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Unger HW, Acharya S, Arnold L, Wu C, van Eijk AM, Gore-Langton GR, Ter Kuile FO, Lufele E, Chico RM, Price RN, Moore BR, Thriemer K, Rogerson SJ. The effect and control of malaria in pregnancy and lactating women in the Asia-Pacific region. Lancet Glob Health 2023; 11:e1805-e1818. [PMID: 37858590 DOI: 10.1016/s2214-109x(23)00415-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/10/2023] [Accepted: 08/23/2023] [Indexed: 10/21/2023]
Abstract
Half of all pregnancies at risk of malaria worldwide occur in the Asia-Pacific region, where Plasmodium falciparum and Plasmodium vivax co-exist. Despite substantial reductions in transmission, malaria remains an important cause of adverse health outcomes for mothers and offspring, including pre-eclampsia. Malaria transmission is heterogeneous, and infections are commonly subpatent and asymptomatic. High-grade antimalarial resistance poses a formidable challenge to malaria control in pregnancy in the region. Intermittent preventive treatment in pregnancy reduces infection risk in meso-endemic New Guinea, whereas screen-and-treat strategies will require more sensitive point-of-care tests to control malaria in pregnancy. In the first trimester, artemether-lumefantrine is approved, and safety data are accumulating for other artemisinin-based combinations. Safety of novel antimalarials to treat artemisinin-resistant P falciparum during pregnancy, and of 8-aminoquinolines during lactation, needs to be established. A more systematic approach to the prevention of malaria in pregnancy in the Asia-Pacific is required.
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Affiliation(s)
- Holger W Unger
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Tiwi, NT, Australia; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Sanjaya Acharya
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Lachlan Arnold
- Royal Melbourne Hospital Clinical School, The University of Melbourne, Parkville, VIC, Australia
| | - Connie Wu
- Royal Melbourne Hospital Clinical School, The University of Melbourne, Parkville, VIC, Australia
| | - Anna Maria van Eijk
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Georgia R Gore-Langton
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Feiko O Ter Kuile
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Elvin Lufele
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Vector-Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - R Matthew Chico
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Ric N Price
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Brioni R Moore
- Curtin Medical School, Curtin University, Bentley, WA, Australia; Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia; Telethon Kids Institute, Perth Children's Hospital, Nedlands, WA, Australia
| | - Kamala Thriemer
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Stephen J Rogerson
- Department of Infectious Diseases, University of Melbourne, The Doherty Institute, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, The Doherty Institute, Melbourne, VIC, Australia
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Kabalu Tshiongo J, Luzolo F, Kabena M, Kuseke L, Djimde M, Mitashi P, Lumbala C, Kayentao K, Menting S, Mens PF, Schallig HDFH, Lutumba P, Tinto H, Muhindo Mavoko H, Maketa V. Performance of ultra-sensitive malaria rapid diagnostic test to detect Plasmodium falciparum infection in pregnant women in Kinshasa, the Democratic Republic of the Congo. Malar J 2023; 22:322. [PMID: 37872634 PMCID: PMC10594769 DOI: 10.1186/s12936-023-04749-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/11/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Low peripheral parasitaemia caused by sequestration of Plasmodium falciparum in the placenta hampers the diagnosis of malaria in pregnant women, leading to microscopy or conventional rapid diagnostic tests (RDTs) false-negative results. Although mainly asymptomatic, maternal malaria remains harmful to pregnant women and their offspring in endemic settings and must be adequately diagnosed. Ultra-sensitive RDTs (uRDTs) are thought to be more sensitive than RDTs, and their diagnostic performance was assessed in the current study in pregnant women living in Kinshasa, a stable malaria transmission area in the Democratic Republic of the Congo. METHODS To assess and compare the diagnostic performances of both RDTs and uRDTs, 497 peripheral blood samples were tested using microscopy and quantitative polymerase chain reaction (qPCR) as the index and the reference tests, respectively. The agreement between the different diagnostic tests assessed was estimated by Cohen's Kappa test. RESULTS The median parasite density by qPCR was 292 p/μL of blood [IQR (49.7-1137)]. Using qPCR as the reference diagnostic test, the sensitivities of microscopy, RDT and uRDT were respectively [55.7% (95% CI 47.6-63.6)], [81.7% (95%CI 74.7-87.3)] and [88% (95% CI 81.9-92.6)]. The specificities of the tests were calculated at 98.5% (95% CI 96.6-99.5), 95.2% (95% CI 92.5-97.2) and 94.4% (95% CI 91.4-96.6) for microscopy, RDT and uRDT, respectively. The agreement between qPCR and uRDT was almost perfect (Kappa = 0.82). For parasite density (qPCR) below 100 p/µL, the sensitivity of RDT was 62% (95% CI 47.1-75.3) compared to 68% (95% CI 53.3-80.4) for uRDT. Between 100 and 200 p/µL, the sensitivity of RDT was higher, but still lower compared to uRDT: 89.4% (95% CI 66.8-98.7) for RDT versus 100% (95% CI 82.3-100) for uRDT. In both cases, microscopy was lower, with 20% (95% CI 10-33.7) and 47.3% (95% CI 24.4-71.1) respectively. CONCLUSIONS uRDT has the potential to improve malaria management in pregnant women as it has been found to be slightly more sensitive than RDT in the detection of malaria in pregnant women but the difference was not significant. Microscopy has a more limited value for the diagnosis of malaria during the pregnancy, because of its lower sensitivity.
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Affiliation(s)
- Japhet Kabalu Tshiongo
- Department of Tropical Medicine, University of Kinshasa (UNIKIN), Kinshasa, Democratic Republic of the Congo.
- Amsterdam University Medical Centres, Department of Medical Microbiology and Infection Prevention, Laboratory for Experimental Parasitology, Academic Medical Centres at the University of Amsterdam, Amsterdam, The Netherlands.
- Amsterdam Institute for Infection and Immunity, Infectious Diseases Programme, Amsterdam, The Netherlands.
