Prevalence and diagnostics of congenital malaria in rural Burundi, a cross-sectional study

Abstract

BackgroundCongenital malaria, defined as the presence of asexual forms of malaria parasites in the peripheral blood during the first 7 days of life, remains a neglected area of research. Knowledge gaps exist about prevalence and management of malaria in this age group. The objective of this study was to evaluate the prevalence of congenital malaria and the validity of a rapid diagnostic test (RDT) for its diagnosis in rural Burundi.MethodsA cross-sectional study was conducted in a meso-endemic malaria context in Burundi among 290 mothers, and their newborns (n = 303), who delivered at the maternity departments of Kirundo and Mukenke Hospitals during March and April 2014. Peripheral blood samples were collected from all mothers/newborns pairs in order to examine the presence of malaria parasites with two RDT (SD-Bioline HRP2 and Carestart pan-pLDH) and a blood slide. In addition, quantitative real-time polymerase chain reaction (PCR) was performed from the newborn peripheral sample. Frequencies and proportions were calculated for categorical variables. Sensitivity and specificity were calculated with a 95 % confidence interval (CI).ResultsNone of the newborns were found positive by PCR (0/303; 95 % CI 0.0–1.3). The prevalence in newborns born from microscopy-positive mothers was 0 % (0/44; 95 % CI 0.0–8.0). Two newborns were positive with SD-Bioline HRP2 (0.7 %, 95 % CI 0.2–2.4) but none with Carestart pan-pLDH or microscopy. Sensitivity of the diagnostic tests could not be evaluated as no congenital malaria was detected. Specificity of SD-Bioline HRP2, Carestart pan-pLDH and microscopy to detect congenital malaria was 99.3 % (95 % CI 97.6–99.8), 100.0 % (95 % CI 98.3–100.0) and 100.0 % (95 % CI 98.8–100.0), respectively.ConclusionIn Burundi or the Central African region, no recent prevalence studies for congenital malaria have been carried out. This study found that the prevalence of congenital malaria in two hospitals in Kirundo province is zero. RDT showed to have an excellent specificity and, therefore, can be used to rule out congenital malaria: the risk of overtreatment is low. However, as no cases of congenital malaria were detected, the study was not able to draw conclusions about the sensitivity of the RDT, nor about risk factors for congenital malaria. Further studies evaluating the sensitivity of RDT for diagnosis of congenital malaria are needed.

Congenital Malaria and Its Associated Factors at Issaka Gazobi Maternity of Niamey in Niger

“…The first study conducted in Niger in 2000 gave a prevalence of 13.3% [ 15 ]. It was 19% in Togo with a parasite density ranging from 360 to 870 P/ μ L [ 19 ], 10% in Burkina [ 20 ], 2.2% in Ghana [ 21 ], 0.64% in Brazzaville [ 22 ], 0.03% in Mali [ 23 ], and 0% in Burundi [ 24 ]. Menendez and Mayor explain this wide variation in the prevalence of congenital malaria infection by: (I) the difference in the definition of congenital malaria, (II) the level of maternal immunity, (III) the type of blood examined (peripheral blood or the umbilical cord blood of the newborn), (IV) the expertise of microscopists, (V) the method of biological confirmation (microscopy, rapid diagnostic test, or chain polymerization reaction), and finally, (VII) the intensity of malaria transmission from the site [ 25 ].…”

Congenital Malaria in Newborns Presented at Tororo General Hospital in Uganda: A Cross-Sectional Study

“…This prevalence data are similar to reports in Tanzania, Burkina Faso, and Nigeria, [15][16][17] but higher than those in Burundi and the Calabar area of Nigeria. 18,19 Two studies that used polymerase chain reaction (PCR) to detect malaria parasitemia found a higher prevalence of congenital malaria but this is most likely because of the more sensitive detection method used. 20,21 Thus, these observed differences in congenital FIGURE 1.…”

Diagnosing congenital malaria in a high-transmission setting: clinical relevance and usefulness of P. falciparum HRP2-based testing

“…Only two other studies have previously evaluated RDT performance to detect congenital malaria infections 37 , 38 . In Nigeria, pLDH-Optimal® RDT did not detect any congenital malaria infection while prevalence by LM was 10.9% 37 and, in Burundi two newborns were found positive by SD-Bioline Pf HRP2 but none by CareStart pan-pLDH 38 .…”