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Modelling the incremental benefit of introducing malaria screening strategies to antenatal care in Africa

Author

Listed:
  • Patrick G. T. Walker

    (Imperial College London)

  • Matt Cairns

    (London School of Hygiene and Tropical Medicine)

  • Hannah Slater

    (Imperial College London
    PATH)

  • Julie Gutman

    (Centers for Disease Control and Prevention)

  • Kassoum Kayentao

    (University of Sciences, Techniques, and Technologies of Bamako)

  • John E. Williams

    (Dodowa Health Research Centre)

  • Sheick O. Coulibaly

    (University of Ouagadougou)

  • Carole Khairallah

    (Liverpool School of Tropical Medicine)

  • Steve Taylor

    (Duke University)

  • Steven R. Meshnick

    (University of North Carolina)

  • Jenny Hill

    (University of Ouagadougou)

  • Victor Mwapasa

    (University of Malawi)

  • Linda Kalilani-Phiri

    (Duke University)

  • Kalifa Bojang

    (London School of Hygiene and Tropical Medicine)

  • Simon Kariuki

    (Kenya Medical Research Institute/Centre for Global Health Research)

  • Harry Tagbor

    (University of Health and Allied Sciences)

  • Jamie T. Griffin

    (Queen Mary University of London)

  • Mwayi Madanitsa

    (University of Malawi)

  • Azra C. H. Ghani

    (Imperial College London)

  • Meghna Desai

    (Centers for Disease Control and Prevention)

  • Feiko O. ter Kuile

    (University of Ouagadougou)

Abstract

Plasmodium falciparum in pregnancy is a major cause of adverse pregnancy outcomes. We combine performance estimates of standard rapid diagnostic tests (RDT) from trials of intermittent screening and treatment in pregnancy (ISTp) with modelling to assess whether screening at antenatal visits improves upon current intermittent preventative therapy with sulphadoxine-pyrimethamine (IPTp-SP). We estimate that RDTs in primigravidae at first antenatal visit are substantially more sensitive than in non-pregnant adults (OR = 17.2, 95% Cr.I. 13.8-21.6), and that sensitivity declines in subsequent visits and with gravidity, likely driven by declining susceptibility to placental infection. Monthly ISTp with standard RDTs, even with highly effective drugs, is not superior to monthly IPTp-SP. However, a hybrid strategy, recently adopted in Tanzania, combining testing and treatment at first visit with IPTp-SP may offer benefit, especially in areas with high-grade SP resistance. Screening and treatment in the first trimester, when IPTp-SP is contraindicated, could substantially improve pregnancy outcomes.

Suggested Citation

  • Patrick G. T. Walker & Matt Cairns & Hannah Slater & Julie Gutman & Kassoum Kayentao & John E. Williams & Sheick O. Coulibaly & Carole Khairallah & Steve Taylor & Steven R. Meshnick & Jenny Hill & Vic, 2020. "Modelling the incremental benefit of introducing malaria screening strategies to antenatal care in Africa," Nature Communications, Nature, vol. 11(1), pages 1-12, December.
    • Handle: RePEc:nat:natcom:v:11:y:2020:i:1:d:10.1038_s41467-020-17528-3
    DOI: 10.1038/s41467-020-17528-3
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