{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T06:53:58Z","timestamp":1768892038045,"version":"3.49.0"},"reference-count":57,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,2,14]],"date-time":"2023-02-14T00:00:00Z","timestamp":1676332800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Antioquia","award":["INV3161"],"award-info":[{"award-number":["INV3161"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>This study aimed to evaluate the accuracy of the thick blood smear (TBS) versus quantitative polymerase chain reaction (qPCR) for the diagnosis of malaria associated with pregnancy (MAP) caused by P. falciparum or P. vivax in Colombia in its gestational malaria (GM), placental malaria (PM), and congenital malaria (CM) forms as well as to compare its accuracy in different subgroups of pregnant women according to the presence of fever, anemia and a history of malaria. This was a diagnostic evaluation of 829 pregnant women, 579 placentas, 381 umbilical cord samples, and 221 neonatal peripheral blood samples. Accuracy was evaluated based on the parameters of sensitivity, specificity, predictive values, likelihood ratios, and validity index, with their 95% confidence intervals. The frequency of GM was 36% (n = 297\/829), PM 27% (n = 159\/579), and CM 16.5% (n = 63\/381) in umbilical cord samples and 2% (n = 5\/221) in neonatal peripheral blood samples. For GM, the sensitivity was 55%, with higher rates in those infected with P. vivax (68%), with a history of malaria (69%), and with fever (96%). These three subgroups presented the best results in terms of the negative likelihood ratio and validity index. For PM, sensitivity was 8%; in subgroup analyses in terms of species, symptomatology (anemia and fever), and history of malaria, it was 1\u201318%, and the negative likelihood ratio was &gt;0.80 in all subgroups. No false positives were recorded in any of the subgroups. The TBS did not detect any cases of CM. This study found the TBS yielded satisfactory results in terms of diagnosing GM for P. vivax, pregnant women with previous malaria and febrile. It also showed that the TBS is not useful for diagnosing PM and CM. It is necessary to conduct surveillance of MAP with molecular methods in in groups where TBS is deficient (asymptomatic GM, P. falciparum, and pregnant women without history of malaria) to optimize the timely treatment of PM and CM, avoid the deleterious effects of MAP and achieve the malaria elimination goals in Colombia.<\/jats:p>","DOI":"10.3390\/tropicalmed8020119","type":"journal-article","created":{"date-parts":[[2023,2,15]],"date-time":"2023-02-15T01:38:18Z","timestamp":1676425098000},"page":"119","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Diagnostic Accuracy of a Thick Blood Smear Compared to qPCR for Malaria Associated with Pregnancy in Colombia"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7101-929X","authenticated-orcid":false,"given":"Jaiberth Antonio","family":"Cardona-Arias","sequence":"first","affiliation":[{"name":"Escuela de Microbiolog\u00eda, Universidad de Antioquia, Medell\u00edn 050010, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1361-3124","authenticated-orcid":false,"given":"Luis Felipe","family":"Higuita Guti\u00e9rrez","sequence":"additional","affiliation":[{"name":"Escuela de Microbiolog\u00eda, Universidad de Antioquia, Medell\u00edn 050010, Colombia"},{"name":"Facultad de Medicina, Universidad Cooperativa de Colombia, Medell\u00edn 050010, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0428-9887","authenticated-orcid":false,"given":"Jaime","family":"Carmona-Fonseca","sequence":"additional","affiliation":[{"name":"Grupo Salud y Comunidad C\u00e9sar Uribe Piedrah\u00edta, Facultad de Medicina, Universidad de Antioquia, Medell\u00edn 050010, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,14]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2022, December 01). World Malaria Report 2022. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240040496."},{"key":"ref_2","first-page":"468","article-title":"Malaria and pregnancy: Complications, prevention and treatment","volume":"57","year":"2014","journal-title":"Prog. Obstet. Ginecol."},{"key":"ref_3","unstructured":"Malaria Policy Advisory Group World Health Organization (2017). Meeting Report of the Evidence Review Group on Malaria in Pregnancy, Geneva, Switzerland, 9\u201311 July 2017, World Health Organization."},{"key":"ref_4","first-page":"75","article-title":"The epidemiology of malaria in Colombia: A heretical view","volume":"13","year":"2020","journal-title":"Soc. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1186\/s12936-016-1314-6","article-title":"Diagnosis of placental malaria in poorly fixed and processed placental tissue","volume":"15","author":"Liu","year":"2016","journal-title":"Malar. