Assessment of the Accuracy of Malaria Microscopy in Private Health Facilities in Entebbe Municipality, Uganda; A Cross-sectional Study

Author(s):  
Tobius Mutabazi ◽  
Emmanuel Arinaitwe ◽  
Alex Ndyabakira ◽  
Emmanuel Sendaula ◽  
Alex Kakeeto ◽  
...  

Abstract Introduction: Although microscopy remains the gold standard for malaria diagnosis, little is known about its accuracy in the private health facilities in Uganda. We evaluated the accuracy of malaria microscopy, and factors associated with inaccurate smear results at private health facilities in Entebbe Municipality, Uganda.Methods: Between April and May 2018, all patients referred for a malaria smear in 16 private health facilities in Entebbe municipality were screened, and 321 patients were enrolled. A questionnaire was administered to collect demographic and clinical information, facility-based smear results were recorded from the participant’s consultation notes, and a research slide was obtained for expert microscopy. A health facility assessment was conducted, and information on experience in performing malaria microscopy was collected from all facility personnel reading smears and the data was linked to the participant’s clinic visit. Results: The prevalence of malaria parasitemia was 15.0% by expert microscopy. The sensitivity, specificity and negative predictive value of the facility-based microscopy were high (95.8%, 90.1% and 99.2% respectively). However; the positive predictive value (PPV) was low with 27/73 (63%) patients diagnosed with malaria not having the disease. Majority of the inaccurate results were from 2 of the 23 laboratory personnel reading the smears. The factors associated with inaccurate smear readings included being read by a technician; 1) who had less than 5 years’ experience in reading malaria smears (adjusted Odds Ratio [OR] = 9.74, 95% Confidence Interval [CI] (1.06 – 89.5), p-value=0.04), and 2) who was examining less than 5 smears a day (OR = 38.8, 95% CI 9.65- 156, p-value <0.001).Conclusion: The accuracy of malaria microscopy in this setting was high, although one third of the patients diagnosed with malaria did not have the disease. Majority of the errors in smear readings were made by two laboratory personnel, with the main factor associated with inaccurate smear results being low experience in malaria microscopy. In-service training may be sufficient to eliminate inaccurate smear results in this setting, and these private facilities would be ideal model facilities to improve the quality of malaria microscopy in Uganda especially in the public sector.

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Tobius Mutabazi ◽  
Emmanuel Arinaitwe ◽  
Alex Ndyabakira ◽  
Emmanuel Sendaula ◽  
Alex Kakeeto ◽  
...  

Abstract Background Although microscopy remains the gold standard for malaria diagnosis, little is known about its accuracy in the private health facilities in Uganda. This study evaluated the accuracy of malaria microscopy, and factors associated with inaccurate smear results at private health facilities in Entebbe Municipality, Uganda. Methods Between April and May 2018, all patients referred for a malaria smear in 16 private health facilities in Entebbe municipality were screened, and 321 patients were enrolled. A questionnaire was administered to collect demographic and clinical information, facility-based smear results were recorded from the participant’s consultation notes, and a research slide was obtained for expert microscopy during exit interview. A health facility assessment was conducted, and information on experience in performing malaria microscopy was collected from all facility personnel reading smears and the data was linked to the participant’s clinic visit. Results The test positivity rate of malaria parasitaemia was 15.0% by expert microscopy. The sensitivity, specificity and negative predictive value of the facility-based microscopy were high (95.8%, 90.1 and 99.2%, respectively). However; the positive predictive value (PPV) was low with 27/73 (63%) patients diagnosed with malaria not having the disease. Majority of the inaccurate results were from 2 of the 23 laboratory personnel reading the smears. The factors associated with inaccurate smear readings included being read by a technician; (1) who had less than 5 years’ experience in reading malaria smears (adjusted Odds Ratio [aOR] = 9.74, 95% confidence interval [CI] (1.06–89.5), p-value = 0.04), and (2) who was examining less than 5 smears a day (aOR = 38.8, 95% CI 9.65–156, p-value < 0.001). Conclusions The accuracy of malaria microscopy in this setting was high, although one third of the patients diagnosed with malaria did not have the disease. Majority of the errors in smear readings were made by two laboratory personnel, with the main factor associated with inaccurate smear results being low experience in malaria microscopy. In-service training may be sufficient to eliminate inaccurate smear results in this setting, and these private facilities would be ideal model facilities to improve the quality of malaria microscopy in Uganda especially in the public sector where accuracy is still poor.


