Diagnosis of Malaria in Pregnancy: Field Situation and Use of Rapid Tests

Introduction: Malaria is endemic in India and constitutes a major public health challenge. Submicroscopic infection during pregnancy might be associated with increased risk of adverse pregnancy outcomes including low birth weight babies and maternal anaemia. Simple and easy to use malarial diagnostic tools with adequate sensitivity such as rapid diagnostic tests will help in accurate diagnosis and prompt treatment of pregnancy associated malaria and help in averting adverse pregnancy outcomes.

Aim: To assess testing methods available at a public hospital for diagnosis of malaria in pregnancy and discuss the use of appropriate test for diagnosis of malaria.

Material and methods: Data was analysed of pregnant women admitted in antenatal care (ANC ) ward with fever for period between January 2009 and December 2009 retrospectively with respect to demography of patients, slide positivity, Rapid malaria antigen test(RMAT) positive . Malaria PV/PF antigen card test by Accucare was used.

Results: Of the total ANC admissions 2880 in our hospital in the year 2009, 189 pregnant women were admitted with fever (6.5%) in our ANC ward. The standard protocol in our institute is to send peripheral smear (PS) for MP for all such cases and start presumptive therapy with chloroquine if symptoms suggestive of malaria. PS MP was positive in 28/189 i.e. 14.8%. Those who had persistent fever especially if PS for MP is negative were tested by RMAT (135 cases). Of those, 40 were positive 21.2 %.Utility and comparison of the tests will be discussed.

Conclusion: PS for MP is gold standard for diagnosis and gives additional information regarding type of parasite and density however it is requires expertise. RMAT is available, easy to perform and it is recommended that all RMAT are followed-up with microscopy to confirm the results and if positive, to quantify the proportion of red blood cells that are infected.