Alemayehu Aklilu, Zeynudin Ahmed, Beyene Joseph, Yewhalaw Delenasaw
School of Medical Laboratory Science, Institute of Health, Jimma University, Jimma, Ethiopia.
Department of Medical Laboratory Science, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia.
Malar J. 2025 Jun 1;24(1):175. doi: 10.1186/s12936-025-05426-2.
BACKGROUND: Accurate, reliable, and timely diagnosis is essential for mitigating malaria in pregnancy (MiP) and its adverse outcomes. This study aimed to evaluate the accuracy of malaria diagnostic tests for detecting Plasmodium infection in peripheral, placental, and cord blood and placental biopsy in the Majang Zone of Gambella Region, Southwest Ethiopia. METHODS: A cross-sectional study involving 640 (460 pregnant and 180 parturient) women visiting five public health facilities for antenatal care and delivery services in Majang Zone was conducted from November 2022 to March 2023. Peripheral, placental, and cord blood were collected to detect Plasmodium infection by rapid diagnostic test (RDT), microscopy, and quantitative Polymerase Chain Reaction (qPCR). Placental biopsy was collected for placental malaria (PM) diagnosis by histopathology. Performance indices, Kappa Coefficient, and Receiver Operating Characteristic were determined using Statistical Package for Social Science Version 26.0, Microsoft Excel Version 19.0, and Stata Version 17.0. RESULTS: One thousand blood (640 peripheral, 180 placental, and 180 cord) and 180 placental biopsy specimens collected from pregnant and parturient women were analysed in this study. Malaria positivity rate among pregnant and parturient women was 21.1% and 28.9%, respectively. Considering peripheral blood qPCR as a reference, the sensitivity, specificity, accuracy, and agreement of RDT were (63.5%, 93.0%, 0.807, and 0.683), and microscopy were (73.1%, 98.0%, 0.855, and 0.764) to detect Plasmodium infection in combined peripheral blood of pregnant and parturient women, respectively. Considering placental blood qPCR as a reference, the sensitivity, specificity, accuracy, and agreement of RDT were (56.3%, 95.5%, 0.759, and 0.574), microscopy were (81.3%, 97.7%, 0.895, and 0.822), and histopathology (87.5%, 100.0%, 0.892, and 0.911) to detect Plasmodium infection in placental blood of parturient women, respectively. Considering placental histopathology a as reference, the sensitivity, specificity, accuracy, and agreement of RDT were (56.8%, 97.1%, 0.753, and 0.609), microscopy were (68.2%, 98.5%, 0.918, and 0.735), and qPCR (100.0%, 95.7%, 0.978, and 0.911) to detect Plasmodium infection in placental blood of parturient women, respectively. CONCLUSION: Diagnostic performance of RDT and microscopy was sub-optimal to detect Plasmodium infection among pregnant and parturient women. More sensitive diagnostic tests are needed to mitigate MiP.
背景：准确、可靠且及时的诊断对于减轻妊娠疟疾（MiP）及其不良后果至关重要。本研究旨在评估疟疾诊断检测在埃塞俄比亚西南部甘贝拉地区马江区检测外周血、胎盘血、脐带血中的疟原虫感染以及胎盘活检的准确性。 方法：2022年11月至2023年3月，在马江区对640名（460名孕妇和180名产妇）到五个公共卫生机构接受产前护理和分娩服务的妇女进行了一项横断面研究。采集外周血、胎盘血和脐带血，通过快速诊断检测（RDT）、显微镜检查和定量聚合酶链反应（qPCR）检测疟原虫感染。采集胎盘活检组织，通过组织病理学诊断胎盘疟疾（PM）。使用社会科学统计软件包第26.0版、微软Excel第19.0版和Stata第17.0版确定性能指标、kappa系数和受试者工作特征。 结果：本研究分析了从孕妇和产妇中采集的1000份血液样本（640份外周血、180份胎盘血和180份脐带血）以及180份胎盘活检标本。孕妇和产妇的疟疾阳性率分别为21.1%和28.9%。以外周血qPCR为参考，在孕妇和产妇的外周血混合样本中检测疟原虫感染时，RDT的灵敏度、特异度、准确性和一致性分别为（63.5%、93.0%、0.807和0.683），显微镜检查分别为（73.1%、98.0%、0.855和0.764）。以胎盘血qPCR为参考，在产妇的胎盘血中检测疟原虫感染时，RDT的灵敏度、特异度、准确性和一致性分别为（56.3%、95.5%、0.759和0.574），显微镜检查分别为（81.3%、97.7%、0.895和0.822），组织病理学分别为（87.5%、100.0%、0.892和0.911）。以胎盘组织病理学为参考，在产妇的胎盘血中检测疟原虫感染时，RDT的灵敏度、特异度、准确性和一致性分别为（56.8%、97.1%、0.753和0.609），显微镜检查分别为（68.2%、98.5%、0.918和0.735），qPCR分别为（100.0%、95.7%、0.978和0.911）。 结论：RDT和显微镜检查在检测孕妇和产妇中的疟原虫感染方面诊断性能欠佳。需要更敏感的诊断检测来减轻妊娠疟疾。
Eur J Obstet Gynecol Reprod Biol X. 2023-9-2
Trop Med Infect Dis. 2023-2-14
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