Factoring Quality Laboratory Diagnosis into the Malaria Control Agenda for Sub-Saharan Africa

Aidoo, Michael

doi:10.4269/ajtmh.13-0108

Cited by 5 publications

(4 citation statements)

References 33 publications

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“…The observations from the QA pilot are consistent with findings from another recent external QA programme implemented in a limited number of rural health facilities in western Kenya and provide additional evidence for a coordinated approach to strengthening malaria diagnostics across the larger clinical and laboratory systems [21, 24]. Significant gains were observed in malaria diagnostic QA/QC practices over the pilot.…”

Section: Discussionsupporting

confidence: 79%

Evaluation of a laboratory quality assurance pilot programme for malaria diagnostics in low-transmission areas of Kenya, 2013

Wanja

Achilla

Obare

et al. 2017

Malar J

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BackgroundOne objective of the Kenya National Malaria Strategy 2009–2017 is scaling access to prompt diagnosis and effective treatment. In 2013, a quality assurance (QA) pilot was implemented to improve accuracy of malaria diagnostics at selected health facilities in low-transmission counties of Kenya. Trends in malaria diagnostic and QA indicator performance during the pilot are described.MethodsFrom June to December 2013, 28 QA officers provided on-the-job training and mentoring for malaria microscopy, malaria rapid diagnostic tests and laboratory QA/quality control (QC) practices over four 1-day visits at 83 health facilities. QA officers observed and recorded laboratory conditions and practices and cross-checked blood slides for malaria parasite presence, and a portion of cross-checked slides were confirmed by reference laboratories.ResultsEighty (96%) facilities completed the pilot. Among 315 personnel at pilot initiation, 13% (n = 40) reported malaria diagnostics training within the previous 12 months. Slide positivity ranged from 3 to 7%. Compared to the reference laboratory, microscopy sensitivity ranged from 53 to 96% and positive predictive value from 39 to 53% for facility staff and from 60 to 96% and 52 to 80%, respectively, for QA officers. Compared to reference, specificity ranged from 88 to 98% and negative predictive value from 98 to 99% for health-facility personnel and from 93 to 99% and 99%, respectively, for QA officers. The kappa value ranged from 0.48–0.66 for facility staff and 0.57–0.84 for QA officers compared to reference. The only significant test performance improvement observed for facility staff was for specificity from 88% (95% CI 85–90%) to 98% (95% CI 97–99%). QA/QC practices, including use of positive-control slides, internal and external slide cross-checking and recording of QA/QC activities, all increased significantly across the pilot (p < 0.001). Reference material availability also increased significantly; availability of six microscopy job aids and seven microscopy standard operating procedures increased by a mean of 32 percentage points (p < 0.001) and 38 percentage points (p < 0.001), respectively.ConclusionsSignificant gains were observed in malaria QA/QC practices over the pilot. However, these advances did not translate into improved accuracy of malaria diagnostic performance perhaps because of the limited duration of the QA pilot implementation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-017-1856-2) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 79%

Evaluation of a laboratory quality assurance pilot programme for malaria diagnostics in low-transmission areas of Kenya, 2013

Wanja

Achilla

Obare

et al. 2017

Malar J

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“…The findings above are supported by (Aidoo,2013) who found that malaria case management requires coordinated efforts by several healthcare professionals for laboratory tests to have a significant impact on malaria control and elimination, a paradigm shift is needed in patients care (Aidoo, 2013). Also, prompt and accurate diagnosis of malaria is the key to effective disease management, guiding the management of febrile patients and reducing the unnecessary use of anti-malarial drugs.…”

Section: Private Laboratory Techniciansmentioning

confidence: 78%

An Exploration of Malaria Medication Decisions Making Process in Tanzania: A Case of Mbeya Region

Kisawike¹

2020

ijird

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Background of the Research ProblemThe treatment and control of malaria pose a serious challenge. Yet, access to prompt and effective malaria treatment, a foundation of any malaria control strategy, is sub-optimal in many settings. An important part of strategies for combating malaria is reducing mortality and morbidity through early diagnosis and prompt treatment (Rønn, 1998) as cited by Kisawike (2015). This will, however, be influenced by factors related to cost, availability and cultural beliefs about the causes and effective cures (Oreagbaet al., 2005). The epidemiological, medicinal and entomological aspects of malaria and its consequences for the social and economic outlook of countries in which it is endemic are well documented (Rodriguez,1993). People seek treatment for malaria from a wide range of providers, including pharmacies, formal health centres/hospitals/dispensaries and traditional medicines. However, there are many problems with the treatment provisions. Hence, factors influencing malaria medication decision making process need to be investigated.Reducing the human infectivity of the malaria parasite through early and effective treatment is still challenging. Different studies in Tanzania and other African countries on effective and prompt malaria treatment identified a number of challenges to malaria treatment in relation to health systems. The challenges identified were barriers to the successful malaria case management due to poor adherence to drug regimes, and underdosage in many households because of poverty and the fact that clinical cure of fever is what matters to many individuals (Mboeraet al., 2002); stock-out of the anti-malarial remedies especially in the public health centres (

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“…7 A coordinated approach in offering pre-service clinical and laboratory training together with systems that support scale-up of laboratory services could provide the means not only for effective malaria case management but also for management of non-malaria febrile illnesses, disease surveillance and accurate control programme evaluations. 8 Another study from Namibia showed that the distribution of RDT in 2005 led to more accurate diagnosis, which explained the sharp decline in malaria cases beginning in 2006. 9 The study indicated, however, that personnel training and supervision in the use of these tests remained problematic.…”

Section: S35mentioning

confidence: 99%

Advances in malaria elimination in Botswana: a dramatic shift to parasitological diagnosis, 2008–2014

Moakofhi¹,

Edwards

Motlaleng

et al. 2018

public health action

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Malaria elimination requires infection detection using quality assured diagnostics and appropriate treatment regimens. Although Botswana is moving towards malaria elimination, reports of unconfirmed cases may jeopardise this effort. This study aimed to determine the proportion of cases treated for malaria that were confirmed by rapid diagnostic testing (RDT) and/or microscopy. This was a retrospective descriptive study using routine national data from the integrated disease surveillance and case-based surveillance systems from 2008 to 2014. The data were categorised into clinical and confirmed cases each year. An analysis of the data on cases registered in three districts that reported approximately 70% of all malaria cases was performed, stratified by year, type of reporting health facilities and diagnostic method. During 2008-2014, 50 487 cases of malaria were reported in Botswana, and the proportion of RDT and/or blood microscopy confirmed cases improved from 6% in 2008 to 89% in 2013. The total number of malaria cases decreased by 97% in the same period, then increased by 41% in 2013. This study shows that malaria diagnostic tests dramatically improved malaria diagnosis and consequently reduced the malaria burden in Botswana. The study identified a need to build capacity on microscopy for species identification, parasite quantification and guiding treatment choices.

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Factoring Quality Laboratory Diagnosis into the Malaria Control Agenda for Sub-Saharan Africa

Cited by 5 publications

References 33 publications

Evaluation of a laboratory quality assurance pilot programme for malaria diagnostics in low-transmission areas of Kenya, 2013

Evaluation of a laboratory quality assurance pilot programme for malaria diagnostics in low-transmission areas of Kenya, 2013

An Exploration of Malaria Medication Decisions Making Process in Tanzania: A Case of Mbeya Region

Advances in malaria elimination in Botswana: a dramatic shift to parasitological diagnosis, 2008–2014

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