External quality assessment of Giemsa-stained blood film microscopy for the diagnosis of malaria and sleeping sickness in the Democratic Republic of the Congo

Mukadi, Pierre; Gillet, Philippe; Lukuka, Albert; Atua, Benjamin; Sheshe, Nicole; Kanza, Albert; Mayunda, Jean Bosco; Mongita, Briston; Senga, Raphaël; Ngoyi, John; Muyembe, Jean‐Jacques; Jacobs, Jan; Lejon, Veerle

doi:10.2471/blt.12.112706

Cited by 22 publications

(30 citation statements)

References 15 publications

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“…These findings were in agreement with the study conducted in the Democratic Republic of the Congo that the number of laboratories reporting false positive result was lower in the second assessment than the previous assessment [8]. This indicates that supportive site visits offered an opportunity to assess the actual condition and skills practiced in the laboratory and provide problem-solving strategies, corrective action and onsite training based on the identified gaps and the previous assessment feedback.…”

Section: Introductionsupporting

confidence: 88%

“…The blind rechecking method is a process by which slides are randomly selected from diagnostic health centers, transported to the higher level laboratory and reexamined blindly to evaluate the performance of laboratories [6]. Studies done by Pakistan and Congo showed that external quality assessment methods were found to be feasible and acceptable to improve the quality of malaria microscopy service [7, 8]. The major deficiencies may be due to poor competency, poor equipment, poor reagents, or poor infrastructure and work practices that require urgent alteration [7].…”

Section: Introductionmentioning

confidence: 99%

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External quality assessment of malaria microscopy diagnosis among public health facilities in West Amhara Region, Ethiopia

et al. 2017

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ObjectiveTo evaluate the importance of external quality assessment program on malaria microscopic diagnosis.ResultsA total of 3148 slides were collected in 4 consecutive external quality assessment rounds and blindly rechecked at Amhara Public Health Institute. The average agreement between health facility and APHI slide readers was 96.6%. The percent agreement for parasite detection and species identification for P. falciparum became improved in four consecutive EQA rounds from 93.88 to 99.24% and 92.67 to 97.35% respectively. The rates of false positive and false negative were also dramatically decreased in each round from 10.5 to 0.79% and 2.14 to 0.74% respectively. Therefore, we recommend that malaria EQA program should maintain and expand in all malaria diagnostic health facilities in the region to provide accurate and reliable malaria microscopic service.

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Section: Introductionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

External quality assessment of malaria microscopy diagnosis among public health facilities in West Amhara Region, Ethiopia

et al. 2017

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“…Mandy et al and Mukadi et al . noted improved performance after several rounds of participation in PT ( 32 , 37 ); however, Paramasivan et al . noted no significant improvement after submitting five rounds of TB panels, even after communicating observed deficiencies to participants ( 63 ).…”

Section: Resultsmentioning

confidence: 95%

External quality assessment in resource–limited countries

Carter

2017

Biochem Med

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IntroductionHealth laboratory services are a critical component of national health systems but face major operational challenges in resource-limited (RL) settings. New funding for health systems strengthening in RL countries has increased the demand for diagnostics and provided opportunities to address these constraints. An approach to sustainably strengthen national laboratory systems in sub-Saharan African countries is the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme. External Quality Assessment (EQA) is a requirement for laboratory accreditation. EQA comprises proficiency testing (PT), rechecking of samples and on-site evaluation.Materials and methodsA systematic literature search was conducted to identify studies addressing laboratory EQA and quality monitoring in RL countries. Unpublished reports were also sought from national laboratory authorities and personnel.ResultsPT schemes in RL countries are provided by commercial companies, institutions in developed countries and national programmes. Most government-supported PT schemes address single diseases using a vertical approach. Regional approaches to delivering PT have also been implemented across RL countries. Rechecking schemes address mainly tuberculosis (TB), malaria and human immunodeficiency virus (HIV); integrated rechecking programmes have been piloted. Constraints include sample transportation, communication of results, unknown proficiency of referee staff and limited resources for corrective action. Global competency assessment standards for malaria microscopists have been established.ConclusionsEQA is vital for monitoring laboratory performance and maintaining quality of laboratory services, and is a valuable tool for identifying and assessing technology in use, identifying gaps in laboratory performance and targeting training needs. Accreditation of PT providers and competency of EQA personnel must be ensured.

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“…“Minor error” was defined as identification error of P.vivax and of a mixed infection (reporting single infection in case of mixed parasites) [15]. The distinction between a minor and a major error was based on the effect the error could potentially have for the patient's diagnosis and clinical management [16]. …”

Section: Methodsmentioning

confidence: 99%

Performance evaluation of laboratory professionals on malaria microscopy in Hawassa Town, Southern Ethiopia

2014

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BackgroundMicroscopic diagnosis of Giemsa stained thick and thin blood films by skilled microscopists has remained the standard laboratory method for the diagnosis of malaria. However, detection and identification of malaria parasites require well trained laboratory personnel.The objective of the study was to evaluate the performance of laboratory technologists and technicians in detecting and identifying malaria parasites in Hawassa town, Southern Ethiopia.MethodsA cross-sectional study design was employed among a total of 80 laboratory professionals working in public and private health facilities. A standardized pre-validated slide panel and questionnaires were distributed to laboratory professionals working at eleven health facilities in Hawassa town, Southern Ethiopia. The panels included ten slides for diagnosis, [slide1:P.falciparum, 104/μl; slide 2:P.falciparum, 53404/μl; slide 3 and 4: mixed infection (both P. falciparum and P. vivax); slide 5:P.vivax, 23503/μl; slide 6:P.vivax, 400/μl; and slides 7, 8, 9 and 10: negative slides]. Participants were asked to return the responses which were compared with expert microscopist. Agreement in detecting and identifying malaria parasites between participants and expert microscopists was estimated using the Kappa score.ResultsThe mean age of the participants was 27 (SD = 4.1) years. More than half of the participants (56.9%) were female. Fourteen (19.4%) of the participants correctly reported all the ten distributed slides, whereas 58(80.6%) missed at least one slide. Overall, the sensitivity and specificity of participants in detection of malaria parasites were 82% and 96.5% respectively. The overall agreement between participants and reference readers on detection of malaria parasite was 88% (Kappa = 0.76) while on identification of malaria species was 74.3% (kappa = 0.63). Lower agreement on detection and identification of slides with low parasitic density and mixed infection were observed. Agreement was relatively lower for government health centers (69%; kappa = 0.56). None of the participants reported parasitic load per micro liter method.ConclusionAgreement of the participants with expert microscopist in the detection of malaria parasites was better than agreement in the identification of different species of malaria. Poor agreement was reported in detection of parasites at a low density and mixed infections.

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External quality assessment of Giemsa-stained blood film microscopy for the diagnosis of malaria and sleeping sickness in the Democratic Republic of the Congo

Cited by 22 publications

References 15 publications

External quality assessment of malaria microscopy diagnosis among public health facilities in West Amhara Region, Ethiopia

External quality assessment of malaria microscopy diagnosis among public health facilities in West Amhara Region, Ethiopia

External quality assessment in resource–limited countries

Performance evaluation of laboratory professionals on malaria microscopy in Hawassa Town, Southern Ethiopia

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