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1093\/tropej\/fmz083","article-title":"Congenital malaria in newborns delivered to mothers with malaria-infected placenta in Blue Nile State, Sudan","volume":"66","author":"Omer","year":"2020","journal-title":"J. Trop. Pediatr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"195","DOI":"10.24953\/turkjped.2016.02.011","article-title":"Congenital malaria: Importance of diagnosis and treatment in pregnancy","volume":"58","year":"2016","journal-title":"Turk. J. Pediatr."},{"key":"ref_8","first-page":"12","article-title":"Incidencia de Las Malarias Gestacional, Cong\u00e9nita y Placentaria en Urab\u00e1 (Antioquia, Colombia), 2005\u20132007","volume":"60","author":"Maestre","year":"2009","journal-title":"Rev. Colomb. Obstet. Ginecol."},{"key":"ref_9","unstructured":"Centers for Disease Control and Prevention (2022, December 01). Intermittent Preventive Treatment of Malaria for Pregnant Women (IPTp), Available online: https:\/\/www.cdc.gov\/malaria\/malaria_worldwide\/reduction\/iptp.html#:~:text=Malaria%20infection%20during%20pregnancy%20can,a%20risk%20factor%20for%20death."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Carmona-Fonseca, J., and Cardona-Arias, J.A. (2022). Placental malaria caused by Plasmodium vivax or P. falciparum in Colombia: Histopathology and mediators in placental processes. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0263092"},{"key":"ref_11","unstructured":"World Health Organization (2015). Guidelines for Treatment of Malaria."},{"key":"ref_12","first-page":"140","article-title":"Overview of epidemiology of malaria associated with pregnancy in northwestern Colombia, 1985\u20132020","volume":"53","year":"2021","journal-title":"J. Commun. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Cardona, J., and Carmona, J. (2021). Meta-analysis of the prevalence of malaria associated with pregnancy in Colombia 2000-2020. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0255028"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"10944","DOI":"10.1038\/s41598-022-15011-1","article-title":"Frequency of gestational malaria and maternal\u2013neonatal outcomes, in Northwestern Colombia 2009\u20132020","volume":"12","author":"Cardona","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Cardona, J., and Carmona, J. (2022). Frequency of placental malaria and its associated factors in northwestern Colombia, pooled analysis 2009\u20132020. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0268949"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Cardona, J., and Carmona, J. (2022). Congenital malaria: Frequency and epidemiology in Colombia, 2009\u20132020. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0263451"},{"key":"ref_17","unstructured":"Ministerio de Salud y Protecci\u00f3n Social de Colombia (2022, December 01). Gu\u00eda de Pr\u00e1ctica Cl\u00ednica Diagn\u00f3stico y Tratamiento de la Malaria, Available online: https:\/\/www.minsalud.gov.co\/sites\/rid\/Lists\/BibliotecaDigital\/RIDE\/VS\/PP\/ET\/Guia-atencion-clinica-malaria.pdf."},{"key":"ref_18","unstructured":"Instituto Nacional de Salud de Colombia (2022, December 01). Manual Para el Diagn\u00f3stico de Malaria no Complicada en Puestos de Diagn\u00f3stico y Tratamiento, Available online: https:\/\/www.minsalud.gov.co\/sites\/rid\/Lists\/BibliotecaDigital\/RIDE\/IA\/INS\/manual-diagnostico-malaria-no-complicada.pdf."},{"key":"ref_19","first-page":"117","article-title":"Concordance analysis of three diagnostic tests for malaria in the symptomatic population of Colombian endemic municipalities","volume":"40","author":"Guerra","year":"2020","journal-title":"Biomedica"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e00797-17","DOI":"10.1128\/IAI.00797-17","article-title":"Clinical outcomes of submicroscopic infections and correlates of protection of VAR2CSA antibodies in a longitudinal study of pregnant women in Colombia","volume":"86","author":"Gavina","year":"2018","journal-title":"Infect. Immun."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"220","DOI":"10.17843\/rpmesp.2020.372.4759","article-title":"Malaria placentaria submicrosc\u00f3pica: Histopatolog\u00eda y expresi\u00f3n de mediadores de procesos fisiol\u00f3gicos","volume":"37","author":"Carmona","year":"2020","journal-title":"Rev. Peru. Med. Exp. Salud P\u00fablica"},{"key":"ref_22","first-page":"368078","article-title":"Submicroscopic and asymptomatic congenital infection by Plasmodium vivax or P. falciparum in Colombia: 37 cases with placental histopathology and cytokine profile in maternal and placental blood","volume":"2017","author":"Agudelo","year":"2017","journal-title":"J. Trop. Med."},{"key":"ref_23","first-page":"106","article-title":"Clinical implications of asymptomatic Plasmodium falciparum infections in Malawi","volume":"68","author":"Buchwald","year":"2019","journal-title":"Clin. Infect. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1016\/S1473-3099(18)30046-X","article-title":"The persistence and oscillations of submicroscopic Plasmodium falciparum and Plasmodium vivax infections over time in Vietnam: An open cohort study","volume":"18","author":"Nguyen","year":"2018","journal-title":"Lancet Infect. