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

Pierre Mukadi, Veerle Lejon, Barbara Barbé, Philippe Gillet, Christophe Nyembo, Albert Lukuka, Joris Likwela, Crispin Lumbala, Justin Mbaruku, Wim Vander Veken, Dieudonné Mumba, Pascal Lutumba, Jean-Jacques Muyembe, Jan Jacobs

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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.

Original languageEnglish
JournalPLoS ONE
Volume11
Issue number1
Pages (from-to)e0146450
ISSN1932-6203
DOIs
Publication statusPublished - 2016

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