Abstract
BackgroundIn 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.MethodsIn 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.ResultsIn 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.ConclusionThese 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.
Highlights
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
Prevalence of asymptomatic P. falciparum infection in pregnant women at the first prenatal care (PNC) visit rapid diagnostic test (RDT) and microscopy data were available for 332 blood samples and of these, 166 samples were analysed by polymerase chain reaction (PCR)
69.8% stated that their nets were treated with insecticide and 81.8% reported having slept under the bed net the night before the interview (Table 1)
Summary
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 sequestration of infected erythrocytes in the intervillous spaces induces a local inflammation and a massive infiltration of immune cells (macrophages, monocytes and lymphocytes) and is often observed and described as ‘inflammatory placental malaria’ [2,5] This condition disturbs exchanges between the mother and the foetus and leads to poor pregnancy outcomes, such as abortion, stillbirths, low birth weight and infant mortality [6]. In malaria-endemic areas, it is estimated that 25% of pregnant women are infected with malaria parasites, with the greatest risk of infection and morbidity in primiparous adolescents, and those coinfected with HIV [13]
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