| | - Flory Luzolo
- Department of Tropical Medicine, University of Kinshasa (UNIKIN), Kinshasa, Democratic Republic of the Congo
| | - Melissa Kabena
- Department of Tropical Medicine, University of Kinshasa (UNIKIN), Kinshasa, Democratic Republic of the Congo
| | - Lise Kuseke
- Department of Tropical Medicine, University of Kinshasa (UNIKIN), Kinshasa, Democratic Republic of the Congo
| | - Moussa Djimde
- Amsterdam University Medical Centres, Department of Medical Microbiology and Infection Prevention, Laboratory for Experimental Parasitology, Academic Medical Centres at the University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Infectious Diseases Programme, Amsterdam, The Netherlands
- Malaria Research and Training Center (MRTC), University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - Patrick Mitashi
- Department of Tropical Medicine, University of Kinshasa (UNIKIN), Kinshasa, Democratic Republic of the Congo
| | - Crispin Lumbala
- Clinton Health Access Initiative, Kinshasa, Democratic Republic of the Congo
- Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Kassoum Kayentao
- Malaria Research and Training Center (MRTC), University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - Sandra Menting
- Amsterdam University Medical Centres, Department of Medical Microbiology and Infection Prevention, Laboratory for Experimental Parasitology, Academic Medical Centres at the University of Amsterdam, Amsterdam, The Netherlands
| | - Petra F Mens
- Amsterdam University Medical Centres, Department of Medical Microbiology and Infection Prevention, Laboratory for Experimental Parasitology, Academic Medical Centres at the University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Infectious Diseases Programme, Amsterdam, The Netherlands
| | - Henk D F H Schallig
- Amsterdam University Medical Centres, Department of Medical Microbiology and Infection Prevention, Laboratory for Experimental Parasitology, Academic Medical Centres at the University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Infectious Diseases Programme, Amsterdam, The Netherlands
| | - Pascal Lutumba
- Department of Tropical Medicine, University of Kinshasa (UNIKIN), Kinshasa, Democratic Republic of the Congo
- Institut Supérieur Des Techniques Médicales de Kinshasa (ISTM-Kinshasa), Kinshasa, Democratic Republic of the Congo
| | - Halidou Tinto
- Institut de Recherche en Sciences de La Santé - Clinical Research Unit of Nanoro (IRSS-CRUN), Nanoro, Burkina Faso
| | - Hypolite Muhindo Mavoko
- Department of Tropical Medicine, University of Kinshasa (UNIKIN), Kinshasa, Democratic Republic of the Congo
| | - Vivi Maketa
- Department of Tropical Medicine, University of Kinshasa (UNIKIN), Kinshasa, Democratic Republic of the Congo
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Cardona-Arias JA, Higuita Gutiérrez LF, Carmona-Fonseca J. Diagnostic Accuracy of a Thick Blood Smear Compared to qPCR for Malaria Associated with Pregnancy in Colombia. Trop Med Infect Dis 2023; 8:tropicalmed8020119. [PMID: 36828535 PMCID: PMC9959527 DOI: 10.3390/tropicalmed8020119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 02/17/2023] Open
Abstract
This study aimed to evaluate the accuracy of the thick blood smear (TBS) versus quantitative polymerase chain reaction (qPCR) for the diagnosis of malaria associated with pregnancy (MAP) caused by P. falciparum or P. vivax in Colombia in its gestational malaria (GM), placental malaria (PM), and congenital malaria (CM) forms as well as to compare its accuracy in different subgroups of pregnant women according to the presence of fever, anemia and a history of malaria. This was a diagnostic evaluation of 829 pregnant women, 579 placentas, 381 umbilical cord samples, and 221 neonatal peripheral blood samples. Accuracy was evaluated based on the parameters of sensitivity, specificity, predictive values, likelihood ratios, and validity index, with their 95% confidence intervals. The frequency of GM was 36% (n = 297/829), PM 27% (n = 159/579), and CM 16.5% (n = 63/381) in umbilical cord samples and 2% (n = 5/221) in neonatal peripheral blood samples. For GM, the sensitivity was 55%, with higher rates in those infected with P. vivax (68%), with a history of malaria (69%), and with fever (96%). These three subgroups presented the best results in terms of the negative likelihood ratio and validity index. For PM, sensitivity was 8%; in subgroup analyses in terms of species, symptomatology (anemia and fever), and history of malaria, it was 1-18%, and the negative likelihood ratio was >0.80 in all subgroups. No false positives were recorded in any of the subgroups. The TBS did not detect any cases of CM. This study found the TBS yielded satisfactory results in terms of diagnosing GM for P. vivax, pregnant women with previous malaria and febrile. It also showed that the TBS is not useful for diagnosing PM and CM. It is necessary to conduct surveillance of MAP with molecular methods in in groups where TBS is deficient (asymptomatic GM, P. falciparum, and pregnant women without history of malaria) to optimize the timely treatment of PM and CM, avoid the deleterious effects of MAP and achieve the malaria elimination goals in Colombia.
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Affiliation(s)
| | - Luis Felipe Higuita Gutiérrez
- Escuela de Microbiología, Universidad de Antioquia, Medellín 050010, Colombia
- Facultad de Medicina, Universidad Cooperativa de Colombia, Medellín 050010, Colombia
| | - Jaime Carmona-Fonseca
- Grupo Salud y Comunidad César Uribe Piedrahíta, Facultad de Medicina, Universidad de Antioquia, Medellín 050010, Colombia
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Gómez-Hoyos R, Cardona-Arias JA, Higuita Gutiérrez LF, Salas-Zapata W, Carmona-Fonseca J. Systematic review of the diagnostic accuracy of thick smear compared to polymerase chain reaction for pregnancy-associated malaria, 2010-2022. Rev Peru Med Exp Salud Publica 2022; 39:302-311. [PMID: 36478163 PMCID: PMC11397769 DOI: 10.17843/rpmesp.2022.393.11739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/28/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE. To evaluate the accuracy of thick smear (TS) versus quantitative polymerase chain reaction (PCR) for pregnancy-associated malaria (PAM). MATERIALS AND METHODS. We carried out a systematic review of diagnostic tests in nine databases. Methodological quality was evaluated with QUADAS. Sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and area under the ROC curve were estimated. Heterogeneity was determined with the Der Simonian-Laird Q method and uncertainty with the weighted percentage of each study on the overall result. RESULTS. We included 10 studies with 5691 pregnant women, 1415 placentas and 84 neonates. In the studies with nested PCR (nPCR) and quantitative PCR (qPCR) as the standard, the diagnostic accuracy results were statistically similar, with very low sensitivity (50 and 54%, respectively), high specificity (99% in both cases), high PLR and poor NLR. When nPCR was used, the DOR was 162 (95%CI=66-401) and the area under the ROC curve was 95%, while with qPCR it was 231 (95%CI=27-1951) and 78%, respectively. CONCLUSIONS. We demonstrated that research on the diagnostic accuracy of TS in PAM is limited. Microscopy showed poor performance in the diagnosis of asymptomatic or low parasitemia infections, which reinforces the importance of implementing other types of techniques for the follow-up and control of malaria infections in pregnant women, in order to achieve the control and possible elimination of PAM.
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Affiliation(s)
| | | | | | | | - Jaime Carmona-Fonseca
- Grupo Salud y Comunidad César Uribe Piedrahíta, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
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Unger HW, Bleicher A, Ome-Kaius M, Aitken EH, Rogerson SJ. Associations of maternal iron deficiency with malaria infection in a cohort of pregnant Papua New Guinean women. Malar J 2022; 21:153. [PMID: 35619134 PMCID: PMC9137066 DOI: 10.1186/s12936-022-04177-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 05/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Iron deficiency (ID) is common in malaria-endemic settings. Intermittent preventative treatment of malaria in pregnancy (IPTp) and iron supplementation are core components of antenatal care in endemic regions to prevent adverse pregnancy outcomes. ID has been associated with reduced risk of malaria infection, and correspondingly, iron supplementation with increased risk of malaria infection, in some studies. METHODS A secondary analysis was conducted amongst 1888 pregnant women enrolled in a malaria prevention trial in Papua New Guinea. Maternal ID was defined as inflammation-corrected plasma ferritin levels < 15 μg/L at antenatal enrolment. Malaria burden (Plasmodium falciparum, Plasmodium vivax) was determined by light microscopy, polymerase chain reaction, and placental histology. Multiple logistic and linear regression analyses explored the relationship of ID or ferritin levels with indicators of malaria infection. Models were fitted with interaction terms to assess for modification of iron-malaria relationships by gravidity or treatment arm. RESULTS Two-thirds (n = 1226) and 13.7% (n = 258) of women had ID and peripheral parasitaemia, respectively, at antenatal enrolment (median gestational age: 22 weeks), and 18.7% (120/1,356) had evidence of malaria infection on placental histology. Overall, ID was associated with reduced odds of peripheral parasitaemia at enrolment (adjusted odds ratio [aOR] 0.50; 95% confidence interval [95% CI] 0.38, 0.66, P < 0.001); peripheral parasitaemia at delivery (aOR 0.68, 95% CI 0.46, 1.00; P = 0.050); and past placental infection (aOR 0.35, 95% CI 0.24, 0.50; P < 0.001). Corresponding increases in the odds of infection were observed with two-fold increases in ferritin levels. There was effect modification of iron-malaria relationships by gravidity. At delivery, ID was associated with reduced odds of peripheral parasitaemia amongst primigravid (AOR 0.44, 95% CI 0.25, 0.76; P = 0.003), but not multigravid women (AOR 1.12, 95% CI 0.61, 2.05; P = 0.720). A two-fold increase in ferritin associated with increased odds of placental blood infection (1.44, 95% CI 1.06, 1.96; P = 0.019) and active placental infection on histology amongst primigravid women only (1.24, 95% CI 1.00, 1.54; P = 0.052). CONCLUSIONS Low maternal ferritin at first antenatal visit was associated with a lower risk of malaria infection during pregnancy, most notably in primigravid women. The mechanisms by which maternal iron stores influence susceptibility to infection with Plasmodium species require further investigation. TRIAL REGISTRATION
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Affiliation(s)
- Holger W Unger
- Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, NT, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Andie Bleicher
- Department of Medicine (RMH), Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
| | - Maria Ome-Kaius
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Elizabeth H Aitken
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
| | - Stephen J Rogerson
- Department of Medicine (RMH), Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia.
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia.
