Performance Evaluation of Malaria Microscopists Working at Malaria External Quality Assessment Rechecking Laboratories in Ethiopia
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Date
2015-06
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Addis Ababa University
Abstract
Background: The Performance of Malaria Microscopists in all health facilities have been raised
concerns by many experts. Microscopic diagnosis of Giemsa stained thick and thin blood films by
skilled microscopists has remained the standard laboratory method for the diagnosis of malaria.
Microscopists who are working at Malaria Rechecking Laboratories have to be competent to cross
check blood film slides which are collected from testing sites.
Objective: The current study aims to assess the Performance of Malaria Microscopists and Malaria
EQA Rechecking Laboratories in Ethiopia from February 1-May 10, 2015.
Methods/design:A cross-sectional study design was conducted to assess the performance of 107
Malaria Microscopists who were working at 23 Malaria Rechecking Laboratories in Ethiopia. A set
of 12 blood film slides containing Negative and positive (different species, stage, parasite density)
results were distributed to each Malaria microscopists and 10 minutes were given for each blood film
slides. Then all data were analyzed using SPSS Version 20 and agreement in detection and species
identification of malaria parasites between participants and expert microscopists was estimated using
the Kappa score. Chi Square was used for categorical data and P value (P<0.05) was considered
significant.
Result: From a total of 107 study participants, the maximum number of participants 90 (84.1%) were
a male and most of them were working at regional reference laboratory 54(50.5%).About 34(31.8%)
participants were used unrecommended quantification system. Overall, the sensitivity of participants
in detection and species identification of malaria parasites were 96.8% and 56.7%, respectively. The
overall agreement on detection and identification of malaria species was 96.8% (Kappa = 0.9) and
64.77% (kappa = 0.33), respectively. The least malaria species which were identified correctly by the
participants were P. malerea and P.ovale which was identified correctly 2.8% and 32.7%,
respectively. The number of participants who were scored <80% was higher among participants with
diploma 25(100%) followed by participants with degree 59(93.6%) and participants with MSc and
above 13(68.4%)(P=0.001). Participants at Hospital laboratory had higher percent agreement (72.3
%, Kappa=0.51) compared with participants from other health facilities.
Conclusion and Recommendation: Agreement of the participants with expert microscopist in the
identification of different malaria species and quantification were very low. Most participants were
not identified P. malerea and P.ovale correctly. Therefore, to fill those gaps we have to have a policy
for conducting regular competency assessment and training for malaria microscopists.
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Keywords
Malaria