Diagnosis of malaria in pregnancy: accuracy of CareStart™ malaria Pf/PAN against light microscopy among symptomatic pregnant women at the Central Hospital in Yaoundé, Cameroon

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Abstract

Background

The need to start treatment early for pregnant women who present with clinical features of malaria usually conflicts with the need to confirm diagnosis by microscopy (MP) before treatment, due to delays in obtaining results. Parasite sequestration in the placenta is also a problem. Rapid diagnostic tests (RDT), which detect soluble antigens, are a valuable alternative. The objective of this study was to evaluate pretreatment parasite prevalence by microscopy and by RDT and to assess the accuracy of RDT with MP as reference.

Methods

A prospective cross-sectional study was carried out at the obstetrical unit of the Central Hospital in Yaoundé, during the period January-August 2015. Consenting patients with symptoms of suspected malaria in pregnancy were recruited and a blood sample taken for MP and RDT before treatment was started. The estimates of diagnostic performance (with 95% confidence interval) were calculated in OpenEpi online software using the Wilson’s score. The agreement, as reflected by the Cohen’s kappa, was calculated and interpreted using known intervals.

Results

The results showed that, out of the 104 patients recruited, 69.2% (95%CI: 59.1–77.5) were MP positive while 77.94% (95%CI: 63.1–80.9) were RDT positive. The sensitivity of the malaria RDT was 91.67% (95%CI: 83.69–96.77) while the specificity was 53.13% (95%CI: 31.39–65.57). The diagnostic accuracy of the RDT with MP as reference was 79.81% (95%CI: 70.0–86.1). All cases were due to Plasmodium falciparum. A Cohen’s kappa of 0.45 (95%CI: 0.26–0.64) was obtained, consistent with a moderate agreement between the tests.

Conclusions

The diagnostic accuracy of the CareStart™ malaria Pf/PAN compared to microscopy was high, but not as desirable, with a false negative RDT at very high parasitaemia. In tertiary facilities, RDTs appear to provide a better diagnostic solution compared to microscopy. However, future studies with larger sample sizes should make this observation more generalizable; as missing a case could have serious consequences on pregnancy outcome.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12936-022-04109-6.

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Most cited references 40

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Malaria in pregnancy: pathogenesis and immunity.

Stephen J Rogerson, Lars Hviid, Patrick E Duffy … (2007)

Understanding of the biological basis for susceptibility to malaria in pregnancy was recently advanced by the discovery that erythrocytes infected with Plasmodium falciparum accumulate in the placenta through adhesion to molecules such as chondroitin sulphate A. Antibody recognition of placental infected erythrocytes is dependent on sex and gravidity, and could protect from malaria complications. Moreover, a conserved parasite gene-var2csa-has been associated with placental malaria, suggesting that its product might be an appropriate vaccine candidate. By contrast, our understanding of placental immunopathology and how this contributes to anaemia and low birthweight remains restricted, although inflammatory cytokines produced by T cells, macrophages, and other cells are clearly important. Studies that unravel the role of host response to malaria in pathology and protection in the placenta, and that dissect the relation between timing of infection and outcome, could allow improved targeting of preventive treatments and development of a vaccine for use in pregnant women.

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P. falciparum rosetting mediated by a parasite-variant erythrocyte membrane protein and complement-receptor 1.

J A Rowe, J M Moulds, C Newbold … (1997)

The factors determining disease severity in malaria are complex and include host polymorphisms, acquired immunity and parasite virulence. Studies in Africa have shown that severe malaria is associated with the ability of erythrocytes infected with the parasite Plasmodium falciparum to bind uninfected erythrocytes and form rosettes. The molecular basis of resetting is not well understood, although a group of low-molecular-mass proteins called rosettins have been described as potential parasite ligands. Infected erythrocytes also bind to endothelial cells, and this interaction is mediated by the parasite-derived variant erythrocyte membrane protein PfEMP1, which is encoded by the var gene family. Here we report that the parasite ligand for rosetting in a P. falciparum clone is PfEMP1, encoded by a specific var gene. We also report that complement-receptor 1 (CR1) on erythrocytes plays a role in the formation of rosettes and that erythrocytes with a common African CR1 polymorphism (S1(a-)) have reduced adhesion to the domain of PfEMP1 that binds normal erythrocytes. Thus we describe a new adhesive function for PfEMP1 and raise the possibility that CR1 polymorphisms in Africans that influence the interaction between erythrocytes and PfEMP1 may protect against severe malaria.

