title: Performance Evaluation of Malaria Microscopists at Defense Health Facilities in Addis Ababa and Its Surrounding Areas, Ethiopia.
abstract: BACKGROUND
  Blood film microscopy is the gold standard approach for malaria diagnosis, and preferred method for routine patient diagnosis in health facilities. However, the inability of laboratory professionals to correctly detect and identify malaria parasites microscopically leads to an inappropriate administration of anti-malarial drugs to the patients and incorrect findings in research areas. This study was carried out to evaluate the performance of laboratory professionals in malaria diagnosis in health facilities under the Defense Health Main Department in Addis Ababa and its surroundings, Ethiopia.
  
  
  METHODS
  A cross sectional study was conducted from June to July 2015. Totally, 60 laboratory professionals out of the selected 16 health facilities were included in the study. Data were collected by distributing standardized pre-validated malaria slide-panels and self-administered questionnaires among professionals, onsite in each study facility. Sensitivity, specificity, and strength of agreement (with kappa score) in performance among the study participants against WHO-certified expert malaria microscopists were calculated.
  
  
  RESULTS
  Of the 60 study participants, 8.3% (5/60) correctly read all the distributed slides in terms of parasite detection, species identification and parasite counting; whereas, each of the remaining 55(91.7%) interpreted at least two slides incorrectly. The overall sensitivity and specificity of participants' performance in detection of malaria parasites were 65.7% and 100%, respectively. Overall, fair agreement (71.4%; Kappa: 0.4) in detection of malaria parasite was observed between the study subjects and expert readers. The overall sensitivity and specificity of participants in species identification of malaria parasites were respectively 41.3% and 100%. Overall, slight agreement (51.1%; kappa: 0.04) in identification of malaria species was observed. Generally, agreement was lower in parasite detection and species identification at low parasite density and mixed infection cases.
  
  
  CONCLUSIONS
  The general agreement between the study participants and expert microscopists in malaria parasite detection and species identification was very low, particularly in the cases of low-parasite density and mixed infections. Therefore, regular external quality assessments and further refreshment trainings are crucial to enhance the skill of professionals in malaria microscopy; particularly for those in non-malarious areas where exposure to malaria diagnosis is low.
authors.affiliation: Emanuel Mental Specialized Hospital, Medical Laboratory Service, Addis Ababa, Ethiopia.|Department of Medical Laboratory Sciences, Collage of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Tigist
authors.identifier: http://orcid.org/0000-0001-5280-237X
authors.initials: T
authors.lastname: Yitbarek
authors.affiliation: Malaria, Other Parasite and Vector Borne Parasitic Diseases Research Team; Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
authors.forename: Desalegn
authors.initials: D
authors.lastname: Nega
authors.affiliation: Malaria, Other Parasite and Vector Borne Parasitic Diseases Research Team; Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
authors.forename: Geremew
authors.initials: G
authors.lastname: Tasew
authors.affiliation: Colgate University, Department of Biology, Hamilton, New York, United States of America.
authors.forename: Bineyam
authors.initials: B
authors.lastname: Taye
authors.affiliation: Department of Medical Laboratory Sciences, Collage of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Kassu
authors.initials: K
authors.lastname: Desta
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005002:Ethiopia; D005260:Female; D006801:Humans; D007753:Laboratories / Q000592:standards; D008288:Malaria / Q000175:diagnosis / Q000469:parasitology*; D008297:Male; D008853:Microscopy / Q000379:methods* / Q000592:standards; D011786:Quality Control; D000078329:Workforce