Abstract
BackgroundMalaria diagnosis has received renewed interest in recent years, associated with the increasing accessibility of accurate diagnosis through the introduction of rapid diagnostic tests and new World Health Organization guidelines recommending parasite-based diagnosis prior to anti-malarial therapy. However, light microscopy, established over 100 years ago and frequently considered the reference standard for clinical diagnosis, has been neglected in control programmes and in the malaria literature and evidence suggests field standards are commonly poor. Microscopy remains the most accessible method for parasite quantitation, for drug efficacy monitoring, and as a reference of assessing other diagnostic tools. This mismatch between quality and need highlights the importance of the establishment of reliable standards and procedures for assessing and assuring quality. This paper describes the development, function and impact of a multi-country microscopy external quality assurance network set up for this purpose in Asia.MethodsSurveys were used for key informants and past participants for feedback on the quality assurance programme. Competency scores for each country from 14 participating countries were compiled for analyses using paired sample t-tests. In-depth interviews were conducted with key informants including the programme facilitators and national level microscopists.ResultsExternal assessments and limited retraining through a formalized programme based on a reference slide bank has demonstrated an increase in standards of competence of senior microscopists over a relatively short period of time, at a potentially sustainable cost. The network involved in the programme now exceeds 14 countries in the Asia-Pacific, and the methods are extended to other regions.ConclusionsWhile the impact on national programmes varies, it has translated in some instances into a strengthening of national microscopy standards and offers a possibility both for supporting revival of national microcopy programmes, and for the development of globally recognized standards of competency needed both for patient management and field research.
Highlights
Malaria diagnosis has received renewed interest in recent years, associated with the increasing accessibility of accurate diagnosis through the introduction of rapid diagnostic tests and new World Health Organization guidelines recommending parasite-based diagnosis prior to anti-malarial therapy
100 years have elapsed since Ross introduced improvements to malaria diagnosis through Romanowskystained, thick blood film microscopy [1], light microscopy continues to be fundamental to good diagnosis
The objective in each case was to determine the usefulness of the accreditation course for participating national malaria programmes (NMPs) and to describe areas where improvement in design would be of benefit
Summary
Malaria diagnosis has received renewed interest in recent years, associated with the increasing accessibility of accurate diagnosis through the introduction of rapid diagnostic tests and new World Health Organization guidelines recommending parasite-based diagnosis prior to anti-malarial therapy. Microscopy remains the most accessible method for parasite quantitation, for drug efficacy monitoring, and as a reference of assessing other diagnostic tools This mismatch between quality and need highlights the importance of the establishment of reliable standards and procedures for assessing and assuring quality. Clinical diagnosis based solely on symptoms and signs remains common [2] With this decline in malaria incidence, reliance on the clinical diagnosis of malaria is no longer tenable and an accurate parasitebased confirmation is increasingly important for directing treatment and patient management [3]. Such parasitebased diagnosis must be highly accurate, as negative results are used as a basis for withholding treatment that would otherwise be potentially life-saving in a true case of malaria. Proper diagnosis minimizes overtreatment of populations, which in some instances may increase the potential for selecting strains resistant to anti-malarial drugs
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