Evaluation of the Performance of Malaria Microscopist in Primary Health Center and Cross Checker in Belu, East Nusa Tenggara.

Abstract

ABSTRACT Introduction: It was reported that error rate of malaria microscopic examination of microscopist at Primary Health Center and District Health of fice of Belu, Nusa Tenggara Timur (NTT) was high (45-100%). These high level of error rate might becaused by several factors such as lack of qualified personnel, lack of technical skills in the microscopic slide preparation (blood smear) or incompetency in parasite identification on bloods mear preparation. Objectives: To evaluate the performance of malaria microscopists at Primary Health Centers and cross checker in Belu District and determining the factors that contribute to those condition. Methods: The study was an observational and exploratory research with cross sectional approach. The competency of the malaria microscopist at the primary health center and district health office in examining malaria blood smears were evaluated using standard bloods mears and the one from Passive Case Detection (PCD) activities. Performance in preparing bloods mear were evaluatied by observation and filling the checklist. The study was conducted in December 2012 – March 2013 in Belu District, NTT. Results: The competency of the microscopists to identify malaria in fection was low.The error rate in examining PCD bloods mears ranged from 20 - 100%. The error rate of the microscopic reading at district level reached 52%, with a kappa value between 0.41 to 0.60. There was different levels of the error rate using standard and PCD bloods mears. Error rate in diagnosing malaria on PCD blood smears was higher than those on gold standard blood smears. Accuracy to identify P.falciparum was high (100%) than those to identify P.vivax (0 - 75%). False-positive diagnosis is as high as 90% when examining PCD blood smears. Missed diagnosis of malaria parasite also occure in around 60% of personnel when examining blood smears with low density of less than 1000 parasites/il of blood) Conclusion: The accuracy of malaria diagnosis by microscopist in the Health Center in District of Belu is low. The factor that might contribute is the ability of the microscopist to produce a good quality of malaria blood smears. Working experience of the health center microscopist is statistically significant to correlate with accuracy of malaria diagnosis. Keywords: Errorrate, the performance evaluation of microscopists, microscopic examination, blood smear Belu