Abstract
BackgroundIn Angola, malaria is an endemic disease having a major impact on the economy. The WHO recommends testing for all suspected malaria cases, to avoid the presumptive treatment of this disease. In malaria endemic regions laboratory technicians must be very comfortable with microscopy, the golden standard for malaria diagnosis, to avoid the incorrect diagnosis. The improper use of medication promotes drug resistance and undesirable side effects. The present study aims to assess the impact of a three-day refresher course on the knowledge of technicians, quality of blood smears preparation and accuracy of microscopy malaria diagnosis, using qPCR as reference method.MethodsThis study was implemented in laboratories from three hospitals in different provinces of Angola: Bengo, Benguela and Luanda. In each laboratory samples were collected before and after the training course (slide with thin and thick blood smears, a dried blood spot and a form). The impact of the intervention was evaluated through a written test, the quality of slide preparation and the performance of microscopy.ResultsIt was found a significant increase on the written test median score, from 52.5% to 65.0%. A total of 973 slides were analysed to evaluate the quality of thick and thin blood smears. Considering all laboratories there was a significant increase in quality of thick and thin blood smears. To determine the performance of microscopy using qPCR as the reference method we used 1,028 samples. Benguela presented the highest values for specificity, 92.9% and 98.8% pre and post-course, respectively and for sensitivity the best pre-course was Benguela (75.9%) and post-course Luanda (75.0%). However, no significant increase in sensitivity and specificity after the training course was registered in any laboratory analysed.DiscussionThe findings of this study support the need of continuous refresher training for microscopists and other laboratory staff. The laboratories should have a quality control programme to supervise the diagnosis and also to assess the periodicity of new training. However, other variables needed to be considered to have a correct malaria diagnosis, such as adequate equipment and reagents for staining and visualization, good working conditions, motivated and qualified personnel.
Highlights
In Angola, malaria is an endemic disease having a major impact on the economy
Bengo identified one false P. vivax infection and one false negative in microscopy, which was positive for P. malariae using Real time PCR (qPCR)
It was presented the impact of a refreshment course, conducted in three health facilities from different provinces of Angola, in the improvement of malaria diagnosis
Summary
The WHO recommends testing for all suspected malaria cases, to avoid the presumptive treatment of this disease. Accurate malaria diagnosis is essential to a successful and sustainable malaria control as it improves patient care (by reducing the misdiagnosis and inadequate treatment of malaria infections and other febrile diseases), reduces the non-rational drug use that can lead to drug resistance [3,4,5] and enhances the quality of surveillance, preventing the distortion of statistics, misinformed interventions and economic loss [4,5,6]. A study carried out in Angola [7] found evidence that health workers resist to laboratory results (mostly negative ones) mainly due to the lack of trust in the performed tests
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