title: Rapid Diagnostic Test Performance Assessed Using Latent Class Analysis for the Diagnosis of Plasmodium falciparum Placental Malaria.
abstract: Placental malaria causes low birth weight and neonatal mortality in malaria-endemic areas. The diagnosis of placental malaria is important for program evaluation and clinical care, but is compromised by the suboptimal performance of current diagnostics. Using placental and peripheral blood specimens collected from delivering women in Malawi, we compared estimation of the operating characteristics of microscopy, rapid diagnostic test (RDT), polymerase chain reaction, and histopathology using both a traditional contingency table and a latent class analysis (LCA) approach. The prevalence of placental malaria by histopathology was 13.8%; concordance between tests was generally poor. Relative to histopathology, RDT sensitivity was 79.5% in peripheral and 66.2% in placental blood; using LCA, RDT sensitivities increased to 93.7% and 80.2%, respectively. Our results, if replicated in other cohorts, indicate that RDT testing of peripheral or placental blood may be suitable approaches to detect placental malaria for surveillance programs, including areas where intermittent preventive therapy in pregnancy is not used.
authors.affiliation: Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina. Department of Statistics and Operations Research, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Yunhao
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi. Department of Community Health, College of Medicine, Blantyre, Malawi.
authors.forename: Victor
authors.initials: V
authors.lastname: Mwapasa
authors.affiliation: Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: Carole
authors.initials: C
authors.lastname: Khairallah
authors.affiliation: Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina.
authors.forename: Kyaw L
authors.initials: KL
authors.lastname: Thwai
authors.affiliation: Department of Community Health, College of Medicine, Blantyre, Malawi.
authors.forename: Linda
authors.initials: L
authors.lastname: Kalilani-Phiri
authors.affiliation: Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: Feiko O
authors.initials: FO
authors.lastname: Ter Kuile
authors.affiliation: Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Meshnick
authors.affiliation: Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina. Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina. Duke Global Health Institute, Duke University Medical Center, Durham, North Carolina. steve.taylor@duke.edu.
authors.forename: Steve M
authors.initials: SM
authors.lastname: Taylor
mesh_terms: D000953:Antigens, Protozoan / Q000097:blood; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D016778:Malaria, Falciparum / Q000175:diagnosis* / Q000453:epidemiology / Q000469:parasitology; D008295:Malawi / Q000453:epidemiology; D008853:Microscopy; D010920:Placenta / Q000098:blood supply / Q000469:parasitology* / Q000473:pathology; D010963:Plasmodium falciparum / Q000235:genetics / Q000302:isolation & purification*; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000175:diagnosis* / Q000453:epidemiology; D015995:Prevalence; D012680:Sensitivity and Specificity
chemical_list: D000953:Antigens, Protozoan