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Otambo WO, Olumeh JO, Ochwedo KO, Magomere EO, Debrah I, Ouma C, Onyango P, Atieli H, Mukabana WR, Wang C, Lee MC, Githeko AK, Zhou G, Githure J, Kazura J, Yan G. Health care provider practices in diagnosis and treatment of malaria in rural communities in Kisumu County, Kenya. Malar J 2022; 21:129. [PMID: 35459178 PMCID: PMC9034626 DOI: 10.1186/s12936-022-04156-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 04/07/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Accurate malaria diagnosis and appropriate treatment at local health facilities are critical to reducing morbidity and human reservoir of infectious gametocytes. The current study assessed the accuracy of malaria diagnosis and treatment practices in three health care facilities in rural western Kenya. METHODS The accuracy of malaria detection and treatment recommended compliance was monitored in two public and one private hospital from November 2019 through March 2020. Blood smears from febrile patients were examined by hospital laboratory technicians and re-examined by an expert microscopists thereafter subjected to real-time polymerase chain reaction (RT-PCR) for quality assurance. In addition, blood smears from patients diagnosed with malaria rapid diagnostic tests (RDT) and presumptively treated with anti-malarial were re-examined by an expert microscopist. RESULTS A total of 1131 febrile outpatients were assessed for slide positivity (936), RDT (126) and presumptive diagnosis (69). The overall positivity rate for Plasmodium falciparum was 28% (257/936). The odds of slide positivity was higher in public hospitals, 30% (186/624, OR:1.44, 95% CI = 1.05-1.98, p < 0.05) than the private hospital 23% (71/312, OR:0.69, 95% CI = 0.51-0.95, p < 0.05). Anti-malarial treatment was dispensed more at public hospitals (95.2%, 177/186) than the private hospital (78.9%, 56/71, p < 0.0001). Inappropriate anti-malarial treatment, i.e. artemether-lumefantrine given to blood smear negative patients was higher at public hospitals (14.6%, 64/438) than the private hospital (7.1%, 17/241) (p = 0.004). RDT was the most sensitive (73.8%, 95% CI = 39.5-57.4) and specific (89.2%, 95% CI = 78.5-95.2) followed by hospital microscopy (sensitivity 47.6%, 95% CI = 38.2-57.1) and specificity (86.7%, 95% CI = 80.8-91.0). Presumptive diagnosis had the lowest sensitivity (25.7%, 95% CI = 13.1-43.6) and specificity (75.0%, 95% CI = 50.6-90.4). RDT had the highest non-treatment of negatives [98.3% (57/58)] while hospital microscopy had the lowest [77.3% (116/150)]. Health facilities misdiagnosis was at 27.9% (77/276). PCR confirmed 5.2% (4/23) of the 77 misdiagnosed cases as false positive and 68.5% (37/54) as false negative. CONCLUSIONS The disparity in malaria diagnosis at health facilities with many slide positives reported as negatives and high presumptive treatment of slide negative cases, necessitates augmenting microscopic with RDTs and calls for Ministry of Health strengthening supportive infrastructure to be in compliance with treatment guidelines of Test, Treat, and Track to improve malaria case management.
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Affiliation(s)
- Wilfred Ouma Otambo
- grid.442486.80000 0001 0744 8172Department of Zoology, Maseno University, Kisumu, Kenya ,International Centre of Excellence for Malaria Research, Tom Mboya University College of Maseno University, Homa Bay, Kenya
| | - Julius O. Olumeh
- International Centre of Excellence for Malaria Research, Tom Mboya University College of Maseno University, Homa Bay, Kenya ,grid.10604.330000 0001 2019 0495Department of Biology, Faculty of Science and Technology, University of Nairobi, Nairobi, Kenya
| | - Kevin O. Ochwedo
- International Centre of Excellence for Malaria Research, Tom Mboya University College of Maseno University, Homa Bay, Kenya ,grid.10604.330000 0001 2019 0495Department of Biology, Faculty of Science and Technology, University of Nairobi, Nairobi, Kenya
| | - Edwin O. Magomere
- grid.8301.a0000 0001 0431 4443Department of Biochemistry and Molecular Biology, Egerton University, Njoro, Kenya
| | - Isaiah Debrah
- International Centre of Excellence for Malaria Research, Tom Mboya University College of Maseno University, Homa Bay, Kenya ,grid.8652.90000 0004 1937 1485West Africa Centre for Cell Biology of Infectious Pathogen, Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Accra, Ghana
| | - Collins Ouma
- grid.442486.80000 0001 0744 8172Department of Biomedical Sciences and Technology, Maseno University, Kisumu, Kenya
| | - Patrick Onyango
- grid.442486.80000 0001 0744 8172Department of Zoology, Maseno University, Kisumu, Kenya
| | - Harrysone Atieli
- International Centre of Excellence for Malaria Research, Tom Mboya University College of Maseno University, Homa Bay, Kenya
| | - Wolfgang R. Mukabana
- International Centre of Excellence for Malaria Research, Tom Mboya University College of Maseno University, Homa Bay, Kenya ,grid.10604.330000 0001 2019 0495Department of Biology, Faculty of Science and Technology, University of Nairobi, Nairobi, Kenya
| | - Chloe Wang
- grid.266093.80000 0001 0668 7243Depatment of Population Health and Disease Prevention, University of California, Irvine, CA USA
| | - Ming-Chieh Lee
- grid.266093.80000 0001 0668 7243Depatment of Population Health and Disease Prevention, University of California, Irvine, CA USA
| | - Andrew K. Githeko
- grid.33058.3d0000 0001 0155 5938Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Guofa Zhou
- grid.266093.80000 0001 0668 7243Depatment of Population Health and Disease Prevention, University of California, Irvine, CA USA
| | - John Githure
- International Centre of Excellence for Malaria Research, Tom Mboya University College of Maseno University, Homa Bay, Kenya
| | - James Kazura
- grid.67105.350000 0001 2164 3847Centre for Global Health and Diseases, Case Western University Reserve, Cleveland, OH USA
| | - Guiyun Yan
- grid.266093.80000 0001 0668 7243Depatment of Population Health and Disease Prevention, University of California, Irvine, CA USA
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Unger HW, Laurita Longo V, Bleicher A, Ome-Kaius M, Karl S, Simpson JA, Karahalios A, Aitken EH, Rogerson SJ. The relationship between markers of antenatal iron stores and birth outcomes differs by malaria prevention regimen-a prospective cohort study. BMC Med 2021; 19:236. [PMID: 34607575 PMCID: PMC8491429 DOI: 10.1186/s12916-021-02114-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/31/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Iron deficiency (ID) has been associated with adverse pregnancy outcomes, maternal anaemia, and altered susceptibility to infection. In Papua New Guinea (PNG), monthly treatment with sulphadoxine-pyrimethamine plus azithromycin (SPAZ) prevented low birthweight (LBW; <2500 g) through a combination of anti-malarial and non-malarial effects when compared to a single treatment with SP plus chloroquine (SPCQ) at first antenatal visit. We assessed the relationship between ID and adverse birth outcomes in women receiving SPAZ or SPCQ, and the mediating effects of malaria infection and haemoglobin levels during pregnancy. METHODS Plasma ferritin levels measured at antenatal enrolment in a cohort of 1892 women were adjusted for concomitant inflammation using C-reactive protein and α-1-acid glycoprotein. Associations of ID (defined as ferritin <15 μg/L) or ferritin levels with birth outcomes (birthweight, LBW, preterm birth, small-for-gestational-age birthweight [SGA]) were determined using linear or logistic regression analysis, as appropriate. Mediation analysis assessed the degree of mediation of ID-birth outcome relationships by malaria infection or haemoglobin levels. RESULTS At first antenatal visit (median gestational age, 22 weeks), 1256 women (66.4%) had ID. Overall, ID or ferritin levels at first antenatal visit were not associated with birth outcomes. There was effect modification by treatment arm. Amongst SPCQ recipients, ID was associated with a 81-g higher mean birthweight (95% confidence interval [CI] 10, 152; P = 0.025), and a twofold increase in ferritin levels was associated with increased odds of SGA (adjusted odds ratio [aOR] 1.25; 95% CI 1.06, 1.46; P = 0.007). By contrast, amongst SPAZ recipients, a twofold increase in ferritin was associated with reduced odds of LBW (aOR 0.80; 95% CI 0.67, 0.94; P = 0.009). Mediation analyses suggested that malaria infection or haemoglobin levels during pregnancy do not substantially mediate the association of ID with birth outcomes amongst SPCQ recipients. CONCLUSIONS Improved antenatal iron stores do not confer a benefit for the prevention of adverse birth outcomes in the context of malaria chemoprevention strategies that lack the non-malarial properties of monthly SPAZ. Research to determine the mechanisms by which ID protects from suboptimal foetal growth is needed to guide the design of new malaria prevention strategies and to inform iron supplementation policy in malaria-endemic settings. TRIAL REGISTRATION ClinicalTrials.gov NCT01136850 .
