Assessment of Malaria Microscopic Diagnosis Performance of Laboratory Professionals in Addis Ababa’s Public Health Facilities
Volume 5, Issue 1, March 2019, Pages: 1-6
Received: Nov. 28, 2018;
Accepted: Jan. 5, 2019;
Published: Jan. 31, 2019
Views 334 Downloads 103
Leykun Demeke Gebrekidan, ICAP at Columbia University, Addis Ababa, Ethiopia
Honelgn Nahusenay Hiruy, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
Cross-sectional study was conducted using panel blood films and questioner to assess detection & identification performance of laboratory professionals’ and identify factors affecting the performance of malaria microscopic diagnosis. Study participants had 91.7% (95% CI: 89.96 – 93.44) agreement for detection of malaria parasites, 67.63% (95% CI: 64.91 – 70.35) species identification agreement for Plasmodium falciparum, 5.08% false positive and 21.04% false negative results. Correct species identification percentage for Plasmodium falciparum were 60.9% (510), Plasmodium vivax 59.17% (371) and Mixed (Plasmodium falciparum and Plasmodium vivax) 25% (53) were also identified in the study. In addition, sensitivity 94.69% (95% CI: 93.02 – 96.36) and specificity of 79.71 (95% CI: 75.22 – 84.2) were calculated from panel blood film results. The most frequent type of misdiagnosis was 85(40.09%) mixed BFs diagnosed as Plasmodium vivax, 67 (31.6%) mixed BFs as Plasmodium falciparum and 218(26%) Plasmodium falciparum BFs as Plasmodium vivax. Moreover, only 18(8.5%) laboratory professionals were participated in external quality assessment. From multiple logistic regression analysis training was the major factor for species identification percent agreement performance improvement of laboratory professionals. It showed statistical significance with p-value < 0.05 and untrained laboratory professionals were 64% less likely to perform ≥ 85% agreement of species identification. Training of laboratory professionals on malaria microscopic diagnosis help to improve the accuracy and reliability of reported results. This will help to provide the right and recommended medication and patient management.
Leykun Demeke Gebrekidan,
Honelgn Nahusenay Hiruy,
Assessment of Malaria Microscopic Diagnosis Performance of Laboratory Professionals in Addis Ababa’s Public Health Facilities, Biomedical Sciences.
Vol. 5, No. 1,
2019, pp. 1-6.
World Health Organization: A practical handbook management of severe malaria, Third Edition 2011.
EHNRI: Manual for the Laboratory Diagnosis of Malaria first edition - September, 2012
EHNRI: Malaria Laboratory Diagnosis External Quality Assessment Scheme Guidelines, September, 2009.
World Health Organization: Universal access to malaria diagnostic testing an operation manual, 2011.
WHO: Malaria Microscopy Quality Assurance Manual, Version 1. March 2009.
John Frean: Microscopic determination of malaria parasite load: role of image analysis. Microscopy: Science, Technology, Applications and Education A. Méndez-Vilas and J. Díaz (Eds.) 2010, 862-866.
Alexander N, Schellenberg D, Ngasala B, Petzold M, Drakeley C, Sutherland C: Assessing agreement between malaria slide density readings. Malaria Journal 2010, 9:4.
Ohrt C, Obare P, Nanakorn A, Adhiambo C, Awuondo K, Prudhomme W, Remich S, Martin K: Establishing a malaria diagnostics centre of excellence in Kisumu, Kenya. Malaria Journal 2007, 6:79.
O'Meara W, Barcus M, Wongsrichanalai C, Muth S, Maguire J, Jordan R, Prescott W and McKenzie E: Reader technique as a source of variability in determining malaria parasite density by microscopy.Malaria Journal 2006, 5:118.
Kyabayinze DJ, Achan J, Nakanjako D, Mpeka B, Mawejje H, Mugizi R, Kalyango JN, D’Alessandro U, Talisuna A, Jean-Pierre VG: Parasite-based malaria diagnosis: Are Health Systems in Uganda equipped enough to implement the policy? BMC Public Health 2012, 12:695.
Namagembe A, Ssekabira U, Weaver M, Blum N, Burnett S, Dorsey G, Sebuyira LM, Ojaku A, Schneider G, Willis K and Yeka A: Improved clinical and laboratory skills after team based, malaria case management training of health care professionals in Uganda. Malaria Journal 2012, 11:44.
Nankabirwa J, Zurovac D, Njogu JN, Rwakimari JB, Counihan H, Snow RW and Tibenderana JK: Malaria misdiagnosis in Uganda – implications for policy change. Malaria Journal 2009, 8:66.
Zurovac D, Midia B, Ochola SA, English M, Snow RW: Microscopy and outpatient malaria case management among older children and adults in Kenya. Trop Med Int Health 2006, 11:432-440.
Kiggundu M, Nsobya SL , Kamya MR , Filler S, Nasr S, Dorsey G, and Yeka A: Evaluation of a Comprehensive Refresher Training Program in Malaria Microscopy Covering Four Districts of Uganda. American Journal of Tropical Medcine and Hygine 2011, 84(5): 820–824.
Obare P, Ogutu B, Adams M, Odera JS, Lilley K, Dosoo D, Adhiambo C, Owusu-Agyei S, Binka F, Wanja E and Johnson J: Misclassification of Plasmodium infections by conventional microscopy and the impact of remedial training on the proficiency of laboratory technicians in species identification. Malaria Journal 2013, 12:113.
Mukadi P, Gillet P, Lukuka A, Atua B, Sheshe N, Kanza A, Mayunda JB, Mongita B, Senga R, Ngoyi J, Muyembe J, Jacobsb J & Lejonh V.: External quality assessment of Giemsa-stained BF microscopy for the diagnosis of malaria and sleeping sickness in the Democratic Republic of the Congo. Bull World Health Organ 2013;91:441–448.
Khan MA, Walley JD, Munir MA, Khan MA, Khokar NG, Tahir Z, Nazir A, Shams N: District level external quality assurance (EQA) of malaria microscopy in Pakistan: pilot implementation and feasibility. Malaria Journal 2011, 10:45.
Mukadi P, Gillet P, Lukuka A, Atua B, Kahodi S, Lokombe J, Jean-Jacques Muyembe and Jacobs J: External quality assessment of malaria microscopy in the Democratic Republic of the Congo. Malaria Journal 2011, 10:308.
Ashraf S, Kao A, Hugo C, Christophel EM, Fatunmbi B, Luchavez J, Lilley K and Bell D: Developing standards for malaria microscopy: external competency assessment for malaria microscopists in the Asia-Pacific. Malaria Journal 2012, 11:352.
Frean J, Perovic O, Fensham V, McCarthy K, Gottberg A, Gouveia L, Poonsamy B, Dini L, Rossouw J., Keddy K, Alemu W, Yahaya A, Pierson A, Dolmazon V, Cognatc S &. Ndihokubwayo JB: External quality assessment of national public health laboratories in Africa, 2002–2009. Bull World Health Organ 2012;90:191–199A.