Malaria Microscopy Training

Microscopy remains the gold standard for malaria diagnosis. However, laboratory services and associated quality assurance systems are severely lacking in most African countries. To improve capacity for malaria microscopy in Uganda, the Uganda Malaria Surveillance Project (UMSP) in partnership with the Ministry of Health have conducted refresher training in malaria diagnosis by microscopy and RDT’s in districts in Uganda. The aim of the training was to improve health workers’ performance of laboratory tasks relevant to malaria case diagnosis. The curriculum and training materials were developed by a team of laboratory experts from UMSP, MoH, Central Public Health Laboratories (CPHL) and District-based senior laboratory personnel. The involvement of key stakeholders ensured consensus and cohesion with national case management guidelines. The team reviewed and modified relevant sections of a curriculum previously used for training medical workers on integrated management of malaria. A three day comprehensive in service training course was developed, emphasizing practical diagnosis of malaria in a routine clinical setting. The course targeted three categories of laboratory personnel typically working in health facilities in Uganda: Laboratory Technicians, Laboratory Assistants and Microscopists. The course included both didactic and practical hands-on sessions. Training modules include information on Good Laboratory Practice (GLP), quality control/ quality assurance (QC/QA), Microscopy, Malaria diagnosis by microscopy and RDTs, Preparation of reagents used in malaria diagnosis; Preparation and staining of blood smears; Examination of a blood smears for malaria parasites; The standard way of reporting the results; and Record keeping.

Training consisted of a three-day course conducted at a centrally located district hospital or Health Centre IV with adequate laboratory facilities. To minimize disruption of patient services, the laboratory staff at each health facility were divided into two groups and trained in two back-to-back three day sessions. Teaching methods consisted of supervised laboratory practicals, open laboratory time, lectures, group discussions/presentations, demonstrations, and assignments. PowerPoint presentations were developed to train didactic and visual concepts necessary for accurate microscopy. Well-characterized slides with low density parasitaemia, true negatives, and serially diluted P. falciparum were developed for practical slide reading sessions. Digital pictures were developed to teach and evaluate microscopists' ability to correctly identify characteristics of artifact and of various growth stages of each malaria species. Standard operating procedures (SOP's) for sample collection and reception, slide preparation, buffer preparation, stain preparation and staining of slides, slide reading, rereading paradigm, and slide storage were used for training and provided to course participants to take home.

Trainees were assessed for learning attainment in terms of knowledge, and skills, through performance on written pre-test and post-test, and participation in practical sessions. The written examination consisted of multiple choice questions, well-characterized slides and digital pictures to assess microscopists' knowledge of key concepts and facts. A follow-up support supervision visits was conducted approximately 6 weeks after the initial training course were conducted to reinforce training messages, assess skills, and provide individual feedback.

Any potential benefits of parasite based diagnosis depend on accurate results and use of these results in patient management, which requires good programme planning, training, quality assurance, and capacity to deal effectively with non-malarial illness. Poor quality laboratory services have the greatest negative impact on poor and vulnerable people because these people carry the largest burden of ill health. The effective diagnosis of malaria at the laboratory level will help reduce this burden. Improving malaria test accuracy promotes accurate diagnosis of malaria, saving lives and preventing wastage of valuable resources.

Downloads

Training Material.. pdf

P. falciparum Training Slides part1..pdf P. Vivax Training Slides part1..pdf
P. falciparum Training Slides part2..pdf P. Vivax Training Slides part2..pdf
P. falciparum Training Slides part3..pdf P. Vivax Training Slides part3..pdf
P. falciparum Training Slides part4..pdf