title: Quality of malaria microscopy in 12 district hospital laboratories in Tanzania.
abstract: BACKGROUND
  The WHO recommendation for parasitological diagnosis of malaria wherever possible is challenged by evidence of poor-quality microscopy in African hospitals but the reasons are not clear.
  
  
  METHODS
  All 12 of the busier district hospital laboratories from three regions of Tanzania were assessed for quality of the working environment and slide readers read 10 reference slides under exam conditions. Slides that had been routinely read were removed for expert reading.
  
  
  RESULTS
  Of 44 slide readers in the study, 39 (88.6%) correctly read >90% of the reference slides. Of 206 slides that had been routinely read, 33 (16%) were judged to be unreadable, 104 (51%) were readable with difficulty, and 69 (34%) were easily readable. Compared to expert reading of the same slide, the sensitivity of routine slide results of easily readable slides was 85.7% (95% confidence interval: 77.4-94.0), falling to 44.4% (95% confidence interval: 34.5-54.4) for slides that were 'readable with difficulty'.
  
  
  CONCLUSIONS
  The commonest cause of inaccurate results was the quality of the slide itself, correction of which is likely to be achievable within existing resources. A minority of slide readers were unable to read slides even under ideal conditions, suggesting the need for a 'slide reading licence' scheme.
authors.affiliation: Joint Malaria Programme, Kilimanjaro Christian Medical Centre, Moshi, Tanzania. tufuwage@hotmail.com
authors.forename: Hilda
authors.initials: H
authors.lastname: Mbakilwa
authors.forename: Chacha
authors.initials: C
authors.lastname: Manga
authors.forename: Stafford
authors.initials: S
authors.lastname: Kibona
authors.forename: Frank
authors.initials: F
authors.lastname: Mtei
authors.forename: Judith
authors.initials: J
authors.lastname: Meta
authors.forename: Aikande
authors.initials: A
authors.lastname: Shoo
authors.forename: Ben
authors.initials: B
authors.lastname: Amos
authors.forename: Hugh
authors.initials: H
authors.lastname: Reyburn
mesh_terms: D000328:Adult; D019411:Clinical Laboratory Techniques / Q000592:standards*; D005260:Female; D006302:Health Services Research; D006767:Hospitals, District; D006801:Humans; D059021:Laboratory Proficiency Testing; D008288:Malaria / Q000175:diagnosis*; D008297:Male; D008853:Microscopy / Q000592:standards*; D008875:Middle Aged; D012680:Sensitivity and Specificity; D013636:Tanzania