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Affiliation(s)
- Holger W Unger
- Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Valentina Laurita Longo
- Catholic University of Sacred Heart, Rome, Italy.,Department of Obstetrics and Gynaecology, San Pietro-Fatebenefratelli Hospital, Rome, Italy
| | - Andie Bleicher
- Department of Medicine (RMH), Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia
| | - Maria Ome-Kaius
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Stephan Karl
- Australian Institute of Tropical Health & Medicine, James Cook University, Cairns, Australia
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Amalia Karahalios
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Elizabeth H Aitken
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia
| | - Stephen J Rogerson
- Department of Medicine (RMH), Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia. .,Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia.
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8
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Vásquez AM, Vélez G, Medina A, Serra-Casas E, Campillo A, Gonzalez IJ, Murphy SC, Seilie AM, Ding XC, Tobón Castaño A. Evaluation of highly sensitive diagnostic tools for the detection of P. falciparum in pregnant women attending antenatal care visits in Colombia. BMC Pregnancy Childbirth 2020; 20:440. [PMID: 32736543 PMCID: PMC7393871 DOI: 10.1186/s12884-020-03114-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 07/16/2020] [Indexed: 12/20/2022] Open
Abstract
Background In low transmission settings early diagnosis is the main strategy to reduce adverse outcomes of malaria in pregnancy; however, microscopy and rapid diagnostic tests (RDTs) are inadequate for detecting low-density infections. We studied the performance of the highly sensitive-RDT (hsRDT) and the loop mediated isothermal DNA amplification (LAMP) for the detection of P. falciparum in pregnant women. Methods A cross-sectional study was conducted in two malaria-endemic municipalities in Colombia. We screened pregnant women in the context of an antenatal care program in health facilities and evaluated five tests (microscopy, conventional RDT, hsRDT, LAMP and nested polymerase chain reaction-PCR) for the detection of P. falciparum in peripheral blood, using a quantitative reverse transcription PCR (qRT-PCR) as the reference standard. Diagnostic performance of hsRDT and LAMP were compared with routine testing. Results The prevalence of P. falciparum was 4.5% by qRT-PCR, half of those infections were subpatent. The sensitivity of the hsRDT (64.1%) was slightly better compared to microscopy and cRDT (59 and 53.8% respectively). LAMP had the highest sensitivity (89.7%) for detecting P. falciparum and the ability to detect very low-density infections (minimum parasite density detected 0.08 p/μL). Conclusions There is an underestimation of Plasmodium spp. infections by tests routinely used in pregnant women attending antenatal care visits. LAMP methodology can be successfully implemented at local hospitals in malaria-endemic areas. The relevance of detecting and treating this sub-patent P. falciparum infections in pregnant women should be evaluated. Trial registration ClinicalTrials.gov, Identifier: NCT03172221, Date of registration: May 29, 2017.
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Affiliation(s)
- A M Vásquez
- Grupo Malaria, Facultad de Medicina, Universidad de Antioquia, Carrera 53 No. 61-30, Lab 610, Medellín, Colombia.
| | - G Vélez
- Grupo Malaria, Facultad de Medicina, Universidad de Antioquia, Carrera 53 No. 61-30, Lab 610, Medellín, Colombia
| | - A Medina
- Grupo Malaria, Facultad de Medicina, Universidad de Antioquia, Carrera 53 No. 61-30, Lab 610, Medellín, Colombia
| | | | | | | | - S C Murphy
- Malaria Molecular Diagnostic Laboratory, Departments of Laboratory Medicine and Microbiology and the Center for Emerging and Re-emerging Infectious Diseases, 750 Republican St, Seattle, WA, 98109, USA
| | - A M Seilie
- Malaria Molecular Diagnostic Laboratory, Departments of Laboratory Medicine and Microbiology and the Center for Emerging and Re-emerging Infectious Diseases, 750 Republican St, Seattle, WA, 98109, USA
| | | | - A Tobón Castaño
- Grupo Malaria, Facultad de Medicina, Universidad de Antioquia, Carrera 53 No. 61-30, Lab 610, Medellín, Colombia
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9
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Udoh BE, Iwalokun BA, Etukumana E, Amoo J. Asymptomatic falciparum Malaria and its Effects on Type 2 Diabetes Mellitus Patients in Lagos, Nigeria. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2019; 8:32-40. [PMID: 31929776 PMCID: PMC6945314 DOI: 10.4103/sjmms.sjmms_178_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/25/2018] [Accepted: 05/16/2019] [Indexed: 11/04/2022]
Abstract
Background Asymptomatic malaria (ASM) constitutes a reservoir of malaria parasites that sustain transmission and threaten elimination efforts. Studies have also shown a significant relation between insulin resistance and malaria infection. However, data on the clinical effects of ASM and its patterns of carriage among adult malaria patients is limited. Objectives To determine the prevalence of ASM due to Plasmodium falciparum among adult type 2 diabetes (T2DM) patients in Lagos, Nigeria; to assess the diagnostic performance of light microscopy and histidine-rich protein 2 rapid diagnostic test (HRP-2 RDT); and to determine the effects of ASM on glycemic control and anemia. Materials and Methods This cross-sectional study enrolled 208 afebrile, nonobese, nonhypertensive T2DM patients, aged 40-70 years, undergoing treatment (adherence, ≥95%) at six private health facilities in Lagos, Nigeria, between March and August 2015. Sociodemographic data were obtained using a semi-structured questionnaire and clinical case files. Venous blood samples were collected and processed for fasting blood sugar estimation, packed cell volume determination and malaria parasite detection by HRP2-RDT, light microscopy and polymerase chain reaction (PCR). Results The mean age of the patients was 54.5 years. ASM was diagnosed in 16.8%, 7.2% and 4.3% of the patients by PCR, light microscopy and HRP2-RDT, respectively. ASM was significantly (P < 0.05) associated with poor glycemic control, anemia and insulin resistance. The overall parasitemia ranged from 85 to 3789 parasites/μL (median, 1580 parasites/μL). Benchmarking against the PCR results, light microscopy and rapid diagnostic tests were found to have a sensitivity (95% confidence interval) of 42.9% (26.5-59.3) and 22.9% (12.1-39), respectively, in diagnosing ASM. Conclusion This study revealed that T2DM patients in Lagos, Nigeria, are potential reservoirs of asymptomatic Plasmodium falciparum, which has a significantly negative effect on glycemic control and anemia. The study also found PCR to be the most effective diagnostic method.
