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

Hailu, Hiwot Amare; Shiferaw, Melashu Balew; Demeke, Leykun; Derebe, Mulatu Melese; Gelaw, Zelalem Dessie; Emiru, Manamnot Agegne; Lake, Mastewal

doi:10.1186/s13104-017-3080-0

Cited by 12 publications

(28 citation statements)

References 7 publications

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“…Therefore, laboratories should identify and report species correctly. The proportion of species mis-diagnosis in the present study (5.4%) goes in line with previous results of 3.4% in the same study area [12] and it is much lower than previous studies from Hawassa [15] and Oromia [14] where the laboratory professionals correctly identified the species in 74.3% and 44.6% of malaria positive slides during panel testing, respectively. The discrepancy might be due to difference in the method of assessment and the status of EQA and other supportive activities from reference laboratories.…”

Section: Discussionsupporting

confidence: 91%

“…This was due to political instability in areas where respective health laboratories are located. 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.…”

Section: Discussionsupporting

confidence: 89%

“…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.…”

Section: Discussionsupporting

confidence: 88%

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

Tegegne

Ejigu

Alemu

et al. 2020

Preprint

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Background: In most health facilities, microscopic examination of peripheral blood smears is performed for definitive diagnosis of malaria. Despite it produces reliable results about both the infection status and level of parasitemia, microscopic examination of malaria is affected by skill of the laboratory personnel, workload, condition of microscopes and quality of laboratory supplies. Therefore, continuous monitoring of the performance of laboratories is critical in order to make timely corrections. Objective: To assess malaria microscopy performance of diagnostic laboratories in west Amhara region.Methods: A facility based cross-sectional study was conducted from July 2017 to July 2019 among thirty malaria diagnostic laboratories in west Amhara region. Thirty slides were collected from participating laboratories every quarter. Collected slides were taken to Amhara Public Health Institute (APHI) reference laboratory and re-checked by malaria microscopist who were blind to the results from health facilities. Percentage of test agreement, rates of false positive, false negative and species misdiagnosis were calculated using Excel 2010.Results: Among a total of 6689 slides re-examined, results of 6146 slides were the same with that of participating laboratories to give a test agreement of 97.31% and 94.6% in parasite detection and species identification, respectively. Variations in the overall performance of individual laboratories were seen within a range of 81.55% to 97.27% test agreement. Results of 543 (8.12%) slides were discordant, of which 363 (5.4%), 93 (1.4%) and 87 (1.3%) were due to species misdiagnosis, false positive and false negative results, respectively. Conclusion: There was good test agreement between participated laboratories and APHI laboratory. More accurate performance is expected as the country is tracking to malaria elimination. Hence, strengthening the EQA program by integrating rechecking with onsite evaluation is recommended.K

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 88%

See 1 more Smart Citation

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

Tegegne

Ejigu

Alemu

et al. 2020

Preprint

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“…It also shows the impact of EQA on malaria microscopy performance of health laboratories. A similar study conducted in west Amhara before 5 years revealed a mean test agreement of 96.6% with 2.63, 0.7 and 3.4% of re-checked slides reporting false positive, false negative and species mis-diagnosis results, respectively [11]; however the results might not be consistent as there is difference in laboratory staff (due to turnover and recruitment), training, patient flow, quality of supplies and test procedures. Therefore, the aim of the present study was to show the recent 2 years malaria microscopy performance of public health facility laboratories in west Amhara region as assessed through blind rechecking.…”

