Department of Public Health, Institute of Tropical Medicine, Nationalstraat155, B-2000 Antwerpen, Belgium.
Malar J. 2013 Dec 27;12:464. doi: 10.1186/1475-2875-12-464.
Malaria in pregnancy is a major public health problem in endemic countries. Though the signs and symptoms of malaria among pregnant women have been already described, clinical presentation may vary according to intensity of transmission and local perceptions. Therefore, determining common signs and symptoms among pregnant women with a malaria infection may be extremely useful to identify those in need of further investigation by rapid diagnostic test or microscopy.
Six hundred pregnant women attending the maternity clinic of Nanoro District Hospital, Burkina Faso were recruited, 200 with suspected clinical malaria and 400 as controls. Cases were matched with controls by gestational age and parity. Signs and symptoms were collected and a blood sample taken for rapid diagnostic test, microscopy and haemoglobin measurement. A multivariate model was used to assess the predictive value of signs and symptoms for malaria infection.
The overall prevalence of malaria was 42.6% (256/600) while anaemia was found in 60.8% (365/600) of the women. Nearly half (49%) of the cases and 39.5% of the controls had a malaria infection (p = 0.03). The most common signs and symptoms among the cases were fever (36%,72/200), history of fever (29%,58/200) and headache (52%,104/200). The positive predictive value for fever was 53% (95% CI:41-64), history of fever 58% (95% CI:37-63) and headache 51% (95% CI:41-61).
Signs and symptoms suggestive of malaria are frequent among pregnant women living in areas of intense transmission. Common malaria symptoms are not strong predictors of infection. For a better management of malaria in pregnancy, active screening to detect and treat malaria infection early should be performed on all pregnant women attending a health facility.
疟疾是妊娠女性在流行地区面临的主要公共卫生问题。尽管已有关于孕妇疟疾的体征和症状的描述，但临床表现可能因传播强度和当地认知而异。因此，确定感染疟疾的孕妇的常见体征和症状可能对于通过快速诊断检测或显微镜检查识别需要进一步调查的患者非常有用。
我们招募了布基纳法索纳诺罗区医院产科诊所的 600 名孕妇，其中 200 名疑似临床疟疾患者，400 名为对照。病例与对照按孕龄和产次进行匹配。收集体征和症状，并采集血样进行快速诊断检测、显微镜检查和血红蛋白测量。使用多变量模型评估体征和症状对疟疾感染的预测价值。
总体疟疾患病率为 42.6%（256/600），60.8%（365/600）的女性患有贫血。近一半（49%）的病例和 39.5%的对照存在疟疾感染（p=0.03）。病例中最常见的体征和症状是发热（36%，72/200）、发热史（29%，58/200）和头痛（52%，104/200）。发热的阳性预测值为 53%（95%CI：41-64），发热史为 58%（95%CI：37-63），头痛为 51%（95%CI：41-61）。
在疟疾传播强度较高的地区，孕妇出现疑似疟疾的体征和症状较为常见。常见的疟疾症状不是感染的强预测因素。为了更好地管理妊娠期间的疟疾，应在所有就诊于医疗机构的孕妇中开展主动筛查，以尽早发现和治疗疟疾感染。