2021 ◽  
Author(s):  
Bokretsion Gidey ◽  
Desalegn Nega ◽  
Adugna Abera ◽  
Abnet Abebe ◽  
Sindew Mekasha ◽  
...  

Abstract Background: In Ethiopia, malaria cases are declining as a result of proven interventions and in 2017, the country launched a malaria elimination strategy in targeted settings. Accurate malaria diagnosis and prompt treatment are the key components of the strategy to prevent morbidity and stop the continuation of transmission. However, the quality of microscopic diagnosis in general is deteriorating as malaria burden declines. Therefore, this study was carried out to evaluate the competency of microscopists and the performance of health facilities on malaria microscopic diagnosis.Methods: A cross-sectional study was conducted from August 1st to September 30th, 2019 in nine regional states and one city administration. A standard checklist was used for on-site evaluation, archived patient slides were re-checked, and proficiency of microscopists was tested using WHO certified slides from the national slide bank at the Ethiopian Public Health Institute (EPHI). The strength of agreement, the sensitivity, the specificity, and the positive and negative predictive values were calculated.Results: In this study, 102 health facilities (84 health centers and 18 hospitals) were included; from which, 202 laboratory professionals participated. In slide re-checking, moderate agreement (Agreement: 76.0%; Kappa: 0.41) was observed between experts and microscopists on malaria detection in all health facilities. The sensitivity and specificity of routine slide reading and the re-checking results were 78.1% and 80.7%, respectively. Likewise, positive predictive value of 65.1% and negative predictive value of 88.8% were scored in the routine diagnosis. By panel testing, a substantial overall agreement (A: 91.8%; K: 0.79) was observed between microscopists and experts in detecting malaria parasites. The sensitivity and specificity in the detection of malaria parasites was 92.7% and 89.1%, respectively. Furthermore, in identifying species, a slight agreement (A: 57%; K: 0.18) was observed between microscopists and experts. Conclusion: The study found significant false positive and false negative results in routine microscopy on slide re-checking of Plasmodium parasites. Moreover, reduced grade in parasite species identification was reported on the panel tests. Therefore, implementing comprehensive malaria microscopy mentorship, in-service training, and supportive supervision are the key strategies to improve the overall performance of health facilities in malaria microscopy.


2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Bokretsion Gidey ◽  
Desalegn Nega ◽  
Adugna Abera ◽  
Abnet Abebe ◽  
Sindew Mekasha ◽  
...  

