article · PLoS ONE
A nationwide external quality assessment evaluated blood parasite microscopy across diagnostic laboratories in the Democratic Republic of the Congo. Four hundred participating laboratories received a test panel of five slides and submitted a routine slide to assess preparation and staining. Overall diagnostic performance was poor. Nearly a third of participants falsely reported malaria on a parasite-free slide, and identification of non-falciparum malaria species and Trypanosoma parasites was low. When presented with a mixed infection, only 6.0 percent of laboratories identified both parasites. Furthermore, only 13.6 percent of submitted routine slides met quality standards for preparation and staining. Diagnostic accuracy was significantly higher among laboratories with prior assessment experience and those whose staff had received training within the previous two years.
Accurate laboratory diagnosis is vital for treating life-threatening parasitic infections such as malaria and sleeping sickness. High rates of false positives and missed mixed infections can lead to misdiagnosis, inappropriate treatment, and poor patient outcomes. Demonstrating that recent training and regular quality assessments improve performance highlights a clear operational route to strengthen clinical laboratory diagnostic standards across the health sector.
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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.
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DOI: 10.1371/journal.pone.0146450
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