Factors associated with malaria microscopy diagnostic performance following a pilot quality-assurance programme in health facilities in malaria low-transmission areas of Kenya, 2014

Malaria Journal

Research

Wences Arvelo¹  Thomas O. Achia¹  Sara A. Lowther¹  Ann M. Buff²  Zeinab G. Roka³  Lily Chepkurui³  Waqo Boru³  Tura Galgalo⁴  Fredrick Odhiambo⁵  Jesca Okwara Wesongah⁶  Caroline M. Moseti⁷  Collins Moranga⁷  Elizabeth Wanja⁷  Bernhards Ogutu⁸ 

[1] Division of Parasitic Diseases and Malaria, Center for Global Health, U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, 30333, Atlanta, GA, USA;Division of Parasitic Diseases and Malaria, Center for Global Health, U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, 30333, Atlanta, GA, USA;U.S. President’s Malaria Initiative, United Nations Avenue, P.O. Box 606, Village Market, 00621, Nairobi, Kenya;Field Epidemiology and Laboratory Training Programme, P.O. Box 225-00202, Nairobi, Kenya;Field Epidemiology and Laboratory Training Programme, P.O. Box 225-00202, Nairobi, Kenya;Division of Parasitic Diseases and Malaria, Center for Global Health, U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, 30333, Atlanta, GA, USA;Field Epidemiology and Laboratory Training Programme, P.O. Box 225-00202, Nairobi, Kenya;Jomo Kenyatta University of Agriculture and Technology, P.O. Box 62000-00200, Nairobi, Kenya;Jomo Kenyatta University of Agriculture and Technology, P.O. Box 62000-00200, Nairobi, Kenya;United States Army Medical Research Unit-Kenya, Malaria Diagnostics Center, P.O. Box 54, 40100, Kisumu, Kenya;United States Army Medical Research Unit-Kenya, Malaria Diagnostics Center, P.O. Box 54, 40100, Kisumu, Kenya;Kenya Medical Research Institute, Centre for Clinical Research, P.O. Box 1578, 40100, Kisumu, Kenya;

关键词: Malaria;    Microscopy;    Quality assurance;    Interpretation;    Validity;    Reliability;    Laboratory;    Kenya;   

DOI  :  10.1186/s12936-017-2018-2

 received in 2017-06-22, accepted in 2017-09-06,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundMalaria accounts for ~21% of outpatient visits annually in Kenya; prompt and accurate malaria diagnosis is critical to ensure proper treatment. In 2013, formal malaria microscopy refresher training for microscopists and a pilot quality-assurance (QA) programme for malaria diagnostics were independently implemented to improve malaria microscopy diagnosis in malaria low-transmission areas of Kenya. A study was conducted to identify factors associated with malaria microscopy performance in the same areas.MethodsFrom March to April 2014, a cross-sectional survey was conducted in 42 public health facilities; 21 were QA-pilot facilities. In each facility, 18 malaria thick blood slides archived during January–February 2014 were selected by simple random sampling. Each malaria slide was re-examined by two expert microscopists masked to health-facility results. Expert results were used as the reference for microscopy performance measures. Logistic regression with specific random effects modelling was performed to identify factors associated with accurate malaria microscopy diagnosis.ResultsOf 756 malaria slides collected, 204 (27%) were read as positive by health-facility microscopists and 103 (14%) as positive by experts. Overall, 93% of slide results from QA-pilot facilities were concordant with expert reference compared to 77% in non-QA pilot facilities (p < 0.001). Recently trained microscopists in QA-pilot facilities performed better on microscopy performance measures with 97% sensitivity and 100% specificity compared to those in non-QA pilot facilities (69% sensitivity; 93% specificity; p < 0.01). The overall inter-reader agreement between QA-pilot facilities and experts was κ = 0.80 (95% CI 0.74–0.88) compared to κ = 0.35 (95% CI 0.24–0.46) between non-QA pilot facilities and experts (p < 0.001). In adjusted multivariable logistic regression analysis, recent microscopy refresher training (prevalence ratio [PR] = 13.8; 95% CI 4.6–41.4), ≥5 years of work experience (PR = 3.8; 95% CI 1.5–9.9), and pilot QA programme participation (PR = 4.3; 95% CI 1.0–11.0) were significantly associated with accurate malaria diagnosis.ConclusionsMicroscopists who had recently completed refresher training and worked in a QA-pilot facility performed the best overall. The QA programme and formal microscopy refresher training should be systematically implemented together to improve parasitological diagnosis of malaria by microscopy in Kenya.

【 授权许可】

CC BY   
© The Author(s) 2017