The online version of this article (doi:10.1186/1475-2875-11-211) contains supplementary material, which is available to authorized users.
All authors declare no any conflict of interest.
DTRM, CS, JL, TT, AS, ML, PD, AJFL and MA designed the study. DTRM, JL, CS, MO, SB, CP, DJ, PM, DA and MA conducted the study and participated in the laboratory analyses. DTRM drafted the manuscript. All authors reviewed the manuscript and provided critical inputs. All authors read and approved the final manuscript.
Accurate diagnosis and prompt treatment of pregnancy-associated malaria (PAM) are key aspects in averting adverse pregnancy outcomes. Microscopy is the gold standard in malaria diagnosis, but it has limited detection and availability. When used appropriately, rapid diagnostic tests (RDTs) could be an ideal diagnostic complement to microscopy, due to their ease of use and adequate sensitivity in detecting even sub-microscopic infections. Polymerase chain reaction (PCR) is even more sensitive, but it is mainly used for research purposes. The accuracy and reliability of RDTs in diagnosing PAM was evaluated using microscopy and PCR.
A cohort of pregnant women in north-eastern Tanzania was followed throughout pregnancy for detection of plasmodial infection using venous and placental blood samples evaluated by histidine rich protein 2 (HRP-2) and parasite lactate dehydrogenase (pLDH) based RDTs (Parascreen™) or HRP-2 only (Paracheck Pf® and ParaHIT®f), microscopy and nested Plasmodium species diagnostic PCR.
From a cohort of 924 pregnant women who completed the follow up, complete RDT and microscopy data was available for 5,555 blood samples and of these 442 samples were analysed by PCR. Of the 5,555 blood samples, 49 ((proportion and 95% confidence interval) 0.9% [0.7 -1.1]) samples were positive by microscopy and 91 (1.6% [1.3-2.0]) by RDT. Forty-six (50.5% [40.5 - 60.6]) and 45 (49.5% [39.4 – 59.5]) of the RDT positive samples were positive and negative by microscopy, respectively, whereas nineteen (42.2% [29.0 - 56.7]) of the microscopy negative, but RDT positive, samples were positive by PCR. Three (0.05% [0.02 - 0.2]) samples were positive by microscopy but negative by RDT. 351 of the 5,461 samples negative by both RDT and microscopy were tested by PCR and found negative. There was no statistically significant difference between the performances of the different RDTs.
Microscopy underestimated the real burden of malaria during pregnancy and RDTs performed better than microscopy in diagnosing PAM. In areas where intermittent preventive treatment during pregnancy may be abandoned due to low and decreasing malaria risk and instead replaced with active case management, screening with RDT is likely to identify most infections in pregnant women and out-performs microscopy as a diagnostic tool.
Authors’ original file for figure 112936_2012_2189_MOESM1_ESM.jpeg
Mayor A, Serra-Casas E, Bardaji A, Sanz S, Puyol L, Cistero P, Sigauque B, Mandomando I, Aponte JJ, Alonse PL, Menendez C: Sub-microscopic infections and long-term recrudescence of Plasmodium falciparum in Mozambican pregnant women. Malar J. 2009, 8: 9-10.1186/1475-2875-8-9. PubMedCentralCrossRefPubMed
Reyburn H, Mbatia R, Drakeley C, Carneiro I, Mwakasungula E, Mwerinde O, Sangada K, Shao J, Kitua A, Olomi R, Greenwood BM, Whitty CJM: Overdiagnosis of malaria in patients with severe febrile illness in Tanzania: a prospective study. BMJ. 2004, 329: 1212-10.1136/bmj.38251.658229.55. PubMedCentralCrossRefPubMed
Verhoef H, Hodgins E, Eggelte TA, Carter JY, Lema O, West CE, Kok FJ: Anti-malarial drug use among preschool children in an area of seasonal malaria transmission in Kenya. AmJTrop Med Hyg. 1999, 61: 770-775.
Adegnika AA, Verweij JJ, Agnandji ST, Chai SK, Breitling LP, Ramharter MICH, Frolich M, Issifou S, Kremsner PG, Yazdanbakhsh M: Microscopic and sub-microscopic Plasmodium falciparum infection, but not inflammation caused by infection, is associated with low birth weight. AmJTrop Med Hyg. 2006, 75: 798-803.
Mockenhaupt F, Bedu-Addo G, von Gaertner C, Boye R, Fricke K, Hannibal I, Farakaya F, Schaller M, Ulmen U, Acquah PA, Dietz E, Eggelte TA, Bienzle U: Detection and clinical manifestation of placental malaria in southern Ghana. Malar J. 2006, 5: 119-10.1186/1475-2875-5-119. PubMedCentralCrossRefPubMed
Steketee RW, Wirima JJ, Slutsker L, Heymann DL, Breman JG: The problem of malaria and malaria control in pregnancy in sub-Saharan Africa. AmJTrop Med Hyg. 1996, 55: 2-7.
