Comparison of diagnostic accuracy of ultra-sensitive and conventional rapid diagnostic tests for malaria in asymptomatic pregnant women at a tertiary hospital in North-Central Nigeria.

Background: Malaria in pregnancy continues to be a major public health problem in sub-Saharan Africa. Pregnant women are at a higher risk because asymptomatic malaria infections may lead to detrimental pregnancy outcomes. Early diagnosis is the main strategy to reduce these adverse outcomes; however, conventional rapid diagnostic tests (RDTs) are inadequate for detecting low-density infections. There are prospects that ultra-or highly sensitive RDTs may improve the detection of malaria in these populations. The objective of this study is to assess and compare the diagnostic accuracy of ultrasensitive and conventional RDTs for malaria in asymptomatic pregnant women at the Benue State University Teaching Hospital, Makurdi.

Methodology: This was a cross-sectional comparative study conducted in the antenatal clinic of Benue State University Teaching Hospital, Makurdi, Nigeria. It involved 107 asymptomatic pregnant women whose peripheral venous blood samples were obtained and tested with conventional RDT (co-RDT) and ultra-sensitive RDT (us-RDT) to detect Plasmodium falciparum in peripheral blood. The results from microscopy were used as the reference standard. Results were categorised as positive and negative.

Results: The overall prevalence rate of P. falciparum was 14% using microscopy, followed by us-RDT (12.1%) and co-RDT (2.8%). The us-RDT showed a higher sensitivity (66.7% vs. 13.3%), positive predictive value (83.3% vs. 50.0%), negative predictive value (94.7% vs. 87.4%), and test accuracy (93.5% vs. 86.0%) compared to co-RDT. In comparison, the specificity of both tests was similar (97.8%). There was a significant difference in diagnostic performance between the two RDTs (p=0.002).

Conclusion: The study suggests that ultrasensitive RDTs are a more effective test for detecting P. falciparum infection in asymptomatic pregnant women compared to conventional RDTs. This may have important implications for clinical decision-making and the management of malaria in pregnancy.