The Role of Laboratory Supervision in Improving the Quality of Malaria Diagnosis: A Pilot Study in Huambo, Angola

Abstract

Abstract. In 2006, the Angolan National Malaria Control Program introduced clinical guidelines for malaria case management, which included diagnostic confirmation of malaria before administration of treatment; however, diagnostic practices were inconsistent and of unknown quality. In 2009, a laboratory supervision program was implemented in Huambo Province, with the goal of assessing and improving diagnosis of malaria within the confines of available in-country resources. Supervisions were carried out from 2009 to 2014 using a standardized supervision tool by national laboratory trainers. Data from the first supervision were compared with that from the final supervision. Over the study period, the number and level of training of laboratory technicians increased, and there was a nonstatistically significant trend toward improved laboratory conditions. There was a significant reduction in false-positive microscopy slide reading (P = 0.0133). Laboratory infrastructural capacity to diagnose other communicable diseases, including syphilis, human immunodeficiency virus and hepatitis B virus infections (P = 0.0012, 0.0233 and 0.0026, respectively), also improved significantly. Laboratory supervision for malaria diagnosis found significant areas for improvement, and in combination with concurrent capacitybuilding activities, it improved the diagnostic capacity for malaria and other diseases. Importantly, this study demonstrates that locally available resources can be used to improve the accuracy of malaria diagnosis.

Outreach training and supportive supervision for malaria case management in Zambia: the effects of focused capacity building on indicators of diagnostic and clinical performance

“…Similar to previous work [ 25 – 28 ], the results of this study show that supportive supervision may lead to improvements in malaria diagnostic performance. Item and bivariate analyses suggest that the OTSS programme was effective at improving microscopy and RDT diagnostic performance at the majority of facilities enrolled in the programme.…”

“…However, many of the strategies employed by researchers to evaluate the effects of supportive supervision yield mixed results [ 7 ]. Further, a number of studies assessing malaria case management performance via interventional studies have focused exclusively on either laboratory [ 25 – 28 ] or clinical personnel [ 16 ]. Few studies [ 29 , 30 ] have focused on assessing both clinical and laboratory malaria case management practices and diagnostic performance in a concurrent manner—the aim of the OTSS programme.…”

Evaluation of Routine Microscopy Performance for Malaria Diagnosis at Three Different Health Centers in Brazzaville, Republic of Congo

“…The short duration of training of microscopists may also impact acquired knowledge. Therefore, permanent training including laboratory supervision as well as improvement of infrastructure quality and implementation of internal and/or external quality control are needed for achieving improvement of malaria diagnosis by microscopy as observed in Angola [ 22 ]. The other alternative should be the introduction of RDTs in malaria diagnosis procedure and their systematic use in addition to microscopy in these sites.…”

Implementation of external quality assessment of microscopy for improved parasite detection and confirmatory diagnosis of malaria in Tanzanian Military health facilities

“…The findings from ten quarterly visits to MHFs demonstrated that supportive supervision contributed to identifying gaps, and through on-site training, a remarkable improvement in the quality of malaria diagnosis by microscopy was achieved. The increased performance was noticed among individual microscopists and the average aggregated results for each of the MHF as described previously [ 12 , 13 ]. In our view, the reported improvement could also be attributed to provision, and sustaining availability of quality laboratory equipment, reagents and consumables [ 12 ].…”

“…The increased performance was noticed among individual microscopists and the average aggregated results for each of the MHF as described previously [ 12 , 13 ]. In our view, the reported improvement could also be attributed to provision, and sustaining availability of quality laboratory equipment, reagents and consumables [ 12 ]. The observed improvements were apparent in the second quarter after implementing the QIPs during the first quarter, and was maintained in the subsequent quarters and over the three years.…”