Umbers AJ, Boeuf P, Clapham C, Stanisic DI, Baiwog F, Mueller I, Siba P, King CL, Beeson JG, Glazier J, Rogerson SJ: Placental malaria-associated inflammation disturbs the insulin-like growth factor axis of fetal growth regulation. J Inf Dis. 2011, 203: 561-569. 10.1093/infdis/jiq080. CrossRef
Dhorda M, Piola P, Nyehangane D, Tumwebaze B, Nalusaji A, Nabasumba C, Turyakira E, McGready R, Ashley E, Guerin PJ, Snounou G: Performance of a histidine-rich protein 2 rapid diagnostic test, Paracheck Pf-for detection of malaria infections in Ugandan pregnant women. AmJTrop Med Hyg. 2012, 86: 93-95. CrossRef
Gerstl S, Dunkley S, Mukhtar A, De Smet M, Baker S, Maikere J: Assessment of two malaria rapid diagnostic tests in children under five years of age, with follow-up of false-positive pLDH test results, in a hyperendemic falciparum malaria area. Sierra Leone. Malar J. 2010, 9: 28- PubMed
Tjitra E, Suprianto S, Dyer M, Currie BJ, Anstey NM: Field evaluation of the ICT Malaria P.f/P.v immunochromatographic test for detection of Plasmodium falciparum and Plasmodium vivax in patients with a presumptive clinical diagnosis of malaria in eastern Indonesia. J Clin Microbiol. 1999, 37: 2412-2417. PubMedCentralPubMed
de Oliveira AM, Skarbinski J, Ouma PO, Kariuki S, Barnwell JW, Otieno K, Onyona P, Causer LM, Laserson KF, Akhwale WS, Slutsker L, Hamel M: Performance of malaria rapid diagnostic tests as part of routine malaria case management in Kenya. AmJTrop Med Hyg. 2009, 80: 470-474.
Singh NEER, Saxena AJAY, Awadhia SB, Shrivastava RITA, Singh MP: Evaluation of a rapid diagnostic test for assessing the burden of malaria at delivery in India. AmJTrop Med Hyg. 2005, 73: 855-858.
McMorrow ML, Masanja MI, Abdulla SMK, Kahigwa E, Kachur SP: Challenges in routine implementation and quality control of rapid diagnostic tests for malaria in Rufiji District, Tanzania. AmJTrop Med Hyg. 2008, 79: 385-390.
Mens P, Spieker N, Omar S, Heijnen M, Schallig H, Kager PA: Is molecular biology the best alternative for diagnosis of malaria to microscopy? A comparison between microscopy, antigen detection and molecular tests in rural Kenya and urban Tanzania. Trop Med Int Health. 2007, 12: 238-244. PubMed
Ishengoma D, Francis F, Mmbando B, Lusingu J, Magistrado P, Alifrangis M, Theander TG, Bygbjerg IC, Lemnge MM: Accuracy of malaria rapid diagnostic tests in community studies and their impact on treatment of malaria in an area with declining malaria burden in north-eastern Tanzania. Malar J. 2011, 10: 176-10.1186/1475-2875-10-176. PubMedCentralCrossRefPubMed
Wongsrichanalai C, Barcus MJ, Muth S, Sutamihardja A, Wernsdorfer WH: A review of malaria diagnostic tools: microscopy and rapid diagnostic test (RDT). AmJTrop Med Hyg. 2007, 77: 119-127.
Bell DR, Wilson DW, Martin LB: False-positive results of a Plasmodium falciparum histidine-rich protein - 2-detecting malaria rapid diagnostic test due to high sensitivity in a community with fluctuating low parasite density. AmJTrop Med Hyg. 2005, 73: 199-203.
