Impact of malaria diagnostic refresher training programme on competencies and skills in malaria diagnosis among medical laboratory professionals: evidence from Ghana 2015–2019

Abstract

Background The quality of malaria test results is crucial for optimal patient treatment and care. The Ghana Health Service is successfully shifting from presumptive clinical diagnosis and treatment of malaria to the Test, Treat and Track (T3) initiative. In line with the initiative, the National Malaria Control Programme (NMCP) set out to improve the capacity of medical laboratory professionals in Ghana through a five-day Malaria Diagnostic Refresher Training (MDRT) to build competencies and skills in malaria diagnosis, especially in the three components of microscopy: parasite detection, species identification and parasite quantification. This study evaluates the impact of the training on malaria microscopy. Methods The training which was based on the World Health Organization basic malaria microscopy training guide employed presentations and practical approaches to malaria diagnosis. A total number of 765 medical laboratory professionals from various health facilities across the country were trained every other year from 2015 to 2019 and were included in this evaluation. Evaluation of this training was done using pre-test and post-test microscopy scores. The Negative Binomial fixed effect model was used in determining the overall effect of the training in improving the competencies of the participants on malaria microscopy. Results The ability of the medical laboratory professionals to correctly detect malaria parasites increased significantly from a median score of 64% prior to the training to 87% after the training (p < 0.001). The competencies of the medical laboratory scientists to correctly identify malaria parasite species and quantify the number of malaria parasites increased significantly from a median score of 17% and 20% pre-test to 78% and 50% post-test, respectively (p < 0.001). The results showed that participants’ competency level and skill to perform malaria microscopy (species identification, parasite quantification and detection of malaria parasites) increased by approximately two folds after the training compared to the no-training scenario (adjusted rate ratio = 2.07, 95% CI 2.01–2.13, p < 0.001). Conclusion The MDRT programme significantly improved participants’ performance of malaria microscopy over a short period of time.

Field performance of Plasmodium falciparum lactate dehydrogenase rapid diagnostic tests during a large histidine-rich protein 2 deletion survey in Ethiopia

“…Both RDTs used during the survey are WHO prequalified and, therefore, should meet requirements for safety and quality ([ 17 ] and https://extranet.who.int/pqweb/vitro-diagnostics/vitro-diagnostics-lists ). However, the performance of malaria RDT is dependent on several factors in addition to parasite densities [ 18 ] such as reduced community level transmission intensities [ 19 ]; operator skill [ 20 , 21 ], correct transport and storage conditions [ 22 ] and a strong product lot quality monitoring program [ 21 ]. In spite of high performance of PfLDH detection RDTs reported by others [ 12 , 23 – 25 ], the lower sensitivity and specificity of LDH detection RDT reported in this study, 69% and 72% sensitivity against PCR and multiplex assay, respectively and 38% and 36% specificity against PCR multiplex, respectively, could be partly driven by samples with low parasitaemia below the detection threshold of the PfLDH RDT.…”

Malaria diagnostic methods with the elimination goal in view

“…• Guideline for community private drug peddlers and retailers. Tetteh et al 2021 Ansah et al 2015 Bruxvoort et al 2013 Surveillance system • An adequate supply of technologically relevant surveillance tools in malaria-affected regions. • Implementation of the surveillance system for monitoring infections and progress toward elimination.…”

“…This may, in part, be due to a lack of training for health care workers and medical laboratory professionals. In Ghana, it has been shown that providing microscopy training improved the ability of medical laboratory professionals to correctly identify malaria parasites from 64 to 87% (Tetteh et al 2021 ) - this is indicative of a great improvement in diagnostics as the result of a relatively short training program. There is also evidence from another study in Ghana that the integration of RDTs at the informal private drug retailers will result in a reduction in the prescription of antimalarials for malaria-negative individuals.…”

Migration Surveillance as a Maintenance Effort of Malaria Elimination Status (Study in Banyumas Regency, Central Java, Indonesia, 2021)

“…The RDT and microscopic examinations were conducted at the community health center and then sent to the Banyumas Regency Community Health Laboratory to be cross-checked for the type of Plasmodium. Using a microscope to diagnose malaria through parasite detection is the gold standard [30], [31]. Therefore, laboratories at all levels should regularly assess skills, test, and perform quality control to ensure operability, specifically in areas with high transmission [18], [32].…”

“…Not all analysts can properly prepare blood preparations, hence, its implementation requires more samples to cross-check microscopic examination in the laboratory. The ability, skills, and professional competence of a microscopic in making blood preparations, coloring, and checking greatly determine the discovery of malaria parasites, specifically when the density of parasites is low [30]. Therefore, the accuracy and truth of the examination by microscopic need to be observed and monitored continuously [37].…”