External quality assessment of national public health laboratories in Africa, 2002–2009

External quality assessment of Giemsa-stained blood film microscopy for the diagnosis of malaria and sleeping sickness in the Democratic Republic of the Congo

“…Overall, 13.7% of laboratories in our assessment made no error in their parasite density estimate compared with 51% that reported an acceptable value in the WHO assessments. 7 In both the present and previous external quality assessment in the Democratic Republic of the Congo, 8 parasite density tended to be underestimated. One reason may be that density has been expressed in parasites per µl in the country only since 2010.…”

“…12 As observed in WHO external quality assessments, correctly identifying blood parasites other than P. falciparum can be a problem. 7 That half of participating laboratories in our assessment did not recognize the presence of trypanosomes is a concern, especially since the diagnosis of African trypanosomiasis in the Democratic Republic of the Congo will increasingly shift from active case-finding by mobile teams to integration into the horizontal healthcare system. 4 In contrast, ability to identify trypanosomes was relatively good in the slides included in the external quality assessments performed by WHO 7 and in the United Kingdom 12 .…”

“…15 Despite the logistic challenges of organizing external quality assessments in poorly accessible areas of countries lacking in infrastructure, such as the Democratic Republic of the Congo, the response time was not much longer than that reported by WHO for quality assessments of national public health laboratories in other parts of Africa. 7 Another advantage of external quality assessments is that they are usually conceived as didactic programmes: they often include a feed-back report that explains the background to and pitfalls of testing and refreshes knowledge of stateof-the-art techniques. The present quality assessment involved the distribution, at little cost, of a report on the previous external quality assessment and a teaching sheet, both of which helped encourage participation.…”

“…However, 3.0% reported no correct results and 11.0% reported only one correct result. Significantly fewer laboratories reported a correct [6][7][8][9][10][11][12]. In 13.3% of the laboratories, rapid tests had replaced microscopy for malaria diagnosis.…”

“…5 In 2002, the World Health Organization (WHO) launched an external quality assessment programme to improve the proficiency of microbiological testing for diseases prone to cause epidemics in the WHO African Region, including malaria. 6,7 In 2010, the first, national, large-scale external quality assessment in the Democratic Republic of the Congo was carried out in four of the country's 11 provinces. 8 It revealed the poor quality of malaria microscopy.…”