Lusingu J, Vestergaard L, Mmbando B, Drakeley C, Jones C, Akida J, Savaeli ZX, Kitua AY, Lemnge MM, Theander TG: Malaria morbidity and immunity among residents of villages with different Plasmodium falciparum transmission intensity in North-Eastern Tanzania. Malar J. 2004, 3: 26-10.1186/1475-2875-3-26. PubMedCentralCrossRefPubMed
Shulman CE, Dorman EK: Importance and prevention of malaria in pregnancy. Trans R Soc Trop Med Hyg. 2001, 97: 30-35. CrossRef
The United Republic of Tanzania: National Website: 2002 Population and Housing Census Results. 2012, , , [ http:www.tanzania.go.tz/census]
Lusingu JP, Jensen AT, Vestergaard LS, Minja DT, Dalgaard MB, Gesase S, Mmbando BP, Kitua AY, Lemnge MM, Cavanagh D, Hviid L, Theander TG: Levels of plasma immunoglobulin G with specificity against the cysteine-rich interdomain regions of a semiconserved Plasmodium falciparum erythrocyte membrane protein 1, VAR4, predict protection against malarial anemia and febrile episodes. Infect Immun. 2006, 74: 2867-2875. 10.1128/IAI.74.5.2867-2875.2006. PubMedCentralCrossRefPubMed
Mnzava AE, Kilama WL: Observations on the distribution of the Anopheles gambiae complex in Tanzania. Acta Trop. 1986, 43: 277-282. PubMed
Thomsen TT, Ishengoma DS, Mmbando BP, Lusingu JP, Vestergaard LS, Theander TG, Lemnge MM, Bygbjerg IC, Alifrangis M: Prevalence of single nucleotide polymorphisms in the Plasmodium falciparum multidrug resistance gene (Pfmdr-1) in Korogwe District in Tanzania before and after introduction of artemisinin-based combination therapy. AmJTrop Med Hyg. 2011, 85: 979-983. CrossRef
Tanzania Demographic and Health Survey 2004–2005. 2012, , , [ http:www.measuredhs.com/pubs/pdf/FR173/FR173-TZ04-05.pdf]
Amexo M, Tolhurst R, Barnish G, Bates I: Malaria misdiagnosis: effects on the poor and vulnerable. Lancet. 1920, 364: 1896-1898. CrossRef
WHO: Malaria Rapid Diagnostic Test Peformance. Results of WHO product testing of malaria rapid diagnostic tests. 2012, World Health Organization, Geneva, Round 1 (2008)
Ishengoma DRS, Rwegoshora RT, Mdira KY, Kamugisha ML, Anga EO, Bygbjerg IC, Rønn AM, Magesa SM: Health laboratories in the Tanga region of Tanzania: the quality of diagnostic services for malaria and other communicable diseases. Ann Trop Med Parasitol. 2009, 103: 441-453. 10.1179/136485909X451726. CrossRefPubMed
Singer LM, Newman RD, Diarra AMID, Moran AC, Huber CS, Stennies G, Sirima SB, Konate A, Yameogo M, Sawadogo R, Barnwell JW, Parise ME: Evaluation of a malaria rapid diagnostic test for assessing the burden of malaria during pregnancy. AmJTrop Med Hyg. 2004, 70: 481-485.
Baker J, McCarthy J, Gatton M, Kyle DE, Belizario V, Luchavez J, Bell D, Cheng Q: Genetic diversity of Plasmodium falciparum Histidine-Rich Protein 2 (PfHRP2) and its effect on the performance of PfHRP2-based rapid diagnostic tests. J Inf Dis. 2005, 192: 870-877. 10.1086/432010. CrossRef
First Results of Phase 3 Trial of RTS,S/AS01 Malaria Vaccine in African Children. N Eng J Med. 2011, 365: 1863-1875.
Schachterle S, Mtove G, Levens J, Clemens EG, Shi L, Raj A, Munoz B, Reller ME, West S, Dumler SJ, Sullivan D: Prevalence and density related concordance of three diagnostic tests for malaria in hypoendemic Tanzania. J Clin Microbiol. 2011, 49: 3885-3891. 10.1128/JCM.01157-11. PubMedCentralCrossRefPubMed
Forney JR, Wongsrichanalai C, Magill AJ, Craig LG, Sirichaisinthop J, Bautista CT, Miller RS, Ockenhouse CF, Kester KE, Aronson NE, Andersen EM, Quino-Ascurra HÁ, Vidal C, Moran KA, Murray CK, DeWitt CC, Heppner DG, Kain KC, Ballou WR, Gasser RA: Devices for Rapid Diagnosis of Malaria: Evaluation of Prototype Assays That Detect Plasmodium falciparum Histidine-Rich Protein 2 and a Plasmodium vivax-Specific Antigen. J Clin Microbiol. 2003, 41: 2358-2366. 10.1128/JCM.41.6.2358-2366.2003. PubMedCentralCrossRefPubMed
- Reliability of rapid diagnostic tests in diagnosing pregnancy-associated malaria in north-eastern Tanzania
Daniel TR Minja
Pamela A Magistrado
Adrian JF Luty
John PA Lusingu
- BioMed Central
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
e.Med Kampagnen-Visual, Mail Icon II