• 1.

    Desai M, ter Kuile FO, Nosten F, McGready R, Asamoa K, Brabin B, Newman RD, 2007. Epidemiology and burden of malaria in pregnancy. Lancet Infect Dis 7: 93104.

    • Search Google Scholar
    • Export Citation
  • 2.

    WHO Global Malaria Programme, 2012. Intermittent Preventive Treatment of Malaria in Pregnancy Using Sulfadoxine-Pyrimethamine (IPTp-SP). Available at: http://www.who.int/malaria/publications/atoz/who_iptp_sp_policy_recommendation/en/. Accessed May 1, 2013.

  • 3.

    Eisele TP, Larsen DA, Anglewicz PA, Keating J, Yukich J, Bennett A, Hutchinson P, Steketee RW, 2012. Malaria prevention in pregnancy, birthweight, and neonatal mortality: a meta-analysis of 32 national cross-sectional datasets in Africa. Lancet Infect Dis 12: 942949.

    • Search Google Scholar
    • Export Citation
  • 4.

    Van Eijk AM, Hill J, Larsen DA, Webster J, Steketee RW, Eisele TP, ter Kuile FO, 2013. Coverage of intermittent preventive treatment and insecticide-treated nets for the control of malaria during pregnancy in sub-Saharan Africa: asynthesis and meta-analysis of national survey data, 2009–11. Lancet Infect Dis 13: 10291042.

    • Search Google Scholar
    • Export Citation
  • 5.

    Thiam S, Kimotho V, Gatonga P, 2013. Why are IPTp coverage targets so elusive in sub-Saharan Africa? A systematic review of health system barriers. Malar J 12: 353.

    • Search Google Scholar
    • Export Citation
  • 6.

    Grietens KP, Gies S, Coulibaly SO, Ky C, Somda J, Toomer E, Muela Ribera J, D’Alessandro U, 2010. Bottlenecks for high coverage of intermittent preventive treatment in pregnancy: the case of adolescent pregnancies in rural Burkina Faso. PLoS One 5: e12013.

    • Search Google Scholar
    • Export Citation
  • 7.

    Hill J et al., 2015. Access and use of interventions to prevent and treat malaria among pregnant women in Kenya and Mali: a qualitative study. PLoS One 10: 123.

    • Search Google Scholar
    • Export Citation
  • 8.

    Naidoo I, Roper C, 2011. Drug resistance maps to guide intermittent preventive treatment of malaria in African infants. Parasitology 138: 14691479.

    • Search Google Scholar
    • Export Citation
  • 9.

    Geiger C, Compaore G, Coulibaly B, Sie A, Dittmer M, Sanchez C, Lanzer M, Jänisch T, 2014. Substantial increase in mutations in the genes pfdhfr and pfdhps puts sulphadoxine-pyrimethamine-based intermittent preventive treatment for malaria at risk in Burkina Faso. Trop Med Int Health 19: 690697.

    • Search Google Scholar
    • Export Citation
  • 10.

    Mockenhaupt FP, Bedu-Addo G, Eggelte TA, Hommerich L, Holmberg V, von Oertzen C, Bienzle U, 2008. Rapid increase in the prevalence of sulfadoxine-pyrimethamine resistance among Plasmodium falciparum isolated from pregnant women in Ghana. J Infect Dis 198: 15451549.

    • Search Google Scholar
    • Export Citation
  • 11.

    Naidoo I, Roper C, 2013. Mapping “partially resistant”, “fully resistant”, and “super resistant” malaria. Trends Parasitol 29: 505515.

    • Search Google Scholar
    • Export Citation
  • 12.

    Braun V, Rempis E, Schnack A, Decker S, Rubaihayo J, Tumwesigye NM, Theuring S, Harms G, Busingye P, Mockenhaupt FP, 2015. Lack of effect of intermittent preventive treatment for malaria in pregnancy and intense drug resistance in western Uganda. Malar J 14: 372.

    • Search Google Scholar
    • Export Citation
  • 13.

    Harrington WE, Mutabingwa TK, Kabyemela E, Fried M, Duffy PE, 2011. Intermittent treatment to prevent pregnancy malaria does not confer benefit in an area of widespread drug resistance. Clin Infect Dis 53: 224230.

    • Search Google Scholar
    • Export Citation
  • 14.

    Desai M et al., 2016. Impact of sulfadoxine-pyrimethamine resistance on effectiveness of intermittent preventive therapy for malaria in pregnancy at clearing infections and preventing low birth weight. Clin Infect Dis 62: 323333.

