title: Clinical signs and symptoms cannot reliably predict Plasmodium falciparum malaria infection in pregnant women living in an area of high seasonal transmission.
abstract: BACKGROUND
  Malaria in pregnancy is a major public health problem in endemic countries. Though the signs and symptoms of malaria among pregnant women have been already described, clinical presentation may vary according to intensity of transmission and local perceptions. Therefore, determining common signs and symptoms among pregnant women with a malaria infection may be extremely useful to identify those in need of further investigation by rapid diagnostic test or microscopy.
  
  
  METHODS
  Six hundred pregnant women attending the maternity clinic of Nanoro District Hospital, Burkina Faso were recruited, 200 with suspected clinical malaria and 400 as controls. Cases were matched with controls by gestational age and parity. Signs and symptoms were collected and a blood sample taken for rapid diagnostic test, microscopy and haemoglobin measurement. A multivariate model was used to assess the predictive value of signs and symptoms for malaria infection.
  
  
  RESULTS
  The overall prevalence of malaria was 42.6% (256/600) while anaemia was found in 60.8% (365/600) of the women. Nearly half (49%) of the cases and 39.5% of the controls had a malaria infection (p = 0.03). The most common signs and symptoms among the cases were fever (36%,72/200), history of fever (29%,58/200) and headache (52%,104/200). The positive predictive value for fever was 53% (95% CI:41-64), history of fever 58% (95% CI:37-63) and headache 51% (95% CI:41-61).
  
  
  CONCLUSIONS
  Signs and symptoms suggestive of malaria are frequent among pregnant women living in areas of intense transmission. Common malaria symptoms are not strong predictors of infection. For a better management of malaria in pregnancy, active screening to detect and treat malaria infection early should be performed on all pregnant women attending a health facility.
authors.forename: Marc C
authors.initials: MC
authors.lastname: Tahita
authors.forename: Halidou
authors.initials: H
authors.lastname: Tinto
authors.forename: Joris
authors.initials: J
authors.lastname: Menten
authors.forename: Jean-Bosco
authors.initials: JB
authors.lastname: Ouedraogo
authors.forename: Robert T
authors.initials: RT
authors.lastname: Guiguemde
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: van Geertruyden
authors.forename: Annette
authors.initials: A
authors.lastname: Erhart
authors.affiliation: Department of Public Health, Institute of Tropical Medicine, Nationalstraat155, B-2000 Antwerpen, Belgium. udalessandro@mrc.gm.
authors.forename: Umberto
authors.initials: U
authors.lastname: D'Alessandro
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D002050:Burkina Faso / Q000453:epidemiology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D012372:ROC Curve; D012307:Risk Factors; D055815:Young Adult