14th ICID - Poster Abstracts - International Society for Infectious ...

When citing these abstracts please use the following reference:
Author(s) of abstract. Title of abstract [abstract]. Int J Infect Dis 2010;14S1: Abstract number.
Please note that the official publication of the International Journal of Infectious Diseases 2010, Volume 14, Supplement 1
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Final Abstract Number: 80.025
Session: Pediatric and Perinatal Infections
Date: Friday, March 12, 2010
Time: 12:30-13:30
Room: Poster & Exhibition Area/Ground Level
Type: Poster Presentation
Rapid diagnostic tests for neonatal malaria: How reliable?
A. A. OROGADE 1 , S. AMINU 2
1 Ahmadu Bello University Teaching Hospital, KADUNA, KADUNA , Nigeria, 2 A.B.U.T.H. ZARIA,
Zaria, Nigeria
Background: Congenital malaria has a prevalence of 11.5% in Northwestern Nigeria with low
parasite densities which range from 40-120L. Neonatal malaria in this region has a prevalence
of 8.25% with most of these babies presenting with fever in the first week of life. Diagnosis has
been dependent on blood film examination for asexual forms of Plasmodium parasites. Due to the
inherent difficulties in identifying very low levels of parasitaemia by light microscopy, this study
was carried out among febrile and afebrile neonates to compare microscopy with a malaria rapid
diagnostic test (RDT) to determine sensitivity and specificity of the two in diagnosis of neonatal
malaria.
Methods: Presence of malaria parasitaemia were assessed in 50 febrile and 50 afebrile
neonates using thick and thin blood film smears, air dried , stained with freshly prepared Giemsa
stain and examined under a light microscope at X1000 magnification as well as by use of
optiMAL rapid diagnostic malaria kits.
Results: 42/50 of the febrile neonates were positive for falciparum malaria parasites by
microscopy while 19/50 were positive by optiMAL. Thus sensitivity of the light microscopy was
84% and that of RDT was 38%. The true negatives were 48/50 and 50/50 by microscopy and
RDT respectively giving a specificity of 96% for microscopy and 100% RDT . OptiMAL had
positive and negative predictive values of 38% and 100% respectively.
Conclusion: The rapid diagnostic test was easy to perform and results were obtained more
quickly than the microscopy. However its performance in accurately diagnosing patients with
neonatal malaria is unacceptably low. About 2 out of every 10 children with neonatal malaria will
also be missed by light microscopy. Peripartum malaria prevalence which is highly predictive of
congenital/neonatal in this area is about 22% with higher parasite densities up to 400/L. Since
optiMAL is known to have sensitivity of >95% when parasite densities are up to 200/L, it is
recommended that optiMAL be routinely performed when women present in labor to identify and
followup newborn at risk of malaria.