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Open Access Highly Accessed Review

Systematic review and meta-analysis: rapid diagnostic tests versus placental histology, microscopy and PCR for malaria in pregnant women

Johanna H Kattenberg12*, Eleanor A Ochodo13, Kimberly R Boer4, Henk DFH Schallig1, Petra F Mens12 and Mariska MG Leeflang34

Author Affiliations

1 Royal Tropical Institute/Koninklijk Instituut voor de Tropen (KIT), KIT Biomedical Research, Parasitology Unit, Meibergdreef 39, 1105 AZ Amsterdam, the Netherlands

2 Academic Medical Centre, Centre for Infection and Immunity, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands

3 Academic Medical Centre, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands

4 Royal Tropical Institute/Koninklijk Instituut voor de Tropen (KIT), KIT Biomedical Research, Epidemiology Unit, Meibergdreef 39, 1105 AZ Amsterdam, the Netherlands

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Malaria Journal 2011, 10:321  doi:10.1186/1475-2875-10-321

Published: 28 October 2011

Abstract

Background

During pregnancy, malaria infection with Plasmodium falciparum or Plasmodium vivax is related to adverse maternal health and poor birth outcomes. Diagnosis of malaria, during pregnancy, is complicated by the absence or low parasite densities in peripheral blood. Diagnostic methods, other than microscopy, are needed for detection of placental malaria. Therefore, the diagnostic accuracy of rapid diagnostic tests (RDTs), detecting antigen, and molecular techniques (PCR), detecting DNA, for the diagnosis of Plasmodium infections in pregnancy was systematically reviewed.

Methods

MEDLINE, EMBASE and Web of Science were searched for studies assessing the diagnostic accuracy of RDTs, PCR, microscopy of peripheral and placental blood and placental histology for the detection of malaria infection (all species) in pregnant women.

Results

The results of 49 studies were analysed in metandi (Stata), of which the majority described P. falciparum infections. Although both placental and peripheral blood microscopy cannot reliably replace histology as a reference standard for placental P. falciparum infection, many studies compared RDTs and PCR to these tests. The proportion of microscopy positives in placental blood (sensitivity) detected by peripheral blood microscopy, RDTs and PCR are respectively 72% [95% CI 62-80], 81% [95% CI 55-93] and 94% [95% CI 86-98]. The proportion of placental blood microscopy negative women that were negative in peripheral blood microscopy, RDTs and PCR (specificity) are 98% [95% CI 95-99], 94% [95% CI 76-99] and 77% [95% CI 71-82]. Based on the current data, it was not possible to determine if the false positives in RDTs and PCR are caused by sequestered parasites in the placenta that are not detected by placental microscopy.

Conclusion

The findings suggest that RDTs and PCR may have good performance characteristics to serve as alternatives for the diagnosis of malaria in pregnancy, besides any other limitations and practical considerations concerning the use of these tests. Nevertheless, more studies with placental histology as reference test are urgently required to reliably determine the accuracy of RDTs and PCR for the diagnosis of placental malaria. P. vivax-infections have been neglected in diagnostic test accuracy studies of malaria in pregnancy.

Keywords:
Malaria; pregnancy; malaria in pregnancy (MiP); rapid diagnostic tests (RDTs); PCR; microscopy; histology; diagnostic test accuracy; systematic review; meta-analysis