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Affiliation(s)
- Bernice Enobong Udoh
- Department of Medical Microbiology and Parasitology, Olabisi Onabanjo University, Sagamu, Ogun State, Nigeria
| | - Bamidele Abiodun Iwalokun
- Department of Medical Microbiology and Parasitology, Olabisi Onabanjo University, Sagamu, Ogun State, Nigeria.,Department of Molecular Biology and Biotechnology, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Etiobong Etukumana
- Department of Family Medicine, University of Uyo Teaching Hospital, Akwa Ibom, Nigeria
| | - Joseph Amoo
- Department of Medical Microbiology and Parasitology, Olabisi Onabanjo University, Sagamu, Ogun State, Nigeria
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10
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Unger HW, Rosanas-Urgell A, Robinson LJ, Ome-Kaius M, Jally S, Umbers AJ, Pomat W, Mueller I, Kattenberg E, Rogerson SJ. Microscopic and submicroscopic Plasmodium falciparum infection, maternal anaemia and adverse pregnancy outcomes in Papua New Guinea: a cohort study. Malar J 2019; 18:302. [PMID: 31477117 PMCID: PMC6720091 DOI: 10.1186/s12936-019-2931-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/22/2019] [Indexed: 11/29/2022] Open
Abstract
Background Infection during pregnancy with Plasmodium falciparum is associated with maternal anaemia and adverse birth outcomes including low birth weight (LBW). Studies using polymerase chain reaction (PCR) techniques indicate that at least half of all infections in maternal venous blood are missed by light microscopy or rapid diagnostic tests. The impact of these subpatent infections on maternal and birth outcomes remains unclear. Methods In a cohort of women co-enrolled in a clinical trial of intermittent treatment with sulfadoxine–pyrimethamine (SP) plus azithromycin for the prevention of LBW (< 2500 g) in Papua New Guinea (PNG), P. falciparum infection status at antenatal enrolment and delivery was assessed by routine light microscopy and real-time quantitative PCR. The impact of infection status at enrolment and delivery on adverse birth outcomes and maternal haemoglobin at delivery was assessed using logistic and linear regression models adjusting for potential confounders. Together with insecticide-treated bed nets, women had received up to 3 monthly intermittent preventive treatments with SP plus azithromycin or a single clearance treatment with SP plus chloroquine. Results A total of 9.8% (214/2190) of women had P. falciparum (mono-infection or mixed infection with Plasmodium vivax) detected in venous blood at antenatal enrolment at 14–26 weeks’ gestation. 4.7% of women had microscopic, and 5.1% submicroscopic P. falciparum infection. At delivery (n = 1936), 1.5% and 2.0% of women had submicroscopic and microscopic P. falciparum detected in peripheral blood, respectively. Submicroscopic P. falciparum infections at enrolment or at delivery in peripheral or placental blood were not associated with maternal anaemia or adverse birth outcomes such as LBW. Microscopic P. falciparum infection at antenatal enrolment was associated with anaemia at delivery (adjusted odds ratio [aOR] 2.00, 95% confidence interval [CI] 1.09, 3.67; P = 0.025). Peripheral microscopic P. falciparum infection at delivery was associated with LBW (aOR 2.75, 95% CI 1.27; 5.94, P = 0.010) and preterm birth (aOR 6.58, 95% CI 2.46, 17.62; P < 0.001). Conclusions A substantial proportion of P. falciparum infections in pregnant women in PNG were submicroscopic. Microscopic, but not submicroscopic, infections were associated with adverse outcomes in women receiving malaria preventive treatment and insecticide-treated bed nets. Current malaria prevention policies that combine insecticide-treated bed nets, intermittent preventive treatment and prompt treatment of symptomatic infections appear to be appropriate for the management of malaria in pregnancy in settings like PNG.
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Affiliation(s)
- Holger W Unger
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Leanne J Robinson
- Vector Borne Diseases Unit, PNG Institute of Medical Research, Goroka, Papua New Guinea.,Burnet Institute, Melbourne, Australia
| | - Maria Ome-Kaius
- Vector Borne Diseases Unit, PNG Institute of Medical Research, Goroka, Papua New Guinea.,Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Shadrach Jally
- Vector Borne Diseases Unit, PNG Institute of Medical Research, Goroka, Papua New Guinea
| | | | - Willie Pomat
- Vector Borne Diseases Unit, PNG Institute of Medical Research, Goroka, Papua New Guinea
| | - Ivo Mueller
- Walter and Eliza Hall Institute of Medical Research, Parkville, Australia.,Department of Medical Biology, University of Melbourne, Parkville, Australia.,Institut Pasteur, Paris, France
| | | | - Stephen J Rogerson
- Department of Medicine, (RMH), Peter Doherty Institute for Infection and Immunity, The University of Melbourne, 792 Elizabeth Street, Melbourne, VIC, 3000, Australia.
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11
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Toward Improving Accessibility of Point-of-Care Diagnostic Services for Maternal and Child Health in Low- and Middle-Income Countries. POINT OF CARE 2019; 18:17-25. [PMID: 30886544 PMCID: PMC6407818 DOI: 10.1097/poc.0000000000000180] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Point-of-care (POC) testing can improve health care provision in settings with limited access to health care services. Access to POC diagnostic services has shown potential to alleviate some diagnostic challenges and delays associated with laboratory-based methods in low- and middle-income countries. Improving accessibility to POC testing (POCT) services during antenatal and perinatal care is among the global health priorities to improve maternal and child health. This review provides insights on the availability of POC testing designed for diagnosing HIV, syphilis, and malaria in pregnancy to improve maternal and child health. In addition, factors such as accessibility of POC testing, training of health work force, and the efficiency of POC testing services delivery in low- and middle-income countries are discussed. A framework to help increase access to POC diagnostic services and improve maternal and child health outcomes in low- and middle-income countries is proposed.
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12
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Unger HW, Hansa AP, Buffet C, Hasang W, Teo A, Randall L, Ome-Kaius M, Karl S, Anuan AA, Beeson JG, Mueller I, Stock SJ, Rogerson SJ. Sulphadoxine-pyrimethamine plus azithromycin may improve birth outcomes through impacts on inflammation and placental angiogenesis independent of malarial infection. Sci Rep 2019; 9:2260. [PMID: 30783215 PMCID: PMC6381158 DOI: 10.1038/s41598-019-38821-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/10/2019] [Indexed: 12/23/2022] Open
Abstract
Intermittent preventive treatment with sulphadoxine-pyrimethamine (SP) and SP plus azithromycin (SPAZ) reduces low birthweight (<2,500 g) in women without malarial and reproductive tract infections. This study investigates the impact of SPAZ on associations between plasma biomarkers of inflammation and angiogenesis and adverse pregnancy outcomes in 2,012 Papua New Guinean women. Concentrations of C-reactive protein (CRP), α-1-acid glycoprotein (AGP), soluble endoglin (sEng), soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) were measured at enrolment and delivery in a trial comparing SPAZ to SP plus chloroquine (SPCQ). At antenatal enrolment higher CRP (adjusted odds ratio 1.52; 95% confidence interval [CI] 1.03–2.25), sEng (4.35; 1.77, 10.7) and sFlt1 (2.21; 1.09, 4.48) were associated with preterm birth, and higher sEng with low birthweight (1.39; 1.11,3.37), in SPCQ recipients only. Increased enrolment sFlt1:PlGF ratios associated with LBW in all women (1.46; 1.11, 1.90). At delivery, higher AGP levels were strongly associated with low birthweight, preterm birth and small-for-gestational age babies in the SPCQ arm only. Restricting analyses to women without malaria infection did not materially alter these relationships. Women receiving SPAZ had lower delivery AGP and CRP levels (p < 0.001). SPAZ may protect against adverse pregnancy outcomes by reducing inflammation and preventing its deleterious consequences, including dysregulation of placental angiogenesis, in women with and without malarial infection.
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Affiliation(s)
- Holger W Unger
- Department of Medicine at the Doherty Institute, University of Melbourne, Parkville, Victoria, Australia.
| | - Annjaleen P Hansa
- Department of Medicine at the Doherty Institute, University of Melbourne, Parkville, Victoria, Australia.,Central Clinical School and Department of Microbiology, Monash University, Victoria, Australia
| | - Christelle Buffet
- Department of Medicine at the Doherty Institute, University of Melbourne, Parkville, Victoria, Australia
| | - Wina Hasang
- Department of Medicine at the Doherty Institute, University of Melbourne, Parkville, Victoria, Australia
| | - Andrew Teo
- Department of Medicine at the Doherty Institute, University of Melbourne, Parkville, Victoria, Australia
| | - Louise Randall
- Department of Medicine at the Doherty Institute, University of Melbourne, Parkville, Victoria, Australia
| | - Maria Ome-Kaius
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.,Walter and Eliza Hall Institute, Parkville, Victoria, Australia.,Department of Medical Biology, University of Melbourne, Parkville, Victoria, Australia
| | - Stephan Karl
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.,Walter and Eliza Hall Institute, Parkville, Victoria, Australia.,Department of Medical Biology, University of Melbourne, Parkville, Victoria, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia
| | - Ayen A Anuan
- Department of Medicine at the Doherty Institute, University of Melbourne, Parkville, Victoria, Australia
| | - James G Beeson
- Department of Medicine at the Doherty Institute, University of Melbourne, Parkville, Victoria, Australia.,Central Clinical School and Department of Microbiology, Monash University, Victoria, Australia.,Burnet Institute, Melbourne, Victoria, Australia
| | - Ivo Mueller
- Walter and Eliza Hall Institute, Parkville, Victoria, Australia.,Department of Medical Biology, University of Melbourne, Parkville, Victoria, Australia.,Institut Pasteur, Paris, France
| | - Sarah J Stock
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, Queen's Medical Research Institute, Edinburgh, UK
| | - Stephen J Rogerson
- Department of Medicine at the Doherty Institute, University of Melbourne, Parkville, Victoria, Australia
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13
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Abstract
Pregnant women are especially susceptible to malaria infection. Without existing immunity, severe malaria can develop requiring emergency treatment, and pregnancy loss is common. In semi-immune women, consequences of malaria for the mother include anaemia while stillbirth, premature delivery and foetal growth restriction affect the developing foetus. Preventive measures include insecticide-treated nets and (in some African settings) intermittent preventive treatment. Prompt management of maternal infection is key, using parenteral artemisinins for severe malaria, and artemisinin combination treatments (ACTs) in the second and third trimesters of pregnancy. ACTs may soon also be recommended as an alternative to quinine as a treatment in the first trimester of pregnancy. Monitoring the safety of antimalarials and understanding their pharmacokinetics is particularly important in pregnancy with the altered maternal physiology and the risks to the developing foetus. As increasing numbers of countries embrace malaria elimination as a goal, the special needs of the vulnerable group of pregnant women and their infants should not be overlooked.