    • Search Google Scholar
    • Export Citation
  • 15.

    Chico RM, Cano J, Ariti C, Collier TJ, Chandramohan D, Roper C, Greenwood B, 2015. Influence of malaria transmission intensity and the 581G mutation on the efficacy of intermittent preventive treatment in pregnancy: systematic review and meta-analysis. Trop Med Int Health 20: 16211633.

    • Search Google Scholar
    • Export Citation
  • 16.

    World Health Organization, 2005. The Roll Back Malaria Strategy for Improving Access to Treatment through Home Management of Malaria. Geneva, Switzerland: World Health Organization.

  • 17.

    Ruizendaal E, Dierickx S, Peeters Grietens K, Schallig HDFH, Pagnoni F, Mens PF, 2014. Success or failure of critical steps in community case management of malaria with rapid diagnostic tests: a systematic review. Malar J 13: 229.

    • Search Google Scholar
    • Export Citation
  • 18.

    Scott S et al., 2014. Community-based scheduled screening and treatment of malaria in pregnancy for improved maternal and infant health in The Gambia, Burkina Faso and Benin: study protocol for a randomized controlled trial. Trials 15: 340.

    • Search Google Scholar
    • Export Citation
  • 19.

    World Health Organization, 2016. WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience. Geneva, Switzerland: World Health Organization.

  • 20.

    Kattenberg JH, Tahita CM, Versteeg IA, Tinto H, Traoré-Coulibaly M, Schallig HD, Mens PF, 2012. Antigen persistence of rapid diagnostic tests in pregnant women in Nanoro, Burkina Faso, and the implications for the diagnosis of malaria in pregnancy. Trop Med Int Health 17: 550557.

    • Search Google Scholar
    • Export Citation
  • 21.

    Hermsen CC, Telgt DS, Linders EH, van de Locht LA, Eling WM, Mensink EJ, Sauerwein RW, 2001. Detection of Plasmodium falciparum malaria parasites in vivo by real-time quantitative PCR. Mol Biochem Parasitol 118: 247–251.

    • Search Google Scholar
    • Export Citation
  • 22.

    Cottrell G, Moussiliou A, Luty AJF, Cot M, Fievet N, Massougbodji A, Deloron P, Tuikue Ndam N, 2015. Submicroscopic Plasmodium falciparum infections are associated with maternal anemia, premature births, and low birth weight. Clin Infect Dis 60: 14811488.

    • Search Google Scholar
    • Export Citation
  • 23.

    Kattenberg JH, Ochodo EA, Boer KR, Schallig HD, Mens PF, Leeflang MM, 2011. Systematic review and meta-analysis: rapid diagnostic tests versus placental histology, microscopy and PCR for malaria in pregnant women. Malar J 10: 321.

    • Search Google Scholar
    • Export Citation
  • 24.

    World Health Organization, 2012. Malaria Rapid Diagnostic Test Performance: Results of WHO Product Testing of Malaria RDTs: Round 4, Vol 4. Geneva, Switzerland: WHO.

  • 25.

    Joanny F, Löhr SJ, Engleitner T, Lell B, Mordmüller B, 2014. Limit of blank and limit of detection of Plasmodium falciparum thick blood smear microscopy in a routine setting in Central Africa. Malar J 13: 234.

    • Search Google Scholar
    • Export Citation
  • 26.

    Kyabayinze DJ et al., 2016. HRP2 and pLDH-based rapid diagnostic tests, expert microscopy, and PCR for detection of malaria infection during pregnancy and at delivery in areas of varied transmission: a prospective cohort study in Burkina Faso and Uganda. PLoS One 11: e0156954.

    • Search Google Scholar
    • Export Citation
  • 27.

    Williams JE et al., 2016. The performance of a rapid diagnostic test in detecting malaria infection in pregnant women and the impact of missed infections. Clin Infect Dis 62: 837844.

    • Search Google Scholar
    • Export Citation
  • 28.

    Fernandes S et al., 2016. Cost effectiveness of intermittent screening followed by treatment versus intermittent preventive treatment during pregnancy in West Africa: analysis and modelling of results from a non-inferiority trial. Malar J 15: 493.

    • Search Google Scholar
    • Export Citation
  • 29.

    Jarra W, Snounou G, 1998. Only viable parasites are detected by PCR following clearance of rodent malarial infections by drug treatment or immune responses. Infect Immun 66: 37833787.

