# name
Accuracy of an HRP-2/panLDH rapid diagnostic test to detect peripheral and placental Plasmodium falciparum infection in Papua New Guinean women with anaemia or suspected malaria

# metadata.dc.description.abstract[].value
BACKGROUND: The diagnosis of malaria during pregnancy is
                complicated by placental sequestration, asymptomatic infection,
                and low-density peripheral parasitaemia. Where intermittent
                preventive treatment (IPT) with sulfadoxine-pyrimethamine is
                threatened by drug resistance, or is inappropriate due to low
                transmission, intermittent screening and treatment (ISTp) with
                rapid diagnostic tests for malaria (RDT) could be a valuable
                alternative. Therefore, the accuracy of RDTs to detect
                peripheral and placental infection was assessed in a declining
                transmission setting in Papua New Guinea (PNG). METHODS: The
                performance of a combination RDT detecting histidine-rich
                protein-2 (HRP-2) and Plasmodium lactate dehydrogenase (pLDH),
                and light microscopy (LM), to diagnose peripheral Plasmodium
                falciparum and Plasmodium vivax infections during pregnancy,
                were assessed using quantitative real-time PCR (qPCR) as the
                reference standard. Participants in a malaria prevention trial
                in PNG with a haemoglobin </=90 g/L, or symptoms suggestive
                of malaria, were tested. Ability of RDT and LM to detect active
                placental infection on histology was evaluated in some
                participants. RESULTS: Among 876 women, 1162 RDTs were
                undertaken (anaemia: 854 [73.5 %], suspected malaria: 308 [26.5
                %]). qPCR detected peripheral infection during 190 RDT episodes
                (165 P. falciparum, 19 P. vivax, 6 mixed infections). Overall,
                RDT detected peripheral P. falciparum infection with 45.6 %
                sensitivity (95 % CI 38.0-53.4), a specificity of 96.4 %
                (95.0-97.4), a positive predictive value of 68.4 % (59.1-76.8),
                and a negative predictive value of 91.1 % (89.2-92.8). RDT
                performance to detect P. falciparum was inferior to LM, more so
                amongst anaemic women (18.6 vs 45.3 % sensitivity, Liddell's
                exact test, P < 0.001) compared to symptomatic women (72.9 vs
                82.4 % sensitivity, P = 0.077). RDT and LM missed 88.0 % (22/25)
                and 76.0 % (19/25) of P. vivax infections, respectively. In a
                subset of women tested at delivery and who had placental
                histology (n = 158) active placental infection was present in
                19.6 %: all three peripheral blood infection detection methods
                (RDT, LM, qPCR) missed >50 % of these infections.
                CONCLUSIONS: In PNG, HRP-2/pLDH RDTs may be useful to diagnose
                peripheral P. falciparum infections in symptomatic pregnant
                women. However, they are not sufficiently sensitive for use in
                intermittent screening amongst asymptomatic (anaemic) women.
                These findings have implications for the management of malaria
                in pregnancy. The adverse impact of infections undetected by RDT
                or LM on pregnancy outcomes needs further evaluation.

# metadata.dc.source[].value
Articles publicats en revistes (ISGlobal)

# metadata.dc.title[].value
Accuracy of an HRP-2/panLDH rapid diagnostic test to detect peripheral and placental Plasmodium falciparum infection in Papua New Guinean women with anaemia or suspected malaria