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Affiliation(s)
- Stephen J Rogerson
- Department of Medicine at the Doherty Institute, The University of Melbourne, Melbourne, Australia
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14
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Performance of a highly sensitive rapid diagnostic test (HS-RDT) for detecting malaria in peripheral and placental blood samples from pregnant women in Colombia. PLoS One 2018; 13:e0201769. [PMID: 30071004 PMCID: PMC6072118 DOI: 10.1371/journal.pone.0201769] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/20/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Pregnancy poses specific challenges for the diagnosis of Plasmodium falciparum infection due to parasite sequestration in the placenta, which translates in low circulation levels in peripheral blood. The aim of this study is to assess the performance of a new highly sensitive rapid diagnostic test (HS-RDT) for the detection of malaria in peripheral and placental blood samples from pregnant women in Colombia. METHODS This is a retrospective study using 737 peripheral and placental specimens collected from pregnant women in Colombian malaria-endemic regions. Light microscopy (LM), conventional rapid diagnostic tests (Pf/Pv RDT and Pf RDT), and HS-RDT testing were performed. Diagnostic accuracy endpoints of LM, HS-RDT and RDTs were compared with nested polymerase chain reaction (nPCR) as the reference test. RESULTS In comparison with nPCR, the sensitivity of HS-RDT, Pf RDT, Pf/Pv RDT and LM to detect infection in peripheral samples was 85.7% (95% CI = 70.6-93.7), 82.8% (95% CI = 67.3-91.9), 77.1% (95% CI = 61.0-87.9) and 77.1% (95% CI = 61.0-87.9) respectively. The sensitivity to detect malaria in asymptomatic women, was higher with HS-RDT, where LM and Pf/Pv RDT missed half of infections detected by nPCR, but differences were not significant. Overall, specificity was similar for all tests (>99.0%). In placental blood, the prevalence of infection by P. falciparum by nPCR was 2.8% (8/286), by HS-RDT was 1% and by conventional RDTs (Pf RDT and Pf/Pv RDT) and LM was 0.7%. The HS-RDT detected placental infections in peripheral blood that were negative by LM and Pf/Pv RDT, however the number of positive placentas was low. CONCLUSIONS The sensitivity of HS-RDT to detect P. falciparum infections in peripheral and placental samples from pregnant women was slightly better compared to routinely used tests during ANC visits and at delivery. Although further studies are needed to guide recommendations on the use of the HS-RDT for malaria case management in pregnancy, this study shows the potential value of this test to diagnose malaria in pregnancy in low-transmission settings.
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15
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Willie N, Zimmerman PA, Mehlotra RK. Plasmodium falciparum Histidine-Rich Protein 2 Gene Variation in a Malaria-Endemic Area of Papua New Guinea. Am J Trop Med Hyg 2018; 99:697-703. [PMID: 29968556 DOI: 10.4269/ajtmh.18-0137] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Histidine-rich protein 2 of Plasmodium falciparum (PfHRP2) forms the basis of many current malaria rapid diagnostic tests (RDTs). It is concerning that there are parasites that lack part or all of the pfhrp2 gene, and thus do not express the PfHRP2 protein; such parasites are not identifiable by PfHRP2-detecting RDTs. Very limited information is available regarding pfhrp2 genetic variation in Papua New Guinea (PNG). In the present study, this gene variation was evaluated using 169 samples previously collected from the Wosera area in East Sepik Province of PNG. Molecular diagnosis of these samples showed that 81% were infected, and P. falciparum was present in 91% of those infected samples. One hundred and twenty samples were amplified for pfhrp2 exon-2, from which 12 randomly selected amplicons were sequenced, yielding 18 sequences, all of which were unique. Baker repeat type 2 × type 7 numbers ranged from 0 to 108. Epitope mapping analysis revealed that three major epitopes, DAHHAHHA, AHHAADAHHA, and AHHAADAHH, were present in high prevalence and frequencies. These major epitopes have been shown to be recognized by the monoclonal antibodies 3A4 and PTL-3 (DAHHAHHA), C1-13 (AHHAADAHHA), and S2-5 and C2-3 (AHHAADAHH). This study provides further information on the high genetic variation of pfhrp2 and its unclear relationship with prediction of RDT detection sensitivity, and identifies major epitopes in this gene from PNG. These results could be relevant and useful to understand the genetic diversity of this gene and the performance of current and future RDTs in this malarious region of the world.
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Affiliation(s)
- Nigani Willie
- Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Peter A Zimmerman
- Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Rajeev K Mehlotra
- Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio
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16
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Azazy AA, Alhawery AJ, Abdul-Ghani R, Alharbi RA, Almalki SSR. Evaluation of rapid PfHRP-2/pLDH-based tests in diagnosing microscopy-confirmed falciparum malaria in Hodeidah governorate, Yemen. Acta Trop 2018; 178:252-257. [PMID: 29217380 DOI: 10.1016/j.actatropica.2017.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 11/29/2017] [Accepted: 12/02/2017] [Indexed: 11/15/2022]
Abstract
Along with the determination of malaria infection rate among suspected patients attending hospitals in Hodeidah governorate, the present study evaluated the accuracy of Plasmodium falciparum histidine-rich protein-2 (PfHRP-2)/parasite-specific lactate dehydrogenase (pLDH)-based rapid diagnostic test (RDT) for the diagnosis of microscopy-confirmed falciparum malaria. An overall malaria infection rate of 19.3% (57/295) among suspected patients attending hospitals was microscopically confirmed. The sensitivity of thin blood films for the detection of malaria parasites was 79.0% compared to thick films and was greatly affected by the parasite density, being 65.0% or less at parasite densities of ≤1000 parasites/μl of blood. Compared to light microscopy, the present study revealed sensitivity levels of 100.0% (95% CI: 92.0-100.0) vs. 94.7% (95% CI: 84.2-98.6), specificity levels of 97.3% (95% CI: 89.8-99.5) vs. 100.0% (95% CI: 93.9-100.0), positive predictive values of 89.9% (95% CI: 88.3-99.0) vs. 100.0 (95% CI: 91.6-100.0) and negative predictive values of 100.0% (95% CI: 93.9-100.0) vs. 98.7% (95% CI: 89.3-98.7) for the PfHRP-2 and pLDH components of SD BIOLINE® RDT, respectively, for falciparum malaria diagnosis. Therefore, the overall accuracy levels of the PfHRP-2 and pLDH components of the investigated RDT for the diagnosis of microscopy-confirmed falciparum malaria are 98.5% (95% CI: 94.6-99.6) and 97.7% (95% CI: 93.5-99.2), respectively.
