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

Esmée Ruizendaal Department of Medical Microbiology, Academic Medical Centre, Amsterdam, The Netherlands;

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Henk D. F. H. Schallig Department of Medical Microbiology, Academic Medical Centre, Amsterdam, The Netherlands;

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Susana Scott Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom;
Disease Control and Elimination, Medical Research Council Unit, Fajara, The Gambia;

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Maminata Traore-Coulibaly Institut de Recherche en Sciences de la Santé-Unité de Recherche Clinique de Nanoro, (IRSS-URCN), Nanoro, Burkina Faso;

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John Bradley Medical Research Council (MRC) Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, United Kingdom;

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Palpouguini Lompo Institut de Recherche en Sciences de la Santé-Unité de Recherche Clinique de Nanoro, (IRSS-URCN), Nanoro, Burkina Faso;

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Hamtandi M. Natama Institut de Recherche en Sciences de la Santé-Unité de Recherche Clinique de Nanoro, (IRSS-URCN), Nanoro, Burkina Faso;

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Ousmane Traore Institut de Recherche en Sciences de la Santé-Unité de Recherche Clinique de Nanoro, (IRSS-URCN), Nanoro, Burkina Faso;

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Innocent Valea Institut de Recherche en Sciences de la Santé-Unité de Recherche Clinique de Nanoro, (IRSS-URCN), Nanoro, Burkina Faso;

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Susan Dierickx Medical Anthropology Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium;
Amsterdam Institute of Social Science Research, Amsterdam, The Netherlands;

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Koiné M. Drabo Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso;

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Franco Pagnoni Chemin Petite Boissière 44, Geneva, Switzerland;

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Umberto d’ Alessandro Disease Control and Elimination, Medical Research Council Unit, Fajara, The Gambia;
Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom

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Halidou Tinto Institut de Recherche en Sciences de la Santé-Unité de Recherche Clinique de Nanoro, (IRSS-URCN), Nanoro, Burkina Faso;

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Petra F. Mens Department of Medical Microbiology, Academic Medical Centre, Amsterdam, The Netherlands;

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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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