Research Centre: Malaria Centre
Centre for Maternal, Reproductive and Child Health (MARCH)
PubMed ID: 26721833
Web of Science ID: 374248700005
URI: http://researchonline.lshtm.ac.uk/id/eprint/2478716

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