External Quality Assessment of Malaria Microscopy in Hawassa Health Facilities, Southern Ethiopia

Abstract

Background: Misinterpretation of malaria microscopy results can lead to inappropriate case management of malaria. The objective of this study was to assess the quality of malaria microscopy among health facilities in Hawassa city. A cross - sectional study was conducted to assess the quality of malaria microscopy diagnosis in Hawassa city health facility laboratories from November 2012 to January 2013 in Sothern Ethiopia. Validated panel malaria slides were distributed to health facilities accompanied with a questionnaire that assessed factors related to malaria microscopy improvement. Operational definitions for correct result and major and minor errors were outlined. A total of 51 laboratory professionals in 10 health facilities were surveyed with a response rate of 85%. Results were collected and data was analyzed by SPSS, and Win Pepi software. Result: Of 306 malaria slides examined in Sample 1-Sample 6 [S1-S6] only 54% of the examinations reported correctly. Considering major errors in [S1-S4], the most common errors were reporting negative for positive slide 39/83(47%), species identification error 29/83(35%) and density 15/83 (18%). In mixed Plasmodium falciparum/Plasmodium vivax (Pf/Pv) sample, only 18% of participants made correct diagnosis in identifying both Pf/Pv species. In Plasmodium negative sample 45(88.2%) of participants scored (no parasites observed) correctly. Considering S1-S4, 29 of the 165 densities reported were different from the reference density established for each slide. 53% of participants had never participated in a formal training on malaria microscopy, and among those who did, more than half were trained earlier than 2008. All of the participants reported to use tap water in preparation of working Giemsa solution. Conclusion: The present assessment revealed a poor quality of malaria microscopy in Hawassa city administration health facilities. Therefore, responsible bodies are required to improve quality of malaria microscopy, and also provide regular refreshment training for laboratory professionals in malaria microscopy. Further similar study should be conducted in large scale.