Asymptomatic Plasmodium falciparum infection is associated with anaemia in pregnancy and can be more cost-effectively detected by rapid diagnostic test than by microscopy in Kinshasa, Democratic Republic of the Congo.
Asymptomatic Plasmodium falciparum infection is associated with anaemia in pregnancy and can be more cost-effectively detected by rapid diagnostic test than by microscopy in Kinshasa, Democratic Republic of the Congo.
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DOI：
10.1186/1475-2875-13-132
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发表时间：
2014-04-02
期刊：
影响因子：
3
通讯作者：
Van Geertruyden JP
中科院分区：
文献类型：
--
作者：
Matangila JR;Lufuluabo J;Ibalanky AL;Inocêncio da Luz RA;Lutumba P;Van Geertruyden JP
在疟疾高传播地区，妊娠期恶性疟原虫感染的特点是与疟疾有关的贫血、胎盘疟疾，并不总是导致临床症状。这种情况与不良妊娠结局有关。本研究的目的是确定生活在刚果民主共和国金沙萨的健康孕妇无症状恶性疟原虫感染的程度、与贫血的关系以及最具成本效益的诊断技术。在横断面研究设计中，收集了参加产前保健咨询的健康孕妇的社会人口统计学特征和成本数据。采用快速诊断试验（RDT）、镜检和聚合酶链反应（PCR）诊断恶性疟原虫感染。同时测定血红蛋白浓度。总共有332名孕妇参与了这项研究。所有血样均有RDT和镜检数据，并对166份血样进行PCR分析。镜检、rdt和PCR检测无症状恶性疟原虫感染率分别为21.6%、27.4%和29.5%。以PCR为参照，rdt诊断无症状恶性疟原虫感染的敏感性为81.6%，特异性为94.9%。显微镜下相应值分别为67.3%和97.4%。贫血的患病率为61.1%，无症状疟疾的发生率增加了5倍（p < 0.001）。与显微镜相比，rdt更具成本效益。每例显微镜充分诊断病例的增量成本效益比为63.47美元。这些令人震惊的结果强调需要在所有产前保健期间积极诊断和治疗无症状疟疾感染。此外，在刚果民主共和国，应通过推广使用驱虫蚊帐、磺胺嘧啶-乙胺嘧啶间歇预防治疗以及铁和叶酸补充剂，加强疟疾和贫血控制工作。
In areas of high malaria transmission, Plasmodium falciparum infection during pregnancy is characterized by malaria-related anaemia, placental malaria and does not always result in clinical symptoms. This situation is associated with poor pregnancy outcomes. The aim of this study was to determine the extent of asymptomatic P. falciparum infection, its relation with anaemia as well as the most cost-effective technique for its diagnosis in healthy pregnant women living in Kinshasa, Democratic Republic of the Congo. In a cross-sectional study design, information on socio-demographic characteristics and cost data were collected in healthy pregnant women attending antenatal care consultations. Plasmodium falciparum infection was diagnosed using rapid diagnostic test (RDT), microscopy and polymerase chain reaction (PCR). Haemoglobin concentration was also determined. In total, 332 pregnant women were enrolled. RDT and microscopy data were available for all the blood samples and 166 samples were analysed by PCR. The prevalence of asymptomatic P. falciparum infection using microscopy, RDTs and PCR, were respectively 21.6%, 27.4% and 29.5%. Taking PCR as a reference, RDTs had a sensitivity of 81.6% and a specificity of 94.9% to diagnose asymptomatic P. falciparum infection. The corresponding values for microscopy were 67.3% and 97.4%. The prevalence of anaemia was 61.1% and asymptomatic malaria increased five times the odds (p < 0.001) of having anaemia. RDTs were more cost-effective compared to microscopy. Incremental cost-effectiveness ratio was US$ 63.47 per microscopy adequately diagnosed case. These alarming results emphasize the need to actively diagnose and treat asymptomatic malaria infection during all antenatal care visits. Moreover, in DRC, malaria and anaemia control efforts should be strengthened by promoting the use of insecticide-treated nets, intermittent preventive treatment with sulphadoxine-pyrimethamine and iron and folic acid supplements.
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