Abstract
BackgroundRapid and precise diagnosis of malaria is an essential element in effective case management and control of malaria. Malaria microscopy is used as the gold standard for malaria diagnosis, however results remain poor as positivity rate in Nigeria is consistently over 90%. The United States President’s Malaria Initiative (PMI) through the Malaria Action Program for States (MAPS) supported selected states in Nigeria to build capacity for malaria microscopy. This study demonstrates the effectiveness of in-service training on malaria microscopy amongst medical laboratory scientists.MethodThe training was based on the World Health Organization (WHO) basic microscopy training manual. The 10-day training utilized a series of didactic lectures and examination of teaching slides using a CX 21 Olympus binocular microscope. All 108 medical laboratory scientists trained from 2012 to 2015 across five states in Nigeria supported by PMI were included in the study. Evaluation of the training using a pre-and post-test method was based on written test questions; reading photographic slide images of malaria parasites; and prepared slides.ResultThere was a significant improvement in the mean written pre-and post-tests scores from 37.9% (95% CI 36.2–39.6%) to 70.7% (95% CI 68.4–73.1%) (p < 0.001). The mean counting post-test score improved significantly from 4.2% (95% CI 2.6–5.7%) to 27.9% (95% CI 25.3–30.5%) (p < 0.001). Mean post-test score for computer-based picture speciation test (63.0%) and picture detection test (89.2%) were significantly higher than the mean post-test score for slide reading speciation test (38.3%) and slide reading detection test (70.7%), p < 0.001 in both cases.ConclusionParasite detection and speciation using enhanced visual imaging was significantly improved compared with using direct microscopy. Regular in-service training and provision of functional and high resolution microscopes are needed to ensure quality routine malaria microscopy.
Highlights
Rapid and precise diagnosis of malaria is an essential element in effective case management and control of malaria
Data from all the 108 medical laboratory scientists trained between 2012 and 2015 was analysed; majority were males 76 (70.4%); 100 (92.6%) were from secondary health facilities; and 96% were on World Health Organization (WHO) expert level 4
In this study, we have described the effectiveness of a 10-day malaria microscopy training to improve the diagnostic capacity of trained medical laboratory scientist across five states in Nigeria
Summary
Rapid and precise diagnosis of malaria is an essential element in effective case management and control of malaria. Malaria microscopy is used as the gold standard for malaria diagnosis, results remain poor as positivity rate in Nigeria is consistently over 90%. Malaria remains a global public health concern and a recent publication by the World Health Organization (WHO) estimates a world-wide malaria burden of 198 million with an estimated 584,000 deaths. Two countries i.e. Nigeria and the Democratic Republic of Congo account for 34% of Nigeria adopted the policy of parasite based diagnosis before treatment of suspected cases in 2007 to align with the WHO 3Ts initiative of test, treat and track. Over-diagnosis and over-treatment of malaria persist despite large scale up of malaria rapid diagnostic tests across the country [2]. The National Guideline for Diagnosis and Treatment of Malaria in Nigeria (2015)
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