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Open Access Research

Reliability of rapid diagnostic test for diagnosing peripheral and placental malaria in an area of unstable malaria transmission in Eastern Sudan

Awadalla H Kashif1, Gamal K Adam2, Ahmed A Mohmmed3, Salah E Elzaki4, Ahmed M AbdelHalim1 and Ishag Adam5*

Author affiliations

1 Faculty of Medical Laboratory Sciences, University of Khartoum, Khartoum, Sudan

2 Faculty of Medicine, University of Gadarif, Gadarif, Sudan

3 Faculty of Medicine, The National Ribat University, P.O. Box 1157, Khartoum, Sudan

4 Tropical Medicine Research Institute, National Centre for Research, Khartoum, Sudan

5 Faculty of Medicine, University of Khartoum, Khartoum, Sudan

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Citation and License

Diagnostic Pathology 2013, 8:59  doi:10.1186/1746-1596-8-59

Published: 15 April 2013

Abstract

Background

Diagnosing Plasmodium falciparum malaria during pregnancy is a great challenge for clinicians because of the low density of parasites in the peripheral blood and parasite sequestration in the placenta. Nevertheless, few data on the use of malaria rapid diagnostic test (RDT) during pregnancy have been published.

Methods

P. falciparum infections were assessed in 156 febrile pregnant women by microscopic examination of their blood smears and by RDT and polymerase chain reactions (PCR). In addition, 150 women were assessed at the time of delivery by microscopy, RDT, PCR and placental histology investigations. The study was conducted at the Gadarif Hospital, Eastern Sudan. The SD Bioline P. f / P. v (Bio Standard Diagnostics, Gurgaon, Korea) RDT kit was evaluated in this study.

Results

Among the febrile pregnant women, 17 (11.0%), 26 (16.7%) and 18 (11.5%) positive cases of P. falciparum were detected by microscopy, RDT, and PCR, respectively. The sensitivity and specificity of the microscopy was 94.4% and 100%, respectively. The corresponding values for RDT evaluation were 83.3% and 92.0%, as compared with PCR as the gold standard.

While there were no detected cases of malaria by microscopic examination of blood smears, 27 (18.0%), 21(14.0%) and 46 (30.7%) out of the 150 placentae investigated had P. falciparum as determined by RDT, PCR, and histology, respectively. The sensitivity and specificity for RDT was 17.4% and 81.7%, respectively. The corresponding values for PCR were 6.5% and 82.7%, where histology was used as the gold standard.

Conclusions

The RDT kit used in this study has poor performance for peripheral and placental P. falciparum malaria detection in this setting.

Virtual slides

The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1092363465928479 webcite

Keywords:
Plasmodium falciparum; Rapid diagnostic kit; Microscopy; Placental malaria; Pregnancy