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

Malaria Journal

Gizachew Kedida¹  Tsegaye Getachew²  Adugna Woyessa²  Wondimeneh Liknew²  Adisu Kebede²  Getachew Tollera²  Hussien Mohammed²  Ebba Abate²  Desalegn Ararso²  Bokretsion Gidey²  Geremew Tasew²  Ashenafi Assefa²  Sindew Mekasha²  Abeba G/Tsadik²  Dereje Yenealem²  Ermias Woldie²  Adugna Abera²  Abnet Abebe²  Desalegn Nega²  Degu Mehari³  Mebrahtom Haile³  Dereje Dillu³  Hiwot Solomon³  Kebede Etana³ 

[1] Ethiopian Medical Laboratory Associations (EMLA), PO Box: 4866, Tewodros Square, Addis Ababa, Ethiopia;Ethiopian Public Health Institute (EPHI), PO Box 1242, Patriot Street, Gulele Subcity, Addis Ababa, Ethiopia;Federal Ministry of Health (FMoH), PO Box 80002, Sudan Street, Addis Ababa, Ethiopia;

关键词: External quality assurance;    Mentorship;    Malaria microscopy;    Re-checking;    Competency;   

DOI  :  10.1186/s12936-021-03655-9

来源: Springer

【 摘 要 】

BackgroundIn Ethiopia, malaria cases are declining as a result of proven interventions, and in 2017 the country launched a malaria elimination strategy in targeted settings. Accurate malaria diagnosis and prompt treatment are the key components of the strategy to prevent morbidity and stop the continuation of transmission. However, the quality of microscopic diagnosis in general is deteriorating as malaria burden declines. This study was carried out to evaluate the competency of microscopists and the performance of health facilities on malaria microscopic diagnosis.MethodsA cross-sectional study was conducted from 1 August to 30 September, 2019 in 9 regional states and one city administration. A standard checklist was used for on-site evaluation, archived patient slides were re-checked and proficiency of microscopists was tested using a WHO-certified set of slides from the national slide bank at the Ethiopian Public Health Institute (EPHI). The strength of agreement, sensitivity, specificity, and positive and negative predictive values were calculated.ResultsIn this study, 102 health facilities (84 health centres and 18 hospitals) were included, from which 202 laboratory professionals participated. In slide re-checking, moderate agreement (agreement (A): 76.0%; Kappa (K): 0.41) was observed between experts and microscopists on malaria detection in all health facilities. The sensitivity and specificity of routine slide reading and the re-checking results were 78.1 and 80.7%, respectively. Likewise, positive predictive value of 65.1% and negative predictive value of 88.8% were scored in the routine diagnosis. By panel testing, a substantial overall agreement (A: 91.8%; K: 0.79) was observed between microscopists and experts in detecting malaria parasites. The sensitivity and specificity in the detection of malaria parasites was 92.7 and 89.1%, respectively. In identifying species, a slight agreement (A: 57%; K: 0.18) was observed between microscopists and experts.ConclusionThe study found significant false positive and false negative results in routine microscopy on slide re-checking of Plasmodium parasites. Moreover, reduced grade in parasite species identification was reported on the panel tests. Implementing comprehensive malaria microscopy mentorship, in-service training and supportive supervision are key strategies to improve the overall performance of health facilities in malaria microscopy.

【 授权许可】

CC BY