Assessment of Malaria Microscopic Diagnosis Performance of Laboratory Professionals in Addis Ababa’s Public Health Facilities

Abstract

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.

Performance of Malaria Microscopy External Quality Assessment and networking among Health Facilities in West Amhara Region, Ethiopia

“…The mean test agreement in detecting malaria parasites in the present study (97.31%) was in line with previous results from Amhara region of Ethiopia (96.6%) [12], and Pakistan (99.0-99.5%) [13]. On the other side the test agreement was higher than recent results of 78%, 88% and 91.7% from Oromia region of Ethiopia [14], Hawassa [15] and Addis Ababa [16], respectively. Variations in laboratory workload, training and assessment methods might bring the difference.…”

“…Among 180 (2.69%) discordant slides in parasite detection, 87 (1.4%) were false positive results which was similar with previous findings of 2%, 2.64% and 4.05% from Canada [17], west Amhara region [12] and Addis Ababa [16], respectively. On the contrary, higher false positive rates of 7.8%, 24.6% and 24.4% were reported from USA [18], Congo [19] and Ethiopia [14], respectively.…”

Evaluation Of Malaria Microscopy Diagnosis Performance In Public Hospitals Of Eastern And Centeral Part Of Oromia Region, Ethiopia, 2019

“…In service training was another factor significantly associated with quality of malaria microscopy performance in the in this study. Laboratory professionals who were trained on malaria microscopy diagnosis were 1.28 times reported better quality results than those who were not trained This study is consistent with the study done in Tigray, West Oromia, Addis Ababa and Democratic republic of Congo in which training status of laboratory professionals showed significant association with quality of malaria microscopy diagnosis [14,21,22,23]. This might shows that provision of theoretical and practical refresher training for laboratory personnel is a primary means of accurate detection and identification of malaria parasites.…”

“…This study is in line with the study conducted in Kenya in which laboratory professionals who had more work experience 3.8 times diagnosis malaria microscope accurately than those with less work experience. [22] However, this study is not similar with the study done in Tigray, North Ethiopia in work experience in malaria diagnosis is not significantly associated with quality of malaria diagnosis [21].The discrepancy might be due to method of data collection and sampling technique used in the study done in Tigray.…”

“…The discrepancy might be due to the difference in method and frequency of assessment in which studies were conducted more than one round in Bahir Dar and Pakistan compared to this study From the total of discordant slides, false positivity and false negativity rate were 9.5% and 5.6% which implies either wrongly considering artefacts as parasites in smear due to poor quality of reagent or incorrect staining procedure or failure to scan the recommended field to detect low concentration of parasites and lack of training .This study is supported by the study done in West Amhara and Addis Ababa in which false positivity rate ranged from 0.79-10.5%. [15,22] This study reported lower false positive rate than the report of the study done in Democratic republic of Congo and West Oromia in which false positivity rate results were 24.6% and 24.4% [16,24]. This indicates the laboratory professionals incorrectly considered artefacts as parasites which lead mistreatment of suspected malaria patients and delayed diagnosis of underlying cause of the illness.…”