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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

Junior R Matangila13*, Jean Lufuluabo2, Axel L Ibalanky1, Raquel A Inocêncio da Luz3, Pascal Lutumba1 and Jean-Pierre Van Geertruyden3

Author Affiliations

1 Département de Médecine Tropicale, Université de Kinshasa, B.P. 747, Kinshasa, XI, République Démocratique du Congo

2 Institut Superieur de Techniques Médicales, Kinshasa RDC, Kinshasa, République Démocratique du Congo

3 International Health Unit, Department of Epidemiology, University of Antwerp, Campus DrieEiken, Universiteitsplein 1, Wilrijk 2610, Belgium

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Malaria Journal 2014, 13:132  doi:10.1186/1475-2875-13-132

Published: 2 April 2014

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

Keywords:
Asymptomatic P. falciparum infection; Anaemia; Pregnancy; Cost-effectiveness; Democratic Republic of the Congo