title: Performance of Microscopy for the Diagnosis of Malaria and Human African Trypanosomiasis by Diagnostic Laboratories in the Democratic Republic of the Congo: Results of a Nation-Wide External Quality Assessment.
abstract: The present External Quality Assessment (EQA) assessed microscopy of blood parasites among diagnostic laboratories in the Democratic Republic of the Congo. The EQA addressed 445 participants in 10/11 provinces (October 2013-April 2014). Participants were sent a panel of five slides and asked to return a routinely stained slide which was assessed for quality of preparation and staining. Response rate was 89.9% (400/445). For slide 1 (no parasites), 30.6% participants reported malaria, mostly Plasmodium falciparum. Only 11.0% participants reported slide 2 (Plasmodium malariae) correctly, 71.0% reported "malaria" or "Plasmodium falciparum" (considered acceptable). Slide 3 contained Plasmodium falciparum (109/μl) and Trypanosoma brucei brucei trypomastigotes: they were each reported by 32.5% and 16.5% participants respectively, 6.0% reported both. Slide 4 (Trypanosoma) was recognised by 44.9% participants. Slide 5 (Plasmodium ovale) was correctly reported by 6.2% participants, another 68.8% replied "malaria" or "Plasmodium falciparum" (considered acceptable). Only 13.6% of routine slides returned were correctly prepared and stained. The proportion of correct/acceptable scores for at least 4/5 slides was higher among EQA-experienced participants compared to first time participants (40.9% versus 22.4%, p = 0.001) and higher among those being trained < 2 years ago compared to those who were not (42.9% versus 26.3%, p = 0.01). Among diagnostic laboratories in Democratic Republic of the Congo, performance of blood parasite microscopy including non-falciparum species and Trypanosoma was poor. Recent training and previous EQA participation were associated with a better performance.
authors.affiliation: National Institute of Biomedical Research, Kinshasa, Democratic Republic of the Congo.|University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo.
authors.forename: Pierre
authors.initials: P
authors.lastname: Mukadi
authors.affiliation: Institut de Recherche pour le Développement, Montpellier, France.
authors.forename: Veerle
authors.initials: V
authors.lastname: Lejon
authors.affiliation: Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Barbara
authors.initials: B
authors.lastname: Barbé
authors.affiliation: Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Philippe
authors.initials: P
authors.lastname: Gillet
authors.affiliation: University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo.
authors.forename: Christophe
authors.initials: C
authors.lastname: Nyembo
authors.affiliation: National Malaria Control Program, Kinshasa, Democratic Republic of the Congo.
authors.forename: Albert
authors.initials: A
authors.lastname: Lukuka
authors.affiliation: National Malaria Control Program, Kinshasa, Democratic Republic of the Congo.
authors.forename: Joris
authors.initials: J
authors.lastname: Likwela
authors.affiliation: National Human African Trypanosomiasis Control Program, Kinshasa, Democratic Republic of the Congo.
authors.forename: Crispin
authors.initials: C
authors.lastname: Lumbala
authors.affiliation: National Human African Trypanosomiasis Control Program, Kinshasa, Democratic Republic of the Congo.
authors.forename: Justin
authors.initials: J
authors.lastname: Mbaruku
authors.affiliation: National Human African Trypanosomiasis Control Program, Kinshasa, Democratic Republic of the Congo.
authors.forename: Wim
authors.initials: W
authors.lastname: Vander Veken
authors.affiliation: National Institute of Biomedical Research, Kinshasa, Democratic Republic of the Congo.|University of Kinshasa, Kinshasa, Democratic Republic of the Congo.
authors.forename: Dieudonné
authors.initials: D
authors.lastname: Mumba
authors.affiliation: National Institute of Biomedical Research, Kinshasa, Democratic Republic of the Congo.|University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo.|University of Kinshasa, Kinshasa, Democratic Republic of the Congo.
authors.forename: Pascal
authors.initials: P
authors.lastname: Lutumba
authors.affiliation: National Institute of Biomedical Research, Kinshasa, Democratic Republic of the Congo.|University of Kinshasa, Kinshasa, Democratic Republic of the Congo.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Muyembe
authors.affiliation: Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.|Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: Jacobs
mesh_terms: D015023:Democratic Republic of the Congo; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000097:blood*; D008297:Male; D008853:Microscopy / Q000379:methods / Q000592:standards; D010963:Plasmodium falciparum; D041122:Plasmodium ovale; D011785:Quality Assurance, Health Care; D014346:Trypanosoma brucei brucei; D014353:Trypanosomiasis, African / Q000097:blood*