Assessment of the accuracy of malaria microscopy in private health facilities in Entebbe Municipality, Uganda: a cross-sectional study

Malaria Journal

Grant Dorsey¹  Simon Peter Katongole²  Emmanuel Arinaitwe³  Alex Ndyabakira³  Joan Nakayaga Kalyango⁴  Emmanuel Sendaula⁴  Alex Kakeeto⁴  Arthur Mpimbaza⁴  Charles Karamagi⁴  Pauline Byakika-Kibwika⁴  Philip Orishaba⁴  Tobius Mutabazi⁵  Moses R. Kamya⁶  Joaniter I. Nankabirwa⁶  Paul Okimat⁷ 

[1] Department of Medicine, University of California, San Francisco, San Francisco, USA;Faculty of Health Sciences, Uganda Martyrs University, P.O. Box 5498, Kampala, Uganda;Infectious Diseases Research Collaboration (IDRC), P.O. Box 7475, Kampala, Uganda;School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda;School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda;Directorate of Medical Services, Special Forces Command, Uganda People’s Defence Forces, P.O. Box 11, Entebbe, Uganda;School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda;Infectious Diseases Research Collaboration (IDRC), P.O. Box 7475, Kampala, Uganda;School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda;Institute of Public Health and Management, Clarke International University, P.O. Box 7782, Kampala, Uganda;

关键词: Malaria;    Diagnosis;    Accuracy;    Microscopy;    Private health facilities;   

DOI  :  10.1186/s12936-021-03787-y

来源: Springer

【 摘 要 】

BackgroundAlthough microscopy remains the gold standard for malaria diagnosis, little is known about its accuracy in the private health facilities in Uganda. This study evaluated the accuracy of malaria microscopy, and factors associated with inaccurate smear results at private health facilities in Entebbe Municipality, Uganda.MethodsBetween April and May 2018, all patients referred for a malaria smear in 16 private health facilities in Entebbe municipality were screened, and 321 patients were enrolled. A questionnaire was administered to collect demographic and clinical information, facility-based smear results were recorded from the participant’s consultation notes, and a research slide was obtained for expert microscopy during exit interview. A health facility assessment was conducted, and information on experience in performing malaria microscopy was collected from all facility personnel reading smears and the data was linked to the participant’s clinic visit.ResultsThe test positivity rate of malaria parasitaemia was 15.0% by expert microscopy. The sensitivity, specificity and negative predictive value of the facility-based microscopy were high (95.8%, 90.1 and 99.2%, respectively). However; the positive predictive value (PPV) was low with 27/73 (63%) patients diagnosed with malaria not having the disease. Majority of the inaccurate results were from 2 of the 23 laboratory personnel reading the smears. The factors associated with inaccurate smear readings included being read by a technician; (1) who had less than 5 years’ experience in reading malaria smears (adjusted Odds Ratio [aOR] = 9.74, 95% confidence interval [CI] (1.06–89.5), p-value = 0.04), and (2) who was examining less than 5 smears a day (aOR = 38.8, 95% CI 9.65–156, p-value < 0.001).ConclusionsThe accuracy of malaria microscopy in this setting was high, although one third of the patients diagnosed with malaria did not have the disease. Majority of the errors in smear readings were made by two laboratory personnel, with the main factor associated with inaccurate smear results being low experience in malaria microscopy. In-service training may be sufficient to eliminate inaccurate smear results in this setting, and these private facilities would be ideal model facilities to improve the quality of malaria microscopy in Uganda especially in the public sector where accuracy is still poor.

【 授权许可】

CC BY