Comprehensive competency assessment of malaria microscopists and laboratory diagnostic service capacity in districts stratified for malaria elimination in Ethiopia​

Abstract

Background Federal Ministry of Health (FMoH) Ethiopia achieved significant declines in malaria mortality and incidence and has recently launched malaria elimination in selected low transmission settings. Successful malaria elimination calls for rapid and accurate diagnosis of cases so that the patients can promptly be treated before the occurrence of transmission. Therefore, this study assessed the competency of malaria microscopists using panal slides, and laboratory service availability and readiness in terms of supplies and equipments in malaria elimination targeted districts in Ethiopia. Method A cross-sectional study was conducted from February to June 2018 in all hospitals, health centers and private clinics in 20 malaria elimination targeted districts, selected out of the 6 regional states in Ethiopia. All malaria microscopists available in the study health facilities during the study period were included in the study. Questionnaires were used for interviewing sociodemography of personnel and laboratory supplies. Per World Health Organization (WHO) criteria set for proficiency testing, 10 Giemsa stained malaria slide panels (8 positive low/high density pf/pv/Mixed and 2 negative slides) were administered to each study participant for performance assessment on malaria parasite detection, species identification and parasite count using light microscopy. The slide panels are PCR confirmed and WHO approved ones, which have been stored in the slide banks at the national reference laboratory in Ethiopian Public Health Institute. Result In this assessment, 17(16%) district hospitals, 71(67%) health centers (HCs) and 18(17%) private clinics (PCs) were included. Of the 18 PCs, only 10(55.6%) had license certificate. Of the study facilities, 91.5%(97) use light microscopy, 2.83%(3) use RDTs and 2.9%(3) use both microscopy and RDT to detect malaria. Accessible and appropriate storage of Giemsa

Mentorship on malaria microscopy diagnostic service in Ethiopia: Baseline competency of microscopists and performance of health facilities

“…These ndings were almost in agreement with a sensitivity 88% and speci city 91% from a study conducted in Zambia [31]. The sensitivity but not the speci city of this study was higher than the sensitivity 83.2% and speci city 90.1% in a study conducted elsewhere in Ethiopia [28], and sensitivity 63% and speci city 97% in a study reported in Tigray, Ethiopia [30]. The sensitivity and speci city of this study was lower than the sensitivity 96.8% and speci city 96.7% of malaria detection in a study conducted in another place in Ethiopia [30].…”

“…Overall, the performance agreement on the identi cation of malaria species was 57% (K: 0.18) which showed a slight agreement between participants and malaria microscopy experts. This result was higher than in a similar study conducted in elimination targeted districts in Ethiopia with an agreement of 43.8% (k: 0.11) [28] while it was lower than in a study conducted in Tigray, Ethiopia with an agreement of 76% (k: 0.61) [30] and a study reported from Bahirdar, Ethiopia where the agreement was 72% (k: 047) [29]. The reason for the low identi cation of species by the microscopists in the current study may be due to the fact that the microscopists prepared only a thick lm and were unable to differentiate the morphology of the parasites.…”

Past eight-year malaria data in Gedeo zone, southern Ethiopia: trend, reporting-quality, spatiotemporal distribution, and association with socio-demographic and meteorological variables

“…This can be an indication of declining lab capacity of detecting malaria parasites. This declining lab capacity of detecting malaria might be due to the fact that the increased false negative reports associated with reduced sensitivity of microscopy with decreasing parasite densities [ 30 ], unable to detect sequestered P. falciparum parasites [ 31 ] and low competency of microscopists [ 32 ]. In the other way, such increased number of non-malarial febrile illnesses might be related to other febrile cases including yellow fever virus [ 33 , 34 ] and typhoid fever [ 35 , 36 ] infections, as per the studies conducted in southern and south-central Ethiopia.…”

Misidentification of Plasmodium ovale as Plasmodium vivax malaria by a microscopic method: a meta-analysis of confirmed P. ovale cases

“…The routine diagnostic method of patients suspected of having P. ovale infection is the visualization of thick and thin blood smears by microscopy and/or rapid diagnostic tests (RDT), if available 5 . It is well documented that microscopy is an inexpensive and rapid quantification of parasites and is a relatively sensitive method; nevertheless, it has several limitations; it is time consuming, it misdiagnoses Plasmodium species, it requires expert or well-trained microscopists, and it misses Plasmodium species in case of a low parasite density in mixed infection 6 , 7 . Since P. ovale infects only young erythrocytes, the parasite density is low, and infection with other Plasmodium species is mixed 8 , resulting in missed identification by microscopists.…”