Rapid Diagnostic Test Performance Assessed Using Latent Class Analysis for the Diagnosis of Plasmodium falciparum Placental Malaria

Yunhao Liu Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina.
Department of Statistics and Operations Research, University of North Carolina, Chapel Hill, North Carolina.

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Victor Mwapasa Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
Department of Community Health, College of Medicine, Blantyre, Malawi.

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Carole Khairallah Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.

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Kyaw L. Thwai Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina.

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Linda Kalilani-Phiri Department of Community Health, College of Medicine, Blantyre, Malawi.

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Feiko O. ter Kuile Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.

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Steven R. Meshnick Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina.

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Steve M. Taylor Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina.
Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina.
Duke Global Health Institute, Duke University Medical Center, Durham, North Carolina.

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Placental malaria causes low birth weight and neonatal mortality in malaria-endemic areas. The diagnosis of placental malaria is important for program evaluation and clinical care, but is compromised by the suboptimal performance of current diagnostics. Using placental and peripheral blood specimens collected from delivering women in Malawi, we compared estimation of the operating characteristics of microscopy, rapid diagnostic test (RDT), polymerase chain reaction, and histopathology using both a traditional contingency table and a latent class analysis (LCA) approach. The prevalence of placental malaria by histopathology was 13.8%; concordance between tests was generally poor. Relative to histopathology, RDT sensitivity was 79.5% in peripheral and 66.2% in placental blood; using LCA, RDT sensitivities increased to 93.7% and 80.2%, respectively. Our results, if replicated in other cohorts, indicate that RDT testing of peripheral or placental blood may be suitable approaches to detect placental malaria for surveillance programs, including areas where intermittent preventive therapy in pregnancy is not used.

Author Notes

* Address correspondence to Steve M. Taylor, Duke University Medical Center (DUMC), Box 102359, Durham, NC 27710. E-mail: steve.taylor@duke.edu

Financial support: This work was supported by the Malaria in Pregnancy Consortium, which is funded through a grant from the Bill & Melinda Gates Foundation to the Liverpool School of Tropical Medicine (to Feiko O. ter Kuile), and by the National Institute of Allergy and Infectious Diseases under award no. K08AI100924 (to Steve M. Taylor).

Authors' addresses: Yunhao Liu, Kyaw L. Thwai, and Steven R. Meshnick, Department of Epidemiology, University of North CarolinaGillings School of Public Health, Chapel Hill, NC, E-mails: yl6b@live.unc.edu, klthwai@gmail.com, and meshnick@unc.edu. Victor Mwapasa, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Department of Clinical Sciences, Blantyre, Malawi, and Department of Community Health, College of Medicine, Blantyre, Malawi, E-mail: vmwapasa69@gmail.com. Carole Khairallah and Feiko O. ter Kuile, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom, E-mails: carole.khairallah@liverpool.ac.uk and feiko.terkuile@lstmed.ac.uk. Linda Kalilani-Phiri, Department of Community Health, College of Medicine, Blantyre, Malawi, E-mail: lkalilani@medcol.mw. Steve M. Taylor, Department of Medicine, Duke University School of Medicine, Duke University Medical Center (DUMC), Durham, NC, E-mail: steve.taylor@duke.edu.

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