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Affiliation(s)
- Ahmed A Azazy
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha, KSA, Saudi Arabia
| | - Ali Jamaly Alhawery
- Department of Medical Parasitology, Faculty of Medicine and Health Sciences, Hodeidah University, Hodeidah, Yemen
| | - Rashad Abdul-Ghani
- Department of Medical Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen; Tropical Disease Research Center, Faculty of Medicine and Health Sciences, University of Science and Technology, Sana'a, Yemen.
| | - R A Alharbi
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha, KSA, Saudi Arabia
| | - Shaia S R Almalki
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha, KSA, Saudi Arabia
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17
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D'Alessandro U, Hill J, Tarning J, Pell C, Webster J, Gutman J, Sevene E. Treatment of uncomplicated and severe malaria during pregnancy. THE LANCET. INFECTIOUS DISEASES 2018; 18:e133-e146. [PMID: 29395998 DOI: 10.1016/s1473-3099(18)30065-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 07/19/2017] [Accepted: 10/13/2017] [Indexed: 12/13/2022]
Abstract
Over the past 10 years, the available evidence on the treatment of malaria during pregnancy has increased substantially. Owing to their relative ease of use, good sensitivity and specificity, histidine rich protein 2 based rapid diagnostic tests are appropriate for symptomatic pregnant women; however, such tests are less appropriate for systematic screening because they will not detect an important proportion of infections among asymptomatic women. The effect of pregnancy on the pharmacokinetics of antimalarial drugs varies greatly between studies and class of antimalarial drugs, emphasising the need for prospective studies in pregnant and non-pregnant women. For the treatment of malaria during the first trimester, international guidelines are being reviewed by WHO. For the second and third trimester of pregnancy, results from several trials have confirmed that artemisinin-based combination treatments are safe and efficacious, although tolerability and efficacy might vary by treatment. It is now essential to translate such evidence into policies and clinical practice that benefit pregnant women in countries where malaria is endemic. Access to parasitological diagnosis or appropriate antimalarial treatment remains low in many countries and regions. Therefore, there is a pressing need for research to identify quality improvement interventions targeting pregnant women and health providers. In addition, efficient and practical systems for pharmacovigilance are needed to further expand knowledge on the safety of antimalarial drugs, particularly in the first trimester of pregnancy.
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Affiliation(s)
- Umberto D'Alessandro
- Medical Research Council Unit, Banjul, The Gambia; London School of Hygiene & Tropical Medicine, London, UK.
| | - Jenny Hill
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Joel Tarning
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Christopher Pell
- Centre for Social Science and Global Health, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
| | - Jayne Webster
- London School of Hygiene & Tropical Medicine, London, UK
| | - Julie Gutman
- Malaria Branch, US Centers for Diseases Control and Prevention, Atlanta, GA, USA
| | - Esperanca Sevene
- Manhiça Health Research Center (CISM), Manhiça, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
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18
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Lufele E, Umbers A, Ordi J, Ome-Kaius M, Wangnapi R, Unger H, Tarongka N, Siba P, Mueller I, Robinson L, Rogerson S. Risk factors and pregnancy outcomes associated with placental malaria in a prospective cohort of Papua New Guinean women. Malar J 2017; 16:427. [PMID: 29065884 PMCID: PMC5655867 DOI: 10.1186/s12936-017-2077-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 10/19/2017] [Indexed: 12/19/2022] Open
Abstract
Background Plasmodium falciparum in pregnancy results in substantial poor health outcomes for both mother and child, particularly in young, primigravid mothers who are at greatest risk of placental malaria (PM) infection. Complications of PM include maternal anaemia, low birth weight and preterm delivery, which contribute to maternal and infant morbidity and mortality in coastal Papua New Guinea (PNG). Methods Placental biopsies were examined from 1451 pregnant women who were enrolled in a malaria prevention study at 14–26 weeks gestation. Clinical and demographic information were collected at first antenatal clinic visits and women were followed until delivery. Placental biopsies were collected and examined for PM using histology. The presence of infected erythrocytes and/or the malaria pigment in monocytes or fibrin was used to determine the type of placental infection. Results Of 1451 placentas examined, PM infection was detected in 269 (18.5%), of which 54 (3.7%) were acute, 55 (3.8%) chronic, and 160 (11.0%) were past infections. Risk factors for PM included residing in rural areas (adjusted odds ratio (AOR) 3.65, 95% CI 1.76–7.51; p ≤ 0.001), being primigravid (AOR 2.45, 95% CI 1.26–4.77; p = 0.008) and having symptomatic malaria during pregnancy (AOR 2.05, 95% CI 1.16–3.62; p = 0.013). After adjustment for covariates, compared to uninfected women, acute infections (AOR 1.97, 95% CI 0.98–3.95; p = 0.056) were associated with low birth weight babies, whereas chronic infections were associated with preterm delivery (AOR 3.92, 95% CI 1.64–9.38; p = 0.002) and anaemia (AOR 2.22, 95% CI 1.02–4.84; p = 0.045). Conclusions Among pregnant PNG women receiving at least one dose of intermittent preventive treatment in pregnancy and using insecticide-treated bed nets, active PM infections were associated with adverse outcomes. Improved malaria prevention is required to optimize pregnancy outcomes.
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Affiliation(s)
- Elvin Lufele
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Alexandra Umbers
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea.,Department of Medicine and Radiology, Peter Doherty Institute, University of Melbourne, Melbourne, VIC, Australia
| | - Jaume Ordi
- Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | - Maria Ome-Kaius
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Regina Wangnapi
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Holger Unger
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea.,Department of Medicine and Radiology, Peter Doherty Institute, University of Melbourne, Melbourne, VIC, Australia
| | - Nandao Tarongka
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Peter Siba
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Ivo Mueller
- Population Health and Immunity Division, Walter and Eliza Hall Institute, Melbourne, VIC, Australia.,Institute Pasteur, Paris, France
| | - Leanne Robinson
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea.,Population Health and Immunity Division, Walter and Eliza Hall Institute, Melbourne, VIC, Australia.,Burnet Institute, Melbourne, VIC, Australia
| | - Stephen Rogerson
- Department of Medicine and Radiology, Peter Doherty Institute, University of Melbourne, Melbourne, VIC, Australia.
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19
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Kimura M, Koga M, Hasegawa C, Mutoh Y, Kato Y, Maruyama H. Imported malaria in pregnant women experienced in Japan. J Infect Chemother 2017; 23:545-549. [PMID: 28583709 DOI: 10.1016/j.jiac.2017.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 04/25/2017] [Accepted: 05/10/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION With ever-growing global exchanges, the number of travelers, including pregnant women, to the tropics is increasing, which poses a risk of contracting malaria. Although there are several reports on imported malaria in pregnancy from Western countries, those focusing on cases experienced in Japan are very limited. METHODS We searched for cases of malaria in pregnancy in the treatment records submitted to the Research Group on Chemotherapy of Tropical Diseases, Japan, during the period 1993-2016. Literature searches were also conducted using an American and a Japanese search system. RESULTS Ten cases of malaria in pregnant women were identified, including four cases with Plasmodium falciparum. Of eight evaluable cases, only one practiced malaria chemoprophylaxis. Among the nine evaluable cases, eight resulted in uneventful delivery and one P. falciparum case developed severe hepatic disturbance, disseminated intravascular coagulation, and intrauterine fetal death. After the initial attack, none of the Plasmodium vivax/Plasmodium ovale cases practiced chloroquine prophylaxis until delivery. One P. ovale case received a lower dose regimen of chloroquine as acute-stage therapy. CONCLUSION This study demonstrated additional cases of imported malaria in pregnant women to the literature and highlighted various epidemiological, demographic, and clinical characteristics. Some of the clinical issues raised need to be investigated. Due to the paucity of the cases worldwide, sharing information among various countries is indispensable, and international guidelines which are now increasingly recommending the use of artemisinins in pregnant women should be referred.
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Affiliation(s)
- Mikio Kimura
- Department of Internal Medicine, Shin-Yamanote Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan.
| | - Michiko Koga
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Chihiro Hasegawa
- Department of Infectious Diseases, Nagoya City East Medical Center, Nagoya, Japan
| | - Yoshikazu Mutoh
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yasuyuki Kato
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Haruhiko Maruyama
- Division of Parasitology, Department of Infectious Diseases, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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20
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Abstract
One hundred and twenty-five million women in malaria-endemic areas become pregnant each year (see Dellicour et al. PLoS Med7: e1000221 [2010]) and require protection from infection to avoid disease and death for themselves and their offspring. Chloroquine prophylaxis was once a safe approach to prevention but has been abandoned because of drug-resistant parasites, and intermittent presumptive treatment with sulfadoxine-pyrimethamine, which is currently used to protect pregnant women throughout Africa, is rapidly losing its benefits for the same reason. No other drugs have yet been shown to be safe, tolerable, and effective as prevention for pregnant women, although monthly dihydroartemisinin-piperaquine has shown promise for reducing poor pregnancy outcomes. Insecticide-treated nets provide some benefits, such as reducing placental malaria and low birth weight. However, this leaves a heavy burden of maternal, fetal, and infant morbidity and mortality that could be avoided. Women naturally acquire resistance to Plasmodium falciparum over successive pregnancies as they acquire antibodies against parasitized red cells that bind chondroitin sulfate A in the placenta, suggesting that a vaccine is feasible. Pregnant women are an important reservoir of parasites in the community, and women of reproductive age must be included in any elimination effort, but several features of malaria during pregnancy will require special consideration during the implementation of elimination programs.
