Evaluation of Malaria Screening during Pregnancy with Rapid Diagnostic Tests Performed by Community Health Workers in Burkina Faso

Abstract

Abstract.One of the current strategies to prevent malaria in pregnancy is intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP). However, in order for pregnant women to receive an adequate number of SP doses, they should attend a health facility on a regular basis. In addition, SP resistance may decrease IPTp-SP efficacy. New or additional interventions for preventing malaria during pregnancy are therefore warranted. Because it is known that community health workers (CHWs) can diagnose and treat malaria in children, in this study screening and treatment of malaria in pregnancy by CHWs was evaluated as an addition to the regular IPTp-SP program. CHWs used rapid diagnostic tests (RDTs) for screening and artemether-lumefantrine was given in case of a positive RDT. Overall, CHWs were able to conduct RDTs with a sensitivity of 81.5% (95% confidence interval [CI] 67.9-90.2) and high specificity of 92.1% (95% CI 89.9-93.9) compared with microscopy. After a positive RDT, 79.1% of women received artemether-lumefantrine. When treatment was not given, this was largely due to the woman being already under treatment. Almost all treated women finished the full course of artemether-lumefantrine (96.4%). In conclusion, CHWs are capable of performing RDTs with high specificity and acceptable sensitivity, the latter being dependent on the limit of detection of RDTs. Furthermore, CHWs showed excellent adherence to test results and treatment guidelines, suggesting they can be deployed for screen and treat approaches of malaria in pregnancy.BACKGROUND

Asymptomatic malaria and anemia among pregnant women during high and low malaria transmission seasons in Burkina Faso: household-based cross-sectional surveys in Burkina Faso, 2013–2017

“…The prevalence of asymptomatic carriage found in our household-based study was lower compared with the estimated prevalence reported in previous studies, where it was reported to range from 19-51%, among pregnant women attending health facilities as part of their ANC in Burkina Faso [18][19][20][21]. However, the overall aggregate prevalence of asymptomatic MiP (11.0%) reported in our study corroborates the results (12.2%) from the COSMIC household-based survey conducted in Burkina Faso between March 2014 and January 2016 [22,30]. In addition, the prevalence of asymptomatic malaria at the community level during the low transmission season was slightly lower in our study compared to the prevalence of 9.1% reported from a community-based study conducted in Ethiopia during the minor ("low") malaria transmission season [31].…”

“…Thus, it is crucial to explore supplementary measures that could increase the chance of accurately detecting and treating MiP by taking into account these risk factors. From this perspective and according to the WHO recommendations [35], several countries, including Burkina Faso, have set up strategies involving community-based health workers (CHWs) whose tasks include community-based sensitization activities, conducting malaria home diagnoses by RDT, and treatment of uncomplicated malaria within their respective communities [22,36].…”

“…The prevalence of asymptomatic MiP among women attending routine ANC was estimated at about 19-51% based on malaria rapid diagnostic tests (RDTs) [18][19][20][21], whereas anemia prevalence was estimated at around 60% [20,21]. To our best knowledge, there is only one community-based study that has estimated the prevalence of MiP [22] at the household level; in this case, conducted in Nanoro and nested within a cluster-randomized controlled trial. In Burkina Faso, the majority of published data on the subject have been obtained in healthcare settings (i.e., in health facilities).…”

Community-based Malaria Screening and Treatment for Pregnant Women Receiving Standard Intermittent Preventive Treatment With Sulfadoxine-Pyrimethamine: A Multicenter (The Gambia, Burkina Faso, and Benin) Cluster-randomized Controlled Trial

“…Maternal hemoglobin was measured using Hb301 Hemocue (Radiometer Group, Sweden). Blood spots on filter paper were analyzed by Plasmodium falciparum diagnostic polymerase chain reaction (PCR) [14, 15].…”

Screening and Treating Malaria in Pregnancy by Community Health Workers in Benin, Burkina Faso and Gambia: Profiles, Perceptions and Time Commitments

“…The COSMIC trial results showed that adding community-based scheduled screening and treatment by CHWs to the standard IPTp-SP at ANC did not reduce the risk of placental malaria or peripheral malaria infection at delivery. The COSMIC trial did, however, support previous evidence that CHWs can both correctly use RDTs and adhere to test results and treatment guidelines [54,55], increase ANC attendance, particularly in early pregnancy (in Burkina Faso), identify and treat infections between scheduled ANC visits, and encourage women to adhere to a full treatment course. All these aspects point to the potential of CHWs in curbing malaria.…”