Comparison of Malaria diagnostic methods for detection of asymptomatic Plasmodium infections among pregnant women attending antenatal care at Fendeka town health facilities, Jawi district, Northwest Ethiopia

Abstract

Background Malaria in pregnancy remains a major public health problem in the globe especially in sub-Saharan Africa. In malaria endemic areas, majority of pregnant women remain asymptomatic but could still associate with complications on the mother and her offspring. They also serve as reservoirs to transmit infection. Despite these effects, no attention is given for the diagnosis of asymptomatic Plasmodium infections (APIs) using highly sensitive and specific laboratory diagnostic tools among pregnant women in Ethiopia. Therefore, the aim of this study was to compare the performance of RDTs with microscopy and performance of RDTs and microscopy with PCR for detecting APIs among pregnant women attending antenatal care at Fendeka town health facilities, Jawi district, Northwest Ethiopia. Methods Health facility based cross -sectional study was conducted from February-March, 2019. A total of 166 participants were enrolled by using convenient sampling technique. Socio-demographic and other characteristics were collected using semi structured questionnaire. Dried blood spot (DBS) samples were collected for molecular analysis. APIs on pregnant women was diagnosed using rapid diagnostic tests (RDTs), smear microscopy and real-time polymerase chain reaction (RT-PCR). Data were analyzed using SPSS version 20. Descriptive statistics were used to determine the prevalence of APIs. Method comparison was done and Cohen’s kappa coefficient (k) was used to determine the degree of agreement among the diagnostic methods. Parasite densities were also calculated Results Prevalence of API was 17 (10.2%), 18 (10.8%) and 30 (18.1%) using RDTs, microscopy and real-time PCR, respectively. The overall proportion of API was 18.7%. Sensitivity of the RDT was 83.3% as compared with microscopy. RDTs and microscopy also showed sensitivity of 50% and 60%, respectively as compared with PCR. Majority of API identified by microscopy had moderate parasite densities. Conclusions Prevalence of API in the study area was significant. Both RDTs and microscopy had lower sensitivity when compared with real-time PCR. Therefore, routine laboratory diagnosis of API among pregnant women with better laboratory diagnostic tool would be adopted as a part of the antenatal care.