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Affiliation(s)
- Michal Fried
- Laboratory of Malaria Immunology and Vaccinology, NIAID, NIH, Bethesda, MD 20892
| | - Patrick E Duffy
- Laboratory of Malaria Immunology and Vaccinology, NIAID, NIH, Bethesda, MD 20892
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21
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Willilo RA, Molteni F, Mandike R, Mugalura FE, Mutafungwa A, Thadeo A, Benedictor E, Kafuko JM, Kaspar N, Ramsan MM, Mwaipape O, McElroy PD, Gutman J, Colaco R, Reithinger R, Ngondi JM. Pregnant women and infants as sentinel populations to monitor prevalence of malaria: results of pilot study in Lake Zone of Tanzania. Malar J 2016; 15:392. [PMID: 27473039 PMCID: PMC4966757 DOI: 10.1186/s12936-016-1441-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 07/18/2016] [Indexed: 11/30/2022] Open
Abstract
Background As malaria control interventions are scaled-up, rational approaches are needed for monitoring impact over time. One proposed approach includes monitoring the prevalence of malaria infection among pregnant women and children at the time of routine preventive health facility (HF) visits. This pilot explored the feasibility and utility of tracking the prevalence of malaria infection in pregnant women attending their first antenatal care (ANC) visit and infants presenting at 9–12 months of age for measles vaccination. Methods Pregnant women attending first ANC and infants nine to 12 months old presenting for measles vaccination at a non-probability sample of 54 HFs in Tanzania’s Lake Zone (Mara, Mwanza and Kagera Regions) were screened for malaria infection using a malaria rapid diagnostic test (RDT) from December 2012 to November 2013, regardless of symptoms. Participants who tested positive were treated for malaria per national guidelines. Data were collected monthly. Results Overall 89.9 and 78.1 % of expected monthly reports on malaria infection prevalence were received for pregnant women and infants, respectively. Among 51,467 pregnant women and 35,155 infants attending routine preventive HF visits, 41.2 and 37.3 % were tested with RDT, respectively. Malaria infection prevalence was 12.8 % [95 % confidence interval (CI) 11.3–14.3] among pregnant women and 11.0 % (95 % CI 9.5–12.5) among infants, and varied by month. There was good correlation of the prevalence of malaria among pregnant women and infants at the HF level (Spearman rho = 0.6; p < 0.001). This approach is estimated to cost $1.28 for every person tested, with the RDT accounting for 72 % of the cost. Conclusions Malaria infection was common and well correlated among pregnant women and infants attending routine health services. Routine screening of these readily accessible populations may offer a practical strategy for continuously tracking malaria trends, particularly seasonal variation. Positivity rates among afebrile individuals presenting for routine care offer an advantage as they are unaffected by the prevalence of other causes of febrile illness, which could influence positivity rates among febrile patients presenting to outpatient clinics. The data presented here suggest that in addition to contributing to clinical management, ongoing screening of pregnant women could be used for routine surveillance and detection of hotspots.
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Affiliation(s)
| | - Fabrizio Molteni
- National Malaria Control Programme, Dar es Salaam, Tanzania.,Swiss Tropical and Public Health Institute, Dar es Salaam, Tanzania
| | - Renata Mandike
- National Malaria Control Programme, Dar es Salaam, Tanzania
| | | | | | | | | | - Jessica M Kafuko
- President's Malaria Initiative/United States Agency for International Development, Abuja, Nigeria
| | - Naomi Kaspar
- President's Malaria Initiative/United States Agency for International Development, Dar es Salaam, Tanzania
| | | | | | - Peter D McElroy
- President's Malaria Initiative and Malaria Branch, Centers for Disease Control and Prevention, Atlanta, USA
| | - Julie Gutman
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA
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22
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Alareqi LMQ, Mahdy MAK, Lau YL, Fong MY, Abdul-Ghani R, Ali AA, Cheong FW, Tawfek R, Mahmud R. Field evaluation of a PfHRP-2/pLDH rapid diagnostic test and light microscopy for diagnosis and screening of falciparum malaria during the peak seasonal transmission in an endemic area in Yemen. Malar J 2016; 15:49. [PMID: 26821911 PMCID: PMC4730713 DOI: 10.1186/s12936-016-1103-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 01/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria is a public health threat in Yemen, with 149,451 cases being reported in 2013. Of these, Plasmodium falciparum represents 99%. Prompt diagnosis by light microscopy (LM) and rapid diagnostic tests (RTDs) is a key element in the national strategy of malaria control. The heterogeneous epidemiology of malaria in the country necessitates the field evaluation of the current diagnostic strategies, especially RDTs. Thus, the present study aimed to evaluate LM and an RDT, combining both P. falciparum histidine-rich protein-2 (PfHRP-2) and Plasmodium lactate dehydrogenase (pLDH), for falciparum malaria diagnosis and survey in a malaria-endemic area during the transmission season against nested polymerase chain reaction (PCR) as the reference method. METHODS A household-based, cross-sectional malaria survey was conducted in Mawza District, a malaria-endemic area in Taiz governorate. A total of 488 participants were screened using LM and PfHRP-2/pLDH RDT. Positive samples (160) and randomly selected negative samples (52) by both RDT and LM were further analysed using 18S rRNA-based nested PCR. RESULTS The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the RDT were 96.0% (95% confidence interval (CI): 90.9-98.3), 56.0% (95% CI: 44.7-66.8), 76.3% (95% CI: 69.0-82.3), and 90.4% (95% CI: 78.8-96.8), respectively. On the other hand, LM showed sensitivity of 37.6% (95% CI: 29.6-46.3), specificity of 97.6% (95% CI: 91.7-99.7), PPV of 95.9% (95% CI: 86.3-98.9), and NPV of 51.3% (95% CI: 43.2-59.2). The sensitivity of LM dropped to 8.5% for detecting asymptomatic malaria. Malaria prevalence was 32.8% (32.1 and 37.5% for ≥10 and <10 years, respectively) with the RDT compared with 10.7% (10.8 and 9.4% for age groups of ≥10 and <10 years, respectively) with LM. Among asymptomatic malaria individuals, LM and RDT-based prevalence rates were 1.6 and 25.6%, respectively. However, rates of 88.2 and 94.1% of infection with P. falciparum were found among patients who reported fever in the 48 h prior to the survey by LM and PfHRP-2/pLDH RDT, respectively. CONCLUSIONS The PfHRP-2/pLDH RDT shows high sensitivity for the survey of falciparum malaria even for asymptomatic malaria cases. Although the RDT had high sensitivity, its high false-positivity rate limits its utility as a single diagnostic tool for clinical diagnosis of malaria. On the other hand, low sensitivity of LM indicates that a high proportion of malaria cases is missed, underestimating the true prevalence of malaria in the community. Higher NPV of PfHRP-2/pLDH RDT than LM can give a straightforward exclusion of malaria among febrile patients, helping to avoid unnecessary presumptive treatments.
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Affiliation(s)
- Lina M Q Alareqi
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Mohammed A K Mahdy
- Tropical Disease Research Center, University of Science and Technology, Sana'a, Yemen. .,Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen.
| | - Yee-Ling Lau
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Mun-Yik Fong
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Rashad Abdul-Ghani
- Tropical Disease Research Center, University of Science and Technology, Sana'a, Yemen. .,Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen.
| | - Arwa A Ali
- Yemeni-Swedish Hospital, Ministry of Public Health and Population, Taiz, Yemen.
| | - Fei-Wen Cheong
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Rehab Tawfek
- Yemeni-Swedish Hospital, Ministry of Public Health and Population, Taiz, Yemen.
| | - Rohela Mahmud
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
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23
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Yeom JS, Kong Y. Medical treatment of tropical parasitic diseases. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2016. [DOI: 10.5124/jkma.2016.59.9.721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Joon Sup Yeom
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon Kong
- Department of Molecular Parasitology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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