Histidine-rich protein-2 based malaria rapid diagnostic tests performance among febrile pregnant women in high malaria transmission area

The diagnosis of malaria in pregnancy remains a challenge due to the low parasite density and placental sequestration of Plasmodium falciparum. A field performance evaluation of a malaria diagnostic test was carried out in an intense transmission setting in Nanoro, Burkina Faso. Pregnant women with symptoms suggestive of malaria were recruited and their results compared with microscopy, the current gold standard for P. falciparum diagnosis. Overall, 60% (120/200) pregnant women were malaria positive when using RDT while 49% (98/200) were positive when using microscopy. The sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were 98% (95% CI: 92.8-99.8), 76.5% (95% CI: 67-84.3), 80% (95% CI: 71.7-86.7) and 97.5% (95% CI: 91.3-99.7) respectively. The agreement between microscopy and RDT was strong (Kappa coefficient of 0.74) which is good for the test, although specificity was poor. Nevertheless, in remote settings where microscopy is unavailable, the use of this RDT can limit the over-prescription of antimalarial drugs. Key words: Febrile pregnant women, HRP-2, RDT performance, high transmission, Burkina Faso.