External quality assessment of malaria microscopy diagnosis in selected health facilities in Western Oromia, Ethiopia

Abstract

BackgroundAccurate early diagnosis and prompt treatment are one of the key strategies to control and prevent malaria disease. External quality assessment is the most effective method for evaluation of the quality of malaria microscopy diagnosis. The aim of this study was to assess the quality of malaria microscopy diagnosis and its associated factors in selected public health facility laboratories in East Wollega Zone, Western Ethiopia.MethodsFacility-based cross-sectional study design was conducted in 30 randomly selected public health facility laboratories from November 2014 to January 2015 in East Wollega Zone, Western Ethiopia. Ten validated stained malaria panel slides with known Plasmodium species, developmental stage and parasite density were distributed. Data were captured; cleaned and analyzed using SPSS version 20 statistical software-multivariate logistic regressions and the agreement in reading between the peripheral diagnostic centers and the reference laboratory were done using kappa statistics.ResultsA total of 30 health facility laboratories were involved in the study and the overall quality of malaria microscopy diagnosis was poor (62.3%). The associated predictors of quality in this diagnosis were in-service training [(AOR = 16, 95% CI (1.3, 1.96)], smearing quality [(AOR = 24, 95% CI (1.8, 3.13)], staining quality [(AOR = 15, 95% CI (2.35, 8.61), parasite detection [(AOR = 9, 95% CI (1.1, 8.52)] and identification skills [(AOR = 8.6, 95% CI (1.21, 1.63)]. Eighteen (60%) of health facility laboratories had in-service trained laboratory professionals on malaria microscopy diagnosis.ConclusionOverall quality of malaria microscopy diagnosis was poor and a significant gap in this service was observed that could impact on its diagnostic services.

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 slightly higher than previous results from Amhara region of Ethiopia (96.6%) [11], and slightly lower than Pakistan (99.0-99.5%) [14]. On the other side the test agreement was significantly higher than recent results of 78, 88 and 91.7% from Oromia region of Ethiopia [15], Hawassa [16] and Addis Ababa [17], respectively. Variations in laboratory workload, training and assessment methods might bring the difference.…”

“…Rate of false positive results (1.4%) was lower than previous findings of 2, 2.64 and 4.05%, 7.8, 24.6 and 24.4% from Canada [18], west Amhara, Ethiopia [11], Addis Ababa, Ethiopia [17], USA [19], Congo [20] and Oromia, Ethiopia [15], respectively. Similarly, frequency of false negative reporting was also low (1.3%) in the present study, implying that the overall performance of health facilities in malaria parasite detection is acceptably good.…”

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

“…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.…”

“…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. Similarly, frequency of false negative reporting was also low (1.3%) in the present study, implying that the overall performance of health facilities in malaria parasite detection is acceptably good.…”