Modelling the incremental benefit of introducing malaria screening strategies to antenatal care in Africa.

Published online

Journal Article

Plasmodium falciparum in pregnancy is a major cause of adverse pregnancy outcomes. We combine performance estimates of standard rapid diagnostic tests (RDT) from trials of intermittent screening and treatment in pregnancy (ISTp) with modelling to assess whether screening at antenatal visits improves upon current intermittent preventative therapy with sulphadoxine-pyrimethamine (IPTp-SP). We estimate that RDTs in primigravidae at first antenatal visit are substantially more sensitive than in non-pregnant adults (OR = 17.2, 95% Cr.I. 13.8-21.6), and that sensitivity declines in subsequent visits and with gravidity, likely driven by declining susceptibility to placental infection. Monthly ISTp with standard RDTs, even with highly effective drugs, is not superior to monthly IPTp-SP. However, a hybrid strategy, recently adopted in Tanzania, combining testing and treatment at first visit with IPTp-SP may offer benefit, especially in areas with high-grade SP resistance. Screening and treatment in the first trimester, when IPTp-SP is contraindicated, could substantially improve pregnancy outcomes.

Full Text

Duke Authors

Cited Authors

  • Walker, PGT; Cairns, M; Slater, H; Gutman, J; Kayentao, K; Williams, JE; Coulibaly, SO; Khairallah, C; Taylor, S; Meshnick, SR; Hill, J; Mwapasa, V; Kalilani-Phiri, L; Bojang, K; Kariuki, S; Tagbor, H; Griffin, JT; Madanitsa, M; Ghani, ACH; Desai, M; Ter Kuile, FO

Published Date

  • July 30, 2020

Published In

Volume / Issue

  • 11 / 1

Start / End Page

  • 3799 -

PubMed ID

  • 32732892

Pubmed Central ID

  • 32732892

Electronic International Standard Serial Number (EISSN)

  • 2041-1723

Digital Object Identifier (DOI)

  • 10.1038/s41467-020-17528-3

Language

  • eng

Conference Location

  • England