    • Search Google Scholar
    • Export Citation
 
 
 

 

 
 
 

 

 

 

 

 

 

Evaluation of Malaria Screening during Pregnancy with Rapid Diagnostic Tests Performed by Community Health Workers in Burkina Faso

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  • 1 Department of Medical Microbiology, Academic Medical Centre, Amsterdam, The Netherlands;
  • | 2 Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom;
  • | 3 Disease Control and Elimination, Medical Research Council Unit, Fajara, The Gambia;
  • | 4 Institut de Recherche en Sciences de la Santé-Unité de Recherche Clinique de Nanoro, (IRSS-URCN), Nanoro, Burkina Faso;
  • | 5 Medical Research Council (MRC) Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, United Kingdom;
  • | 6 Medical Anthropology Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium;
  • | 7 Amsterdam Institute of Social Science Research, Amsterdam, The Netherlands;
  • | 8 Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso;
  • | 9 Chemin Petite Boissière 44, Geneva, Switzerland;
  • | 10 Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom

One of the current strategies to prevent malaria in pregnancy is intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP). However, in order for pregnant women to receive an adequate number of SP doses, they should attend a health facility on a regular basis. In addition, SP resistance may decrease IPTp-SP efficacy. New or additional interventions for preventing malaria during pregnancy are therefore warranted. Because it is known that community health workers (CHWs) can diagnose and treat malaria in children, in this study screening and treatment of malaria in pregnancy by CHWs was evaluated as an addition to the regular IPTp-SP program. CHWs used rapid diagnostic tests (RDTs) for screening and artemether–lumefantrine was given in case of a positive RDT. Overall, CHWs were able to conduct RDTs with a sensitivity of 81.5% (95% confidence interval [CI] 67.9–90.2) and high specificity of 92.1% (95% CI 89.9–93.9) compared with microscopy. After a positive RDT, 79.1% of women received artemether–lumefantrine. When treatment was not given, this was largely due to the woman being already under treatment. Almost all treated women finished the full course of artemether–lumefantrine (96.4%). In conclusion, CHWs are capable of performing RDTs with high specificity and acceptable sensitivity, the latter being dependent on the limit of detection of RDTs. Furthermore, CHWs showed excellent adherence to test results and treatment guidelines, suggesting they can be deployed for screen and treat approaches of malaria in pregnancy.

Author Notes

Address correspondence to Esmée Ruizendaal, Department of Medical Microbiology, Academic Medical Centre, Amsterdam 1105AZ, The Netherlands. E-mail: esmee.ruizendaal@gmail.com

Authors addresses: Esmée Ruizendaal, Henk D. F. H. Schallig, and Petra F. Mens, Department of Medical Microbiology, Academic Medical Centre, Amsterdam, The Netherlands, E-mails: esmee.ruizendaal@gmail.com, h.d.schallig@amc.uva.nl, and p.f.mens@amc.uva.nl. Susana Scott, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom, and Disease Control and Elimination, Medical Research Council Unit, Fajara, The Gambia, E-mail: sscott@mrc.gm. Maminata Traore-Coulibaly, Palpouguini Lompo, Hamtandi M. Natama, Ousmane Traore, Innocent Valea, and Halidou Tinto, Institut de Recherche en Sciences de la Santé-Unité de Recherche Clinique de Nanoro, (IRSS-URCN), Nanoro, Burkina Faso, E-mails: traore_maminata@yahoo.fr, palponet@yahoo.fr, natamagloire@yahoo.fr, ousmane_tra@yahoo.fr, innocentvalea@yahoo.fr, and halidoutinto@gmail.com. John Bradley, Medical Research Council (MRC) Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, United Kingdom, E-mail: john.bradley@lshtm.ac.uk. Susan Dierickx, Medical Anthropology Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium, and Amsterdam Institute of Social Science Research, Amsterdam, The Netherlands, E-mail: susan.dierickx@vub.ac.be. Koiné M. Drabo, Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso, E-mail: m_drabok@yahoo.fr. Franco Pagnoni, Chemin Petite Boissière, Geneva, Switzerland, E-mail: fpagnoni47@gmail.com. Umberto d’Alessandro, Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom, and Disease Control and Elimination, Medical Research Council Unit, Fajara, The Gambia, E-mail: udalessandro@mrc.gm.

Financial support: This study was funded by European Community’s Seventh Framework Programme under grant agreement no. 305662 (Project: Community-based scheduled screening and treatment of malaria in pregnancy for improved maternal and infant health: a cluster-randomized trial “COSMIC”).

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