title: Malaria diagnostic capacity in health facilities in Ethiopia.
abstract: BACKGROUND
  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. 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.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  Of 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.
  
  
  CONCLUSIONS
  The 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.
authors: Tesfay
authors: T
authors: Abreha
authors: Bereket
authors: B
authors: Alemayehu
authors: Yehualashet
authors: Y
authors: Tadesse
authors: Sintayehu
authors: S
authors: Gebresillassie
authors: Abebe
authors: A
authors: Tadesse
authors: Leykun
authors: L
authors: Demeke
authors: Fanuel
authors: F
authors: Zewde
authors: Meseret
authors: M
authors: Habtamu
authors: Mekonnen
authors: M
authors: Tadesse
authors: Damtew
authors: D
authors: Yadeta
authors: Dawit
authors: D
authors: Teshome
authors: Addis
authors: A
authors: Mekasha
authors: Kedir
authors: K
authors: Gobena
authors: Henock
authors: H
authors: Bogale
authors: Zenebe
authors: Z
authors: Melaku
authors: Richard
authors: R
authors: Reithinger
authors: USAID Ethiopia, Addis Ababa, Ethiopia. hiwtek@yahoo.com.
authors: Hiwot
authors: H
authors: Teka
mesh_terms: D019411:Clinical Laboratory Techniques / Q000295:instrumentation / Q000592:standards / Q000706:statistics & numerical data*; D003151:Community Health Centers / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005002:Ethiopia / Q000453:epidemiology; D006801:Humans; D016778:Malaria, Falciparum / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D016780:Malaria, Vivax / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D010274:Parasitology / Q000706:statistics & numerical data*