title: Performance evaluation of laboratory professionals on malaria microscopy in Hawassa Town, Southern Ethiopia.
abstract: BACKGROUND
  Microscopic diagnosis of Giemsa stained thick and thin blood films by skilled microscopists has remained the standard laboratory method for the diagnosis of malaria. However, detection and identification of malaria parasites require well trained laboratory personnel.The objective of the study was to evaluate the performance of laboratory technologists and technicians in detecting and identifying malaria parasites in Hawassa town, Southern Ethiopia.
  
  
  METHODS
  A cross-sectional study design was employed among a total of 80 laboratory professionals working in public and private health facilities. A standardized pre-validated slide panel and questionnaires were distributed to laboratory professionals working at eleven health facilities in Hawassa town, Southern Ethiopia. The panels included ten slides for diagnosis, [slide1:P.falciparum, 104/μl; slide 2:P.falciparum, 53404/μl; slide 3 and 4: mixed infection (both P. falciparum and P. vivax); slide 5:P.vivax, 23503/μl; slide 6:P.vivax, 400/μl; and slides 7, 8, 9 and 10: negative slides]. Participants were asked to return the responses which were compared with expert microscopist. Agreement in detecting and identifying malaria parasites between participants and expert microscopists was estimated using the Kappa score.
  
  
  RESULTS
  The mean age of the participants was 27 (SD=4.1) years. More than half of the participants (56.9%) were female. Fourteen (19.4%) of the participants correctly reported all the ten distributed slides, whereas 58(80.6%) missed at least one slide. Overall, the sensitivity and specificity of participants in detection of malaria parasites were 82% and 96.5% respectively. The overall agreement between participants and reference readers on detection of malaria parasite was 88% (Kappa=0.76) while on identification of malaria species was 74.3% (kappa=0.63). Lower agreement on detection and identification of slides with low parasitic density and mixed infection were observed. Agreement was relatively lower for government health centers (69%; kappa=0.56). None of the participants reported parasitic load per micro liter method.
  
  
  CONCLUSIONS
  Agreement of the participants with expert microscopist in the detection of malaria parasites was better than agreement in the identification of different species of malaria. Poor agreement was reported in detection of parasites at a low density and mixed infections.
authors.affiliation: College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia. workfresh@gmail.com.
authors.forename: Freshwork
authors.initials: F
authors.lastname: Ayalew
authors.forename: Birkneh
authors.initials: B
authors.lastname: Tilahun
authors.forename: Bineyam
authors.initials: B
authors.lastname: Taye
mesh_terms: D000328:Adult; D003710:Demography; D003951:Diagnostic Errors; D005002:Ethiopia; D005069:Evaluation Studies as Topic; D005260:Female; D006268:Health Facilities; D006801:Humans; D059232:Laboratory Personnel / Q000592:standards*; D008288:Malaria / Q000175:diagnosis*; D008297:Male; D008853:Microscopy / Q000379:methods*; D012015:Reference Standards; D058028:Research Report; D012680:Sensitivity and Specificity