Abstract Background In Ethiopia, malaria cases are declining as a result of proven interventions, and in 2017 the country launched a malaria elimination strategy in targeted settings. Accurate malaria diagnosis and prompt treatment are the key components of the strategy to prevent morbidity and stop the continuation of transmission. However, the quality of microscopic diagnosis in general is deteriorating as malaria burden declines. This study was carried out to evaluate the competency of microscopists and the performance of health facilities on malaria microscopic diagnosis. Methods A cross-sectional study was conducted from 1 August to 30 September, 2019 in 9 regional states and one city administration. A standard checklist was used for on-site evaluation, archived patient slides were re-checked and proficiency of microscopists was tested using a WHO-certified set of slides from the national slide bank at the Ethiopian Public Health Institute (EPHI). The strength of agreement, sensitivity, specificity, and positive and negative predictive values were calculated. Results In this study, 102 health facilities (84 health centres and 18 hospitals) were included, from which 202 laboratory professionals participated. In slide re-checking, moderate agreement (agreement (A): 76.0%; Kappa (K): 0.41) was observed between experts and microscopists on malaria detection in all health facilities. The sensitivity and specificity of routine slide reading and the re-checking results were 78.1 and 80.7%, respectively. Likewise, positive predictive value of 65.1% and negative predictive value of 88.8% were scored in the routine diagnosis. By panel testing, a substantial overall agreement (A: 91.8%; K: 0.79) was observed between microscopists and experts in detecting malaria parasites. The sensitivity and specificity in the detection of malaria parasites was 92.7 and 89.1%, respectively. In identifying species, a slight agreement (A: 57%; K: 0.18) was observed between microscopists and experts. Conclusion The study found significant false positive and false negative results in routine microscopy on slide re-checking of Plasmodium parasites. Moreover, reduced grade in parasite species identification was reported on the panel tests. Implementing comprehensive malaria microscopy mentorship, in-service training and supportive supervision are key strategies to improve the overall performance of health facilities in malaria microscopy.


2020 ◽  
Author(s):  
Bokretsion Gidey ◽  
Desalegn Nega ◽  
Adugna Abera ◽  
Abnet Abebe ◽  
Sindew Mekasha ◽  
...  

Abstract Background: In Ethiopia, malaria case is declining as a result of proven interventions and the country launched malaria elimination strategy in targeted settings since 2017. Accurate malaria diagnosis and prompt treatment are the key components of the strategy to prevent morbidity and stop continuation of the transmission. However, the quality of microscopic diagnosis in general is deteriorating as malaria burden declines. Therefore, this study was carried out toevaluate the competency of microscopists and the performance of health facilities on malaria microscopic diagnosis.Methods: A cross-sectional study was conducted from August 01 to September 30, 2019 in nine Regional States and one city administration. A standard checklist was used for on-site evaluation, archived patient slides were re-checked and proficiency of microscopists was tested using WHO certified slides from national slide bank in public health institute. Strength of agreement, sensitivity, specificity and positive and negative predictive values were calculated.Results: In this study, 102 health facilities (84 health centers and 18 hospitals) were included; from which, 202 laboratory professionals participated. In slide re-checking, moderate agreement (Agreement: 76.0%; Kappa: 0.41) was observed between experts and microscopists on malaria detection in all health facilities. The sensitivity and specificity of routine slide reading and the rechecking results were 78.1% and 80.7%, respectively. Likewise, positive predictive value of 65.1% and negative predictive value of 88.8% were scored in the routine diagnosis. By panel testing, a substantial overall agreement (A: 91.8%; K: 0.79) was observed between microscopists and experts in detecting malaria parasites. The sensitivity and specificity in detection of malaria parasites was 92.7% and 89.1%, respectively. Furthermore, in identifying species, slight agreement (A: 57%; K: 0.18) was observed between microscopists and experts. Conclusion: The study found significant false positive and false negative results in routine microscopy on slide re-checking of Plasmodium parasites. Moreover, reduced grade in parasite species identification was reported on the panel tests. Therefore, implementing comprehensive malaria microscopy mentorship, in-service training and supportive supervision are the key strategies to improve the overall performance of health facilities in malaria microscopy.


2021 ◽  
Author(s):  
Bokretsion Gidey ◽  
Desalegn Nega ◽  
Adugna Abera ◽  
Abnet Abebe ◽  
Sindew Mekasha ◽  
...  

