Abstract
BackgroundAccurate diagnosis of malaria and reduced reliance on presumptive treatment are crucial components of quality case management. From 2008 to 2012, the Improving Malaria Diagnostics project, in collaboration with the Zambia National Malaria Control Centre, implemented an external quality assurance scheme partially comprised of outreach training and supportive supervision (OTSS) in an effort to improve malaria case management across a spectrum of health facilities performing laboratory-based malaria diagnostics. OTSS assessments were conducted by project-trained laboratory and clinical supervisors on a regular basis and measured changes in health facility staff performance over time. Standardized supervision tools were used for data collection and guided OTSS teams to assess health facility infrastructure, record keeping practices, stores of supplies and consumables, good laboratory practices, and staff adherence to guidelines for the case management and diagnosis of suspected malaria cases via direct observations or record reviews. The structure of OTSS also allowed supervisors to provide ongoing support to clinicians and laboratory staff through regular mentoring and on-the-job training.ResultsThis analysis included 88 laboratories and 64 clinics each with four repeated supervisory assessments. Over the course of the project there were significant declines in the number of laboratories experiencing stock-outs of microscopy reagents/consumables (p < 0.001) and significant increases in the number of laboratories instituting the use of microscopy positive controls (p < 0.01), conducting parasite counting (p < 0.05), and converting from a semi-quantitative to a quantitative parasite counting methodology (p < 0.001). Performance in malaria diagnostic and clinical practices [i.e. RDT use (mean(diff) = 14.3%, p < 0.001), blood slide preparation (mean(diff) = 14.7%, p < 0.001), blood slide staining and reading (mean(diff) = 14.0%, p < 0.001), fever case management (mean(diff) = 7.3%, p < 0.01)] and prescriber adherence to negative diagnostic test results (mean(diff) = 7.2%, p < 0.05) showed modest, but significant gains from assessment 1 to assessment 4.ConclusionThe external quality assurance scheme provided periodic representations of clinical and laboratory staff performance. OTSS-enrolled health facilities demonstrated improvements to malaria diagnostic skills, adoption of laboratory best practices, strengthened fever case management practices, and improved prescriber adherence to negative malaria test results.
Highlights
Accurate diagnosis of malaria and reduced reliance on presumptive treatment are crucial components of quality case management
outreach training and supportive supervision (OTSS) assessments generally occurred every 3–6 months for the facilities included in the current analysis and a facility’s total time undergoing these assessments rarely exceeded 2 years spanning a mean of 485 days for clinical OTSS (n = 61 health facilities) and 483 days for laboratory OTSS (n = 79 health facilities)
At the time of the first OTSS assessment, when the majority of facilities were assessed for availability of reference materials, 71.4% (50/70) of all laboratories were missing key malaria diagnostic standard operating procedures and over half (37/67; 55.2%) did not have all recommended malaria diagnostic bench aids available for use by laboratory staff
Summary
Accurate diagnosis of malaria and reduced reliance on presumptive treatment are crucial components of quality case management. As accurate diagnosis of malaria and reduced reliance on presumptive treatment are crucial components of quality case management, the Zambia National Malaria Control Centre (NMCC), known at the National Malaria Elimination Centre, with support from the international community, began implementation of an outreach training and supportive supervision (OTSS) programme in 2009 that was designed to improve malaria case management and diagnostics Such programmes promote quality within and across health facilities by strengthening communication and relationships, focusing on the identification and resolution of problems, helping to optimize the allocation of resources, and empowering health providers to monitor and improve their own performance [5]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
