Performance Evaluation of Malaria Microscopists Working at Malaria External Quality Assessment Rechecking Laboratories in Ethiopia

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Addis Ababa University


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.