Abstract Background: In Ethiopia, malaria cases are declining as a result of proven interventions and in 2017, the country launched a malaria elimination strategy in targeted settings. Accurate malaria diagnosis and prompt treatment are the key components of the strategy to prevent morbidity and stop the continuation of transmission. However, the quality of microscopic diagnosis in general is deteriorating as malaria burden declines. Therefore, this study was carried out to evaluate the competency of microscopists and the performance of health facilities on malaria microscopic diagnosis.Methods: A cross-sectional study was conducted from August 1st to September 30th, 2019 in nine regional states and one city administration. A standard checklist was used for on-site evaluation, archived patient slides were re-checked, and proficiency of microscopists was tested using WHO certified slides from the national slide bank at the Ethiopian Public Health Institute (EPHI). The strength of agreement, the sensitivity, the specificity, and the positive and negative predictive values were calculated.Results: In this study, 102 health facilities (84 health centers and 18 hospitals) were included; from which, 202 laboratory professionals participated. In slide re-checking, moderate agreement (Agreement: 76.0%; Kappa: 0.41) was observed between experts and microscopists on malaria detection in all health facilities. The sensitivity and specificity of routine slide reading and the re-checking results were 78.1% and 80.7%, respectively. Likewise, positive predictive value of 65.1% and negative predictive value of 88.8% were scored in the routine diagnosis. By panel testing, a substantial overall agreement (A: 91.8%; K: 0.79) was observed between microscopists and experts in detecting malaria parasites. The sensitivity and specificity in the detection of malaria parasites was 92.7% and 89.1%, respectively. Furthermore, in identifying species, a slight agreement (A: 57%; K: 0.18) was observed between microscopists and experts. Conclusion: The study found significant false positive and false negative results in routine microscopy on slide re-checking of Plasmodium parasites. Moreover, reduced grade in parasite species identification was reported on the panel tests. Therefore, implementing comprehensive malaria microscopy mentorship, in-service training, and supportive supervision are the key strategies to improve the overall performance of health facilities in malaria microscopy.


Author(s):  
Joseph O. Adoyo ◽  
Eliphas G. Makunyi ◽  
George O. Otieno ◽  
Alison Yoos

Background: Self-referral to higher-level hospitals by women seeking skilled birth attendance services reflects in part their non-adherence to established referral pathways. This choice results in an inappropriate utilization of resources within health system. The Kenya Health Sector Referral Strategy aims at optimising the utilization and access of facilities. The aim of this study was to determine the prevalence and factors associated with self-referral among women seeking skilled birth attendance services in Marsabit County between 1st and 31st Oct 2019.Methods: A cross-sectional study was adopted at the maternity department in the selected public hospitals in Marsabit County, by use of interviewer-administered questionnaires to collect information from 161 women, through systematic sampling between 1st and 31st Oct 2019. Chi-square and multiple logistic regression analysis were used to test for factors associated with self-referral at 95% confidence interval.Results: Of the 161 women interviewed, 47.2% (n=76) were self-referrals. The odds of self-referral to the higher level health facilities were more likely among women: - aged 25-29 (AOR 5.174, CI 1.015-26.365, p-value 0.048); those referred for other ANC services (AOR 4.057, CI 1.405-11.720, p-value 0.010); and those, - who visited the referral facility before for delivery (AOR 5.395, CI 1.411 – 20.628, p-value 0.014). However, self-referral were less likely among women who perceived privacy and confidentiality of services at the referral hospitals (AOR 0.370, CI 0.138-0.990, p-value 0.048).Conclusions: Almost half of women seeking skilled birth attendance were self-referrals, relates to a possible implication on an unprecedented increased workload at referral hospitals and underutilization of primary health facilities.


