title: High sensitivity and specificity of clinical microscopy in rural health facilities in western Kenya under an external quality assurance program.
abstract: Microscopic diagnosis of malaria is a well-established and inexpensive technique that has the potential to provide accurate diagnosis of malaria infection. However, it requires both training and experience. Although it is considered the gold standard in research settings, the sensitivity and specificity of routine microscopy for clinical care in the primary care setting has been reported to be unacceptably low. We established a monthly external quality assurance program to monitor the performance of clinical microscopy in 17 rural health centers in western Kenya. The average sensitivity over the 12-month period was 96% and the average specificity was 88%. We identified specific contextual factors that contributed to inadequate performance. Maintaining high-quality malaria diagnosis in high-volume, resource-constrained health facilities is possible.
authors.affiliation: Academic Model Providing Access to Healthcare, Eldoret, Kenya; Ministry of Health, Uasin Gishu County, Eldoret, Kenya; School of Public Health, Moi University College of Health Sciences, Eldoret, Kenya; Duke University School of Medicine, Durham, North Carolina; Duke Global Health Institute, Durham, North Carolina.
authors.forename: Rebeccah
authors.initials: R
authors.lastname: Wafula
authors.affiliation: Academic Model Providing Access to Healthcare, Eldoret, Kenya; Ministry of Health, Uasin Gishu County, Eldoret, Kenya; School of Public Health, Moi University College of Health Sciences, Eldoret, Kenya; Duke University School of Medicine, Durham, North Carolina; Duke Global Health Institute, Durham, North Carolina.
authors.forename: Edna
authors.initials: E
authors.lastname: Sang
authors.affiliation: Academic Model Providing Access to Healthcare, Eldoret, Kenya; Ministry of Health, Uasin Gishu County, Eldoret, Kenya; School of Public Health, Moi University College of Health Sciences, Eldoret, Kenya; Duke University School of Medicine, Durham, North Carolina; Duke Global Health Institute, Durham, North Carolina.
authors.forename: Olympia
authors.initials: O
authors.lastname: Cheruiyot
authors.affiliation: Academic Model Providing Access to Healthcare, Eldoret, Kenya; Ministry of Health, Uasin Gishu County, Eldoret, Kenya; School of Public Health, Moi University College of Health Sciences, Eldoret, Kenya; Duke University School of Medicine, Durham, North Carolina; Duke Global Health Institute, Durham, North Carolina.
authors.forename: Angeline
authors.initials: A
authors.lastname: Aboto
authors.affiliation: Academic Model Providing Access to Healthcare, Eldoret, Kenya; Ministry of Health, Uasin Gishu County, Eldoret, Kenya; School of Public Health, Moi University College of Health Sciences, Eldoret, Kenya; Duke University School of Medicine, Durham, North Carolina; Duke Global Health Institute, Durham, North Carolina.
authors.forename: Diana
authors.initials: D
authors.lastname: Menya
authors.affiliation: Academic Model Providing Access to Healthcare, Eldoret, Kenya; Ministry of Health, Uasin Gishu County, Eldoret, Kenya; School of Public Health, Moi University College of Health Sciences, Eldoret, Kenya; Duke University School of Medicine, Durham, North Carolina; Duke Global Health Institute, Durham, North Carolina wendypomeara@gmail.com.
authors.forename: Wendy Prudhomme
authors.initials: WP
authors.lastname: O'Meara
mesh_terms: D006801:Humans; D007630:Kenya; D008288:Malaria / Q000175:diagnosis*; D017056:Medical Laboratory Personnel / Q000193:education*; D008853:Microscopy / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000592:standards*; D012680:Sensitivity and Specificity