TY - JOUR
T1 - Evaluation of malaria screening during pregnancy with rapid diagnostic tests performed by community health workers in Burkina Faso
AU - Ruizendaal, Esmee
AU - Schallig, Henk D. F. H.
AU - Scott, Susana
AU - Traore-Coulibaly, Maminata
AU - Bradley, John
AU - Lompo, Palpouguini
AU - Natama, Hamtandi M.
AU - Traore, Ousmane
AU - Valea, Innocent
AU - Dierickx, Susan
AU - Drabo, Koine M.
AU - Pagnoni, Franco
AU - d' Alessandro, Umberto
AU - Tinto, Halidou
AU - Mens, Petra F.
N1 - PPU
PY - 2017
Y1 - 2017
N2 - 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.
AB - 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.
KW - INTERMITTENT PREVENTIVE TREATMENT
KW - SULFADOXINE-PYRIMETHAMINE RESISTANCE
KW - LOW-BIRTH-WEIGHT
KW - DRUG-RESISTANCE
KW - INFECTIONS
KW - METAANALYSIS
KW - WOMEN
KW - PARASITES
KW - AFRICA
KW - IMPACT
U2 - 10.4269/ajtmh.17-0138
DO - 10.4269/ajtmh.17-0138
M3 - A1: Web of Science-article
VL - 97
SP - 1190
EP - 1197
JO - American Journal of Tropical Medicine and Hygiene
JF - American Journal of Tropical Medicine and Hygiene
SN - 0002-9637
IS - 4
ER -