Diagnostic Accuracy and Acceptability of HRP2/Pldh-Based Rapid Diagnostic Tests for Malaria in Pregnancy in Lagos, Nigeria

Abstract

Malaria in pregnancy remains a major contributor to maternal and perinatal morbidity in sub-Saharan Africa. Microscopy of thick and thin blood films has traditionally served as the reference standard for diagnosis. However, rapid diagnostic tests (RDTs) are increasingly used due to their operational simplicity, rapid turnaround time, and minimal infrastructure requirements. To evaluate the diagnostic validity and patient acceptability of rapid diagnostic tests compared with peripheral blood film microscopy in pregnant women. A cross-sectional study was conducted among consenting pregnant women attending antenatal booking at Nigeria Police Hospital, Falomo, Lagos. Sociodemographic, obstetric, and malaria-related data were collected using a pretested structured questionnaire. Peripheral blood samples were tested using both HRP2/pLDH-based RDT and standard light microscopy. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using microscopy as reference. Statistical analyses were performed using SPSS v22. A total of 329 women were enrolled. Malaria prevalence was 22.8% by microscopy and 20.1% by RDT. Compared with microscopy, RDT demonstrated sensitivity of 84.0%, specificity of 98.8%, PPV of 98.6%, and NPV of 86.1%. True positives were 63 (84.0%), false positives 3 (1.2%), and false negatives 12 (16.0%). Acceptability was high: 97.9% preferred RDT, 98.5% found it easy to use, and 90.0% reported no clinic delay associated with testing. HRP2/pLDH-based RDT demonstrated high specificity and good sensitivity for malaria diagnosis in pregnancy, with strong patient acceptability. In resource-constrained settings, RDT represents a practical and reliable alternative to microscopy, particularly where laboratory infrastructure is limited.