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Chen, I., Clarke, S.E., Gosling, R., Hamainza, B., Killeen, G., Magill, A., O\u2019Meara, W., Price, R.N., and Riley, E.M. (2016). \u201cAsymptomatic\u201d Malaria: A chronic and debilitating infection that should be treated. PLoS Med., 13.","DOI":"10.1371\/journal.pmed.1001942"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.pt.2014.02.004","article-title":"The role of submicroscopic parasitemia in malaria transmission: What is the evidence?","volume":"30","author":"Lin","year":"2014","journal-title":"Trends Parasitol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1186\/s12936-015-0943-5","article-title":"Performance of four HRP-2\/pLDH combination rapid diagnostic tests and field microscopy as screening tests for malaria in pregnancy in Indonesia: A cross-sectional study","volume":"14","author":"Ahmed","year":"2015","journal-title":"Malar. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1186\/s12936-015-0927-5","article-title":"Accuracy of an HRP-2\/panLDH rapid diagnostic test to detect peripheral and placental Plasmodium falciparum infection in Papua New Guinean women with anaemia or suspected malaria","volume":"14","author":"Umbers","year":"2015","journal-title":"Malar. J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1186\/1746-1596-8-59","article-title":"Reliability of rapid diagnostic test for diagnosing peripheral and placental malaria in an area of unstable malaria transmission in Eastern Sudan","volume":"8","author":"Kashif","year":"2013","journal-title":"Diagn. Pathol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1370","DOI":"10.1128\/JCM.41.4.1370-1374.2003","article-title":"Diagnosis of Plasmodium falciparum malaria at delivery: Comparison of blood film preparation methods and of blood films with histology","volume":"41","author":"Rogerson","year":"2003","journal-title":"J. Clin. Microbiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"929","DOI":"10.4269\/ajtmh.2011.10-0507","article-title":"Diagnosis of gestational, congenital, and placental malaria in Colombia: Comparison of the efficacy of microscopy, nested polymerase chain reaction, and histopathology","volume":"84","author":"Campos","year":"2011","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1867","DOI":"10.1007\/s00436-022-07512-9","article-title":"Malaria diagnostic methods with the elimination goal in view","volume":"121","author":"Oyegoke","year":"2022","journal-title":"Parasitol. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/bs.acc.2016.11.006","article-title":"Advances in molecular diagnosis of malaria","volume":"80","author":"Zheng","year":"2017","journal-title":"Adv. Clin. Chem."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Cao, J., Sturrock, H.J., Cotter, C., Zhou, S., Zhou, H., Liu, Y., Tang, L., Gosling, R.D., Feachem, R.G., and Gao, Q. (2014). Communicating and monitoring surveillance and response activities for malaria elimination: China\u2019s \u201c1-3-7\u201d strategy. PLoS Med., 11.","DOI":"10.1371\/journal.pmed.1001642"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Sturrock, H.J., Hsiang, M.S., Cohen, J.M., Smith, D.L., Greenhouse, B., Bousema, T., and Gosling, R.D. (2013). Targeting asymptomatic malaria infections: Active surveillance in control and elimination. PLoS Med., 10.","DOI":"10.1371\/journal.pmed.1001467"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1016\/S0140-6736(13)60310-4","article-title":"The changing epidemiology of malaria elimination: New strategies for new challenges","volume":"382","author":"Cotter","year":"2013","journal-title":"Lancet"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1186\/1475-2875-12-79","article-title":"A controlled, parallel, cluster-randomized trial of community-wide screening and treatment of asymptomatic carriers of Plasmodium falciparum in Burkina Faso","volume":"12","author":"Tiono","year":"2013","journal-title":"Malar. J."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1016\/S1473-3099(09)70247-6","article-title":"Overprescribing of antimalarials","volume":"9","author":"Sansom","year":"2009","journal-title":"Lancet Infect. Dis."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1136\/bmj.39073.496829.AE","article-title":"Rapid diagnostic tests compared with malaria microscopy for guiding outpatient treatment of febrile illness in Tanzania: Randomised trial","volume":"334","author":"Reyburn","year":"2007","journal-title":"BMJ"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"c930","DOI":"10.1136\/bmj.c930","article-title":"Rapid testing for malaria in settings where microscopy is available and peripheral clinics where only presumptive treatment is available: A randomised controlled trial in Ghana","volume":"340","author":"Ansah","year":"2010","journal-title":"BMJ"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1136\/bmj.39395.696065.47","article-title":"The impact of response to the results of diagnostic tests for malaria: Cost-benefit analysis","volume":"336","author":"Lubell","year":"2008","journal-title":"BMJ"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Cibulskis, R.E., Aregawi, M., Williams, R., Otten, M., and Dye, C. (2011). Worldwide incidence of malaria in 2009: Estimates, time trends, and a critique of methods. PLoS Med., 8.","DOI":"10.1371\/journal.pmed.1001142"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1186\/1475-2875-9-254","article-title":"A large proportion of asymptomatic Plasmodium infections with low and sub-microscopic parasite densities in the low transmission setting of Temotu Province, Solomon Islands: Challenges for malaria diagnostics in an elimination setting","volume":"9","author":"Harris","year":"2010","journal-title":"Malar. J."