2020 ◽  
Author(s):  
Fraol Jaleta ◽  
Getinet Garoma ◽  
Tadesse Gerenfes

Abstract Back ground: Prompt and accurate malaria diagnosis is essential strategies for effective malaria case management as well as the public health response to malaria. Diagnosis based on clinical grounds alone may lead to misdiagnosis and mistreatment. The objective of this study is to evaluate the performance of malaria microscopy diagnosis public hospitals of Eastern and Central part Oromia, Ethiopia Method : Hospital based cross sectional study was conducted from March, 2019 to May, 2019. All 46 public hospitals of 12 zones in Eastern and Central parts of Oromia, Ethiopia were included in the study. Data were collected using Semi structured questionnaire and known validated positive and negative slides with different species, stage and parasite density distributed to each health facility. It was categorized and cleaned by Epi Info version 3.5.1 and analyzed by SPSS version 20 with multivariate analysis to identify factors associated with poor malaria microscopy diagnosis. Level of agreement was calculated by Kappa statistics. Results: From the total of 46 hospitals , 31 (67.39%) had acceptable quality performance with cumulative grading score of > 80%. The overall percentage of agreement in detection and species identification was 80.45% (Kappa=0.79) and 63.03% (Kappa=0. 38). Laboratory professionals who had work experience greater than five years were 10.56 times better in detecting and identifying malaria parasite when compared to those who had work experience less than or equal to five years (AOR [95%CI]=10.56[1.45-76.73]) . Laboratory professionals who were trained on malaria microscopy diagnosis were 1.28 times reported better quality results than those who were not trained (AOR, % 95CI=1.28[1.5-48.13]) Conclusion: The overall agreement of laboratory professionals in detection and species identification was with substantial and fair with kappa value 0.79 and 0.38 respectively. There were also gaps in correctly reporting stages identification and parasite count from distributed slides. Lack of Training and low work experience of laboratory professionals were factors associated with malaria microscopy diagnostic performance. Hence, capacitating laboratory professionals is essential to ensure good performance of malaria microscopy which reduces misdiagnosis of malaria parasites and mistreatment of malaria suspected patients.


2018 ◽  
Vol 4 (2) ◽  
Author(s):  
Linlin Lindayani

ABSTRAKTujuan dari penelitian ini adalah untuk mengkaji faktor-faktor yang berhubungan dengan kebutuhan perawatan paliatif pada pasein dengan HIV/AIDS di Indonesia. Penelitian ini dilaksanakan dengan metode cross sectional di salah satu Lembaga Swadaya Masyarakat (LSM) yang berfokus pada penanganan HIV/AIDS di Bandung, Indonesia. Instrumen yang digunakan meliputi data pengkajian demografik pasien, sosial-ekonimi, infomasi klinis dan pengkajian kebutuhan paliatif dengan kuesiner yang sudah diterjemahkan kedalam Bahasa Indonesia yaitu Problems and Needs of Palliative Care (PNPC). Sejumlah 215 pasien dengan HIV/AIDS berhasil direkruit dalam penelitian ini. Berdasarkan hasil analisa multivariate dengan linear regresi didapatkan bahwa konsumsi obat antiretroviral (t=-4,13, 95% CI= -3,16- -1,12), jumlah CD4 (t= -3,58, 95% CI= -0,01- -0,00), tempat tinggal (t=-4,33, 95% CI= -5,17- -1,93), pendapatan per bulan (t=-2,24, p value=0,03, 95% CI= -3,419 - -1,052), dan status pernikahan (t=2,11, % CI= -3,419 - -1,052) berhubungan dengan kebutuhan perawatan paliatif pada pasien HIV/AIDS dengan R2 sebesar 0,185. Hasil dari penelitian ini menunjukan konsumsi obat antiretroviral sangat berpengaruh terhadap kebutuhan perawatan paliatif care pasien HIV/AIDS. Sehingga, diharapkan pemerintah Indonesia dapat meningkatkan pelayanan dan penyediaan obat antiretroviral (ARV) pada pasien dengan HIV/AIDS sesuai dengan yang direkomendasikan oleh WHO tahun 2015, yaitu memberikan obat antiretroviral kepada semua pasien HIV/AIDS tanpa mempertimbangkan jumlah CD4. ABSTRACTThe objective of this study was determine patient’s needs of palliative care and factors associated with their needs of palliative care in patients with HIV/AIDS. This study was conducted using a cross sectional study at a HIV/AIDS non-government organization in Bandung, Indonesia. Individuals were assessed for demographic data, social-economic, and clinical information and a questionnaire of Problems and Needs of Palliative Care (PNPC). A total of 215 patients with HIV/AIDS were enrolled. Initiation of ART (t=-4.13, 95% CI= -3.16- -1.12),  a higher CD4 a count (t= -3.58, 95% CI= -0.01- -0.00), living in urban area (t=-4.33, 95% CI= -5.17- -1.93), and higher monthly income (t=-2.24, p value=0.03, 95% CI= -3.419 - -1.052), and unmarried (t=2.11, % CI= -3.419 - -1.052) were related to the needs of palliative care with R square was 0.185. In conclusion, initiation of antiretroviral therapy is key important factors associated with palliative care needs. The findings support the health policy makers to encourage initiating antiretroviral therapy following the WHO guidelines for “treat for all people with HIV”. 


