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

Publication ,  Journal Article
Walker, PGT; Cairns, M; Slater, H; Gutman, J; Kayentao, K; Williams, JE; Coulibaly, SO; Khairallah, C; Taylor, S; Meshnick, SR; Hill, J ...
Published in: Nat Commun
July 30, 2020

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.

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Published In

Nat Commun

DOI

EISSN

2041-1723

Publication Date

July 30, 2020

Volume

11

Issue

1

Start / End Page

3799

Location

England

Related Subject Headings

  • World Health Organization
  • Tanzania
  • Sulfadoxine
  • Pyrimethamine
  • Prenatal Care
  • Pregnancy Trimester, First
  • Pregnancy Complications, Parasitic
  • Pregnancy
  • Plasmodium falciparum
  • Parasitic Sensitivity Tests
 

Citation

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Walker, P. G. T., Cairns, M., Slater, H., Gutman, J., Kayentao, K., Williams, J. E., … Ter Kuile, F. O. (2020). Modelling the incremental benefit of introducing malaria screening strategies to antenatal care in Africa. Nat Commun, 11(1), 3799. https://doi.org/10.1038/s41467-020-17528-3
Walker, Patrick G. T., Matt Cairns, Hannah Slater, Julie Gutman, Kassoum Kayentao, John E. Williams, Sheick O. Coulibaly, et al. “Modelling the incremental benefit of introducing malaria screening strategies to antenatal care in Africa.Nat Commun 11, no. 1 (July 30, 2020): 3799. https://doi.org/10.1038/s41467-020-17528-3.
Walker PGT, Cairns M, Slater H, Gutman J, Kayentao K, Williams JE, et al. Modelling the incremental benefit of introducing malaria screening strategies to antenatal care in Africa. Nat Commun. 2020 Jul 30;11(1):3799.
Walker, Patrick G. T., et al. “Modelling the incremental benefit of introducing malaria screening strategies to antenatal care in Africa.Nat Commun, vol. 11, no. 1, July 2020, p. 3799. Pubmed, doi:10.1038/s41467-020-17528-3.
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. Modelling the incremental benefit of introducing malaria screening strategies to antenatal care in Africa. Nat Commun. 2020 Jul 30;11(1):3799.

Published In

Nat Commun

DOI

EISSN

2041-1723

Publication Date

July 30, 2020

Volume

11

Issue

1

Start / End Page

3799

Location

England

Related Subject Headings

  • World Health Organization
  • Tanzania
  • Sulfadoxine
  • Pyrimethamine
  • Prenatal Care
  • Pregnancy Trimester, First
  • Pregnancy Complications, Parasitic
  • Pregnancy
  • Plasmodium falciparum
  • Parasitic Sensitivity Tests