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Burden, pathology, and costs of malaria in pregnancy: new developments for an old problem.

Anna van Eijk, Steve M Taylor, Elisa Sicuri … (2018)

Over the past 10 years, knowledge of the burden, economic costs, and consequences of malaria in pregnancy has improved, and the prevalence of malaria caused by Plasmodium falciparum has declined substantially in some geographical areas. In particular, studies outside of Africa have increased the evidence base of Plasmodium vivax in pregnancy. Rapid diagnostic tests have been poor at detecting malaria in pregnant women, while PCR has shown a high prevalence of low density infection, the clinical importance of which is unknown. Erythrocytes infected with P falciparum that express the surface protein VAR2CSA accumulate in the placenta, and VAR2CSA is an important target of protective immunity. Clinical trials for a VAR2CSA vaccine are ongoing, but sequence variation needs to be carefully studied. Health system and household costs still limit access to prevention and treatment services. Within the context of malaria elimination, pregnant women could be used to monitor malaria transmission. This Series paper summarises recent progress and highlights unresolved issues related to the burden of malaria in pregnancy.

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Author and article information

Contributors

Cliford Ebontane Ebong: Cliffebong@yahoo.com

Innocent Mbulli Ali:

ORCID: http://orcid.org/0000-0002-1112-6376

innocent.mbulli@univ-dschang.org

Dohbit Sama: dohbit@yahoo.com

Journal

Journal ID (nlm-ta): Malar J

Journal ID (iso-abbrev): Malar J

Title: Malaria Journal

Publisher: BioMed Central (London )

ISSN (Electronic): 1475-2875

Publication date (Electronic): 9 March 2022

Publication date PMC-release: 9 March 2022

Publication date Collection: 2022

Volume: 21

Electronic Location Identifier: 78

Affiliations

[1 ]GRID grid.412661.6, ISNI 0000 0001 2173 8504, Department of Gynecology/Obstetrics, Faculty of Medicine and Biomedical Sciences, , University of Yaoundé 1, ; Yaoundé, Cameroon

[2 ]GRID grid.8201.b, ISNI 0000 0001 0657 2358, Department of Biochemistry, Faculty of Science, , University of Dschang, ; Dschang, Cameroon

[3 ]GRID grid.460723.4, ISNI 0000 0004 0647 4688, Gynecology and Obstetrics Unit, , Central Hospital of Yaoundé, ; Yaoundé, Cameroon

[4 ]GRID grid.418179.2, Malaria Unit, Centre Pasteur du Cameroun, ; Yaoundé, Cameroon

[5 ]GRID grid.415857.a, ISNI 0000 0001 0668 6654, Ministry of Public Health, , National Malaria Control Programme, ; Yaoundé, Cameroon

[6 ]Gyneco-Obstetric and Paediatric Hospital of Yaoundé, Yaoundé, Cameroon

Author information

Innocent Mbulli Ali http://orcid.org/0000-0002-1112-6376

Article

Publisher ID: 4109

DOI: 10.1186/s12936-022-04109-6

PMC ID: 8905860

PubMed ID: 35264170

SO-VID: 71c228e5-fd39-4574-a8c7-28e4359c8c93

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 19 October 2021

Date accepted : 27 February 2022

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ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: malaria,pregnancy,carestart pf/pan rdt,sensitivity,yaoundé,plasmodium falciparum,accuracy

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ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: malaria, pregnancy, carestart pf/pan rdt, sensitivity, yaoundé, plasmodium falciparum, accuracy

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Diagnosis of malaria in pregnancy: accuracy of CareStart™ malaria Pf/PAN against light microscopy among symptomatic pregnant women at the Central Hospital in Yaoundé, Cameroon

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Abstract

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Supplementary Information

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Malaria vaccine development

Most cited references 40

Malaria in pregnancy: pathogenesis and immunity.

P. falciparum rosetting mediated by a parasite-variant erythrocyte membrane protein and complement-receptor 1.

Burden, pathology, and costs of malaria in pregnancy: new developments for an old problem.

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