2016 ◽  
Vol 18 (4) ◽  
Author(s):  
Asia Jabiri ◽  
Herman L. Wella ◽  
Avelina Semiono ◽  
Adellah Saria ◽  
Joyce Protas

Background: Neonatal sepsis contributes significantly to neonatal mortality. This study was carried out to determine the prevalence and factors associated with neonatal sepsis in Dar es Salaam, Tanzania.Methods: A hospital based cross-sectional study was conducted at Mwananyamala and Temeke hospitals in Dar es Salaam, during August-September, 2015. A standardized questionnaire was used to obtain demographic, obstetrics and clinical information. Diagnosis of neonatal sepsis was done clinically. Relationship between outcome variable and exposure variable was done using Chi square test. Multivariate logistic regression was used to measure association after controlling for confounders.Results: A total of 220 neonates were recruited, 69 (31.4%) had sepsis. The risk factors associated with neonatal sepsis were maternal age of >35 years (AOR=6.7; 95%CI 2.1-20.1; p-value-0.001) and resuscitation at birth (AOR=1.25195%CI1. 22-3.88; p-value=0.025).Conclusion: Neonatal sepsis among neonates in Dar es Salaam is associated with maternal and health services related factors. The findings underscore the importance of routine assessment and close monitoring of neonates. It is therefore recommended to have more skilled health personnel and advanced equipment while providing maternal and new-born health care services.


2019 ◽  
Vol 2019 ◽  
pp. 1-9
Author(s):  
Kwuntida Uthaisar Kotepui ◽  
Manas Kotepui ◽  
Chuchard Punsawad

Malaria is a potential medical emergency and should be treated immediately because delays in diagnosis and treatment are the leading causes of death in many countries. This study aimed to assess the knowledge, attitude, and practice related to malaria diagnosis for early detection among healthcare workers in the laboratories of hospitals in Thailand. The design of the study was a descriptive cross-sectional study carried out between January 2016 and March 2017 at 11 hospitals in Thailand. The interviewees included any scientists who were currently working in a medical laboratory. Mean scores for knowledge, attitude, and practice for each healthcare group were calculated and compared between groups. Data analysis was performed using the SPSS version 11.5 software package (SPSS Inc., Chicago, IL, USA). Among a total of 118 healthcare workers, most of the healthcare workers had fair to good knowledge, attitude, and practice related to malaria detection. Among the various positions of healthcare workers, medical technologists possessed a greater knowledge on malaria detection than medical technician assistants or laboratory assistants (X2 = 9.822, d.f. = 2, and P value=0.007). This study infers that knowledge, attitude, and practice related to malaria detection among healthcare workers in laboratories were adequate. However, some points of knowledge and practice must be updated. There is a very urgent need to update knowledge on malaria, especially about the number of Plasmodium species causing relapse in malaria patients. In addition, there is an urgent need to update the practice related to malaria detection, especially about the staining process for early detection of malaria.


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