Abstract
BackgroundAccurate early diagnosis and prompt treatment is one of the key strategies to control and prevent malaria in Ethiopia where both Plasmodium falciparum and Plasmodium vivax are sympatric and require different treatment regimens. Microscopy is the standard for malaria diagnosis at the health centres and hospitals whereas rapid diagnostic tests are used at community-level health posts. The current study was designed to assess malaria microscopy capacity of health facilities in Oromia Regional State and Dire Dawa Administrative City, Ethiopia.MethodsA descriptive cross-sectional study was conducted from February to April 2011 in 122 health facilities, where health professionals were interviewed using a pre-tested, standardized assessment tool and facilities’ laboratory practices were assessed by direct observation.ResultsOf the 122 assessed facilities, 104 (85%) were health centres and 18 (15%) were hospitals. Out of 94 health facilities reportedly performing blood films, only 34 (36%) used both thin and thick smears for malaria diagnosis. The quality of stained slides was graded in 66 health facilities as excellent, good and poor quality in 11(17%), 31 (47%) and 24 (36%) respectively. Quality assurance guidelines and malaria microscopy standard operating procedures were found in only 13 (11%) facilities and 12 (10%) had involved in external quality assessment activities, and 32 (26%) had supportive supervision within six months of the survey. Only seven (6%) facilities reported at least one staff’s participation in malaria microscopy refresher training during the previous 12 months. Although most facilities, 96 (79%), had binocular microscopes, only eight (7%) had the necessary reagents and supplies to perform malaria microscopy. Treatment guidelines for malaria were available in only 38 (31%) of the surveyed facilities. Febrile patients with negative malaria laboratory test results were managed with artemether-lumefantrine or chloroquine in 51% (53/104) of assessed health facilities.ConclusionsThe current study indicated that most of the health facilities had basic infrastructure and equipment to perform malaria laboratory diagnosis but with significant gaps in continuous laboratory supplies and reagents, and lack of training and supportive supervision. Overcoming these gaps will be critical to ensure that malaria laboratory diagnosis is of high-quality for better patient management.
Highlights
Accurate early diagnosis and prompt treatment is one of the key strategies to control and prevent malaria in Ethiopia where both Plasmodium falciparum and Plasmodium vivax are sympatric and require different treatment regimens
Malaria laboratory diagnostic services were available in all facilities surveyed, significant gaps were observed in laboratory infrastructure, equipment, materials and reagent supply chains, human resource capacity, availability of policies, strategic plans and operational procedures, and laboratory services and data recording
Even though the national policy [3] states that microscopy should be used at health centre and hospital levels, more than half of surveyed facilities used rapid diagnostic tests (RDTs), partially because functional microscopes were not available
Summary
Accurate early diagnosis and prompt treatment is one of the key strategies to control and prevent malaria in Ethiopia where both Plasmodium falciparum and Plasmodium vivax are sympatric and require different treatment regimens. The current study was designed to assess malaria microscopy capacity of health facilities in Oromia Regional State and Dire Dawa Administrative City, Ethiopia. Malaria is one of the top ten causes of morbidity, accounting for 17% of all cases and 8% of health facility admissions in 2012 [3]. Accurate early diagnosis and prompt treatment of malaria is among the core strategies to prevent and control malaria [4]. G. through the Global Fund to Fight AIDS, Tuberculosis and Malaria; the U.S President’s Emergency Plan for AIDS Relief and President’s Malaria Initiative), laboratory systems in developing countries remain weak. Strong laboratory systems ensure that curative interventions are more effective (e. g., by avoiding prescription of artemisinin combination therapy (ACT) to patients with nonmalarial causes of fever), and affect treatment-seeking behaviour (i. e. health facilities with a strong laboratory service tend to experience greater access by patients than facilities with a weak laboratory service) [7]
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