IMPROVE CAPACITY IN MALARIA CASE MANAGEMENT AND DIAGNOSTIC THROUGH TRAINING AND DEVELOP A MALARIA DIAGNOSIS QUALITY ASSURANCE SYSTEM
Objective 1: To improve diagnostic capacity for malaria and management of febrile illness in 6 districts in Uganda by training laboratory health care workers in malaria microscopy and RDTs
UMSP seeks to improve diagnostic capacity for malaria and management of febrile illness in 6 districts targeting training 360 laboratory health care workers in malaria microscopy. Prior to the start of the trainings, a number of consultative meetings were conducted with key stakeholder including NMCP, PMI Uganda, and CPHL and others. In these meetings, districts that had never received any malaria diagnostics training were identified.
UMSP has trained 427 health workers in 2011-2012, slightly more than the targeted number for the year. The training was performed by a team of laboratory experts from UMSP, MoH, CPHL and the District laboratory focal persons and targeted laboratory personnel in all health facilities in a given division irrespective of their training background. The mode of training was through illustrated lectures, power point presentations, charts, and hands on practices. The course covered Good Laboratory Practice (GLP), Quality control/ quality assurance, Microscopy, Malaria diagnosis by microscopy and RDTs, Preparation of reagents used in malaria diagnosis, Preparation and staining of blood smears, Examination of blood smears for malaria parasites and the standard way of reporting the results. About 75% of the training was dedicated to practical.
Preceding the training, information was collected on the status of laboratory facilities including staffing, the utilization of laboratory services, and other challenges in the laboratory sector. Pre and Post tests were given to participants to evaluate their competencies, skills and attitudes.
Monitoring and evaluation of the training program has been done through the use of pre- and post-test surveys. Pretests were organized to assess the participants’ ability to recognize malaria parasites and differentiate them from other features (artifacts) in a microscopic field of view. The ability to differentiate plasmodium species and their different stages of development was also tested. Post tests were intended to show the impact of training in terms of skills acquired during the training.
Objective 2: Malaria Diagnosis Quality Assurance Program
All diagnostic tests consist of a series of steps and processes that need to be carried out in the right manner in order to ensure the quality of results. Quality assurance measures must be implemented throughout the testing process, prior to performing the test, while conducting the test, and after completing the test, to assure accurate and reliable test results. Quality assurance also addresses factors that affect testing performance more generally, including internal and external quality control, equipment and reagent quality, workload, workplace conditions, training and laboratory staff support. The purpose of quality system is the maintenance of the overall quality of patient results
Early diagnosis and prompt, effective treatment is the basis for the management of malaria and key to reducing malaria mortality and morbidity. An acceptable microscopy service is one that is cost-effective, provides results that are consistently accurate and timely enough to have a direct impact on treatment. This requires a comprehensive and active quality assurance (QA) program.
A quality assurance manual that outlines the plan for implementing a pilot district level malaria microscopy quality assurance program in Uganda has been developed.It encompasses retraining, validation and the development of competency standards designed to ensure the quality of diagnosis necessary for a successful malaria program, while remaining within the financial and personnel resources likely to be available. The primary aim of the QA program at the basic level is to identify laboratories with serious problems resulting in poor performance. The ultimate goal of the program is to assure the performance of all laboratories and health centres performing malaria microscopy in the districts. The goal is to establish a regional /national benchmark QC system for blinded cross-checking of slides, and central reporting of QA indicators for at least equipment and reagent performance, stock control and workload. The performance of malaria microscopy shall be continuously monitored by a quality assurance programme based on pre-defined standards. The QA program has two essential components namely: 1) assessment of the accuracy of the examination of thick and thin films for malaria diagnosis and monitoring. This shall be performed by visits from supervisors and the external blinded cross-checking of slides. 2) monitoring systems for staff competence, equipment, reagents, stock control, workload, registration and reporting.
A number of meetings have been held with the Central Public Health Laboratory (CPHL) and the NMCP to develop a manual that outlines the plan for implementing a pilot malaria diagnostic quality assurance program in Uganda. The manual encompasses retraining, validation and the development of competency standards designed to ensure the quality of diagnosis necessary for a successful malaria program, while remaining within the financial and personnel resources likely to be available.