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"malERA Consultative Group on Diagnoses and Diagnostics (2011). A research agenda for malaria eradication: Diagnoses and diagnostics. PLoS Med., 8.","DOI":"10.1371\/journal.pmed.1000396"},{"key":"ref_45","first-page":"577","article-title":"La Regi\u00f3n \u201cUrab\u00e1 Antioque\u00f1o-Cuencas altas de los r\u00edos Sin\u00fa y San Jorge-Bajo Cauca Antioque\u00f1o\u201d: \u201cguarida\u201d del paludismo colombiano Revista de la Universidad Industrial de Santander","volume":"49","author":"Carmona","year":"2017","journal-title":"Salud"},{"key":"ref_46","unstructured":"Ministerio de Salud de Colombia (2022, December 01). An\u00e1lisis de Situaci\u00f3n de Salud (ASIS) Colombia, 2019, Available online: https:\/\/www.minsalud.gov.co\/sites\/rid\/Lists\/BibliotecaDigital\/RIDE\/VS\/ED\/PSP\/asis-2019-colombia.pdf."},{"key":"ref_47","first-page":"39","article-title":"Enfoque cl\u00ednico del s\u00edndrome febril agudo en Colombia","volume":"21","author":"Romero","year":"2017","journal-title":"Infectio"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4103\/0972-9062.234620","article-title":"Epidemiology, drug resistance, and pathophysiology of Plasmodium vivax malaria","volume":"55","author":"Dayananda","year":"2018","journal-title":"J. Vector Borne Dis."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1146\/annurev-pathmechdis-012419-032640","article-title":"New insights into malaria pathogenesis","volume":"15","author":"Moxon","year":"2020","journal-title":"Annu. Rev. Pathol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1159\/000353863","article-title":"Diagnostic accuracy measures","volume":"36","author":"Eusebi","year":"2013","journal-title":"Cerebrovasc. Dis."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1561","DOI":"10.1093\/cid\/cis236","article-title":"How hidden can malaria be in pregnant women? Diagnosis by microscopy, placental histology, polymerase chain reaction and detection of histidine-rich protein 2 in plasma","volume":"54","author":"Mayor","year":"2012","journal-title":"Clin Infect. Dis."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1586\/eri.12.98","article-title":"Diagnosing malaria in pregnancy: An update","volume":"10","author":"Fried","year":"2012","journal-title":"Expert Rev. Anti-Infect. Ther."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"e2013010","DOI":"10.4084\/mjhid.2013.010","article-title":"Malaria in pregnancy","volume":"5","author":"Takem","year":"2013","journal-title":"Mediterr. J. Hematol. Infect. Dis."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.actatropica.2004.02.003","article-title":"Polarisation microscopy increases the sensitivity of hemozoin and Plasmodium detection in the histological assessment of placental malaria","volume":"90","author":"Romagosa","year":"2004","journal-title":"Acta Trop."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1002\/jemt.23071","article-title":"Microscopic malaria parasitemia diagnosis and grading on benchmark datasets","volume":"81","author":"Rehman","year":"2018","journal-title":"Microsc. Res. Tech."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"140","DOI":"10.20453\/rmh.v13i4.689","article-title":"Comparaci\u00f3n de las densidades parasitarias en gota gruesa de sangre venosa versus digitopunci\u00f3n en el diagn\u00f3stico de Malaria Vivax","volume":"13","author":"Solari","year":"2002","journal-title":"Rev. M\u00e9d. Herediana"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1016\/j.semerg.2021.05.003","article-title":"Aplicaci\u00f3n del valor umbral del n\u00famero de ciclos (Ct) de PCR en la COVID-19","volume":"47","author":"Serrano","year":"2021","journal-title":"Semergen"}],"container-title":["Tropical Medicine and Infectious Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2414-6366\/8\/2\/119\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:35:18Z","timestamp":1760121318000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2414-6366\/8\/2\/119"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,14]]},"references-count":57,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["tropicalmed8020119"],"URL":"https:\/\/doi.org\/10.3390\/tropicalmed8020119","relation":{},"ISSN":["2414-6366"],"issn-type":[{"value":"2414-6366","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,14]]}}}