Systematic review and meta-analysis: rapid diagnostic tests <it>versus </it>placental histology, microscopy and PCR for malaria in pregnant women
<p>Abstract</p> <p>Background</p> <p>During pregnancy, malaria infection with <it>Plasmodium falciparum </it>or <it>Plasmodium vivax </it>is related to adverse maternal health and poor birth outcomes. Diagnosis of malaria, during pregnancy, is co...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2011-10-01
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| Series: | Malaria Journal |
| Subjects: | |
| Online Access: | http://www.malariajournal.com/content/10/1/321 |
| _version_ | 1818491406852816896 |
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| author | Kattenberg Johanna H Ochodo Eleanor A Boer Kimberly R Schallig Henk DFH Mens Petra F Leeflang Mariska MG |
| author_facet | Kattenberg Johanna H Ochodo Eleanor A Boer Kimberly R Schallig Henk DFH Mens Petra F Leeflang Mariska MG |
| author_sort | Kattenberg Johanna H |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>During pregnancy, malaria infection with <it>Plasmodium falciparum </it>or <it>Plasmodium vivax </it>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 <it>Plasmodium </it>infections in pregnancy was systematically reviewed.</p> <p>Methods</p> <p>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.</p> <p>Results</p> <p>The results of 49 studies were analysed in metandi (Stata), of which the majority described <it>P. falciparum </it>infections. Although both placental and peripheral blood microscopy cannot reliably replace histology as a reference standard for placental <it>P. falciparum </it>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.</p> <p>Conclusion</p> <p>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. <it>P. vivax</it>-infections have been neglected in diagnostic test accuracy studies of malaria in pregnancy.</p> |
| first_indexed | 2024-12-10T17:30:25Z |
| format | Article |
| id | doaj.art-22514f99fdb54fa3a04b9bfc3ac62962 |
| institution | Directory Open Access Journal |
| issn | 1475-2875 |
| language | English |
| last_indexed | 2024-12-10T17:30:25Z |
| publishDate | 2011-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Malaria Journal |
| spelling | doaj.art-22514f99fdb54fa3a04b9bfc3ac629622022-12-22T01:39:42ZengBMCMalaria Journal1475-28752011-10-0110132110.1186/1475-2875-10-321Systematic review and meta-analysis: rapid diagnostic tests <it>versus </it>placental histology, microscopy and PCR for malaria in pregnant womenKattenberg Johanna HOchodo Eleanor ABoer Kimberly RSchallig Henk DFHMens Petra FLeeflang Mariska MG<p>Abstract</p> <p>Background</p> <p>During pregnancy, malaria infection with <it>Plasmodium falciparum </it>or <it>Plasmodium vivax </it>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 <it>Plasmodium </it>infections in pregnancy was systematically reviewed.</p> <p>Methods</p> <p>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.</p> <p>Results</p> <p>The results of 49 studies were analysed in metandi (Stata), of which the majority described <it>P. falciparum </it>infections. Although both placental and peripheral blood microscopy cannot reliably replace histology as a reference standard for placental <it>P. falciparum </it>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.</p> <p>Conclusion</p> <p>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. <it>P. vivax</it>-infections have been neglected in diagnostic test accuracy studies of malaria in pregnancy.</p>http://www.malariajournal.com/content/10/1/321Malariapregnancymalaria in pregnancy (MiP)rapid diagnostic tests (RDTs)PCRmicroscopyhistologydiagnostic test accuracysystematic reviewmeta-analysis |
| spellingShingle | Kattenberg Johanna H Ochodo Eleanor A Boer Kimberly R Schallig Henk DFH Mens Petra F Leeflang Mariska MG Systematic review and meta-analysis: rapid diagnostic tests <it>versus </it>placental histology, microscopy and PCR for malaria in pregnant women Malaria Journal Malaria pregnancy malaria in pregnancy (MiP) rapid diagnostic tests (RDTs) PCR microscopy histology diagnostic test accuracy systematic review meta-analysis |
| title | Systematic review and meta-analysis: rapid diagnostic tests <it>versus </it>placental histology, microscopy and PCR for malaria in pregnant women |
| title_full | Systematic review and meta-analysis: rapid diagnostic tests <it>versus </it>placental histology, microscopy and PCR for malaria in pregnant women |
| title_fullStr | Systematic review and meta-analysis: rapid diagnostic tests <it>versus </it>placental histology, microscopy and PCR for malaria in pregnant women |
| title_full_unstemmed | Systematic review and meta-analysis: rapid diagnostic tests <it>versus </it>placental histology, microscopy and PCR for malaria in pregnant women |
| title_short | Systematic review and meta-analysis: rapid diagnostic tests <it>versus </it>placental histology, microscopy and PCR for malaria in pregnant women |
| title_sort | systematic review and meta analysis rapid diagnostic tests it versus it placental histology microscopy and pcr for malaria in pregnant women |
| topic | Malaria pregnancy malaria in pregnancy (MiP) rapid diagnostic tests (RDTs) PCR microscopy histology diagnostic test accuracy systematic review meta-analysis |
| url | http://www.malariajournal.com/content/10/1/321 |
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