Section: Introductionmentioning

confidence: 90%

Performance of malaria microscopy external quality assessment and networking among health facilities in west Amhara region, Ethiopia

et al. 2020

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Background: Microscopic examination of peripheral blood smear produces reliable results both about the malaria infection status and level of parasitemia. However, test results are affected by skill of the laboratory personnel, workload, condition of microscopes and quality of laboratory supplies. Therefore, continuous monitoring of the performance of laboratories is of pivotal importance in order to make timely correction. Methods: A facility based cross-sectional study was conducted from July 2017 to July 2019 to assess malaria microscopy performance among thirty malaria diagnostic laboratories in west Amhara region. Thirty slides were collected from participating laboratories every quarter. Collected slides were taken to Amhara Public Health Institute reference laboratory and rechecked by malaria microscopists who were blind to the results from health facilities. Percentage of test agreement, rates of false positive, false negative and species misdiagnosis were calculated using Excel 2010. Results: Among a total of 6689 slides rechecked , results of 6146 slides were the same with that of participating laboratories. The test agreement was 97.31 and 94.6% for parasite detection and species identification, respectively. Variations in the overall performance of individual laboratories were seen within a range of 81.55 to 97.27% test agreement. Results of 543 (8.12%) slides were discordant, of which 363 (5.4%), 93 (1.4%) and 87 (1.3%) slides were due to species misdiagnosis, false positive and false negative results, respectively. Conclusion: There was good test agreement between participated laboratories and Amhara Public Health Institute. More accurate performance is expected as the country is tracking to malaria elimination. Hence, further strengthening the external quality assurance program is recommended.

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“…In the absence of differential diagnosis such as access to blood cultures or PCR to rule out causes of clinical symptoms at many public health facilities in endemic areas, especially in young children, untreated P. falciparum malaria can progress rapidly to severe and life-threatening forms of the disease [31]. This can lead to deaths and undermine both the clinical confidence and credibility of health services if patients who might have malaria but are not treated and the cause of symptoms for the hospital visit is not identified [32]. Additionally, untreated cases can contribute to the transmission of malaria in an area [33].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the colorimetric malachite green loop-mediated isothermal amplification (MG-LAMP) assay for the detection of malaria species at two different health facilities in a malaria endemic area of western Kenya

Gachugia

Chebore

Otieno

et al. 2020

Malar J

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Background Prompt diagnosis and effective malaria treatment is a key strategy in malaria control. However, the recommended diagnostic methods, microscopy and rapid diagnostic tests (RDTs), are not supported by robust quality assurance systems in endemic areas. This study compared the performance of routine RDTs and smear microscopy with a simple molecular-based colorimetric loop-mediated isothermal amplification (LAMP) at two different levels of the health care system in a malaria-endemic area of western Kenya. Methods Patients presenting with clinical symptoms of malaria at Rota Dispensary (level 2) and Siaya County Referral Hospital (level 4) were enrolled into the study after obtaining written informed consent. Capillary blood was collected to test for malaria by RDT and microscopy at the dispensary and county hospital, and for preparation of blood smears and dried blood spots (DBS) for expert microscopy and real-time polymerase chain reaction (RT-PCR). Results of the routine diagnostic tests were compared with those of malachite green loop-mediated isothermal amplification (MG-LAMP) performed at the two facilities. Results A total of 264 participants were enrolled into the study. At the dispensary level, the positivity rate by RDT, expert microscopy, MG-LAMP and RT-PCR was 37%, 30%, 44% and 42%, respectively, and 42%, 43%, 57% and 43% at the county hospital. Using RT-PCR as the reference test, the sensitivity of RDT and MG-LAMP was 78.1% (CI 67.5–86.4) and 82.9% (CI 73.0–90.3) at Rota dispensary. At Siaya hospital the sensitivity of routine microscopy and MG-LAMP was 83.3% (CI 65.3–94.4) and 93.3% (CI 77.9–99.2), respectively. Compared to MG-LAMP, there were 14 false positives and 29 false negatives by RDT at Rota dispensary and 3 false positives and 13 false negatives by routine microscopy at Siaya Hospital. Conclusion MG-LAMP is more sensitive than RDTs and microscopy in the detection of malaria parasites at public health facilities and might be a useful quality control tool in resource-limited settings.

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

Cited by 12 publications

References 7 publications

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

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

Performance of malaria microscopy external quality assessment and networking among health facilities in west Amhara region, Ethiopia

Evaluation of the colorimetric malachite green loop-mediated isothermal amplification (MG-LAMP) assay for the detection of malaria species at two different health facilities in a malaria endemic area of western Kenya

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