Background
Malaria is the leading cause of morbidity and mortality in sub-Saharan Africa and is responsible for 90% of the global burden. Studies of malaria microscopy under field conditions show variable sensitivity and specificity. In 2009, WHO AFRO and Amref Health Africa introduced the WHO competency assessment course for malaria microscopists to standardise measurement of performance.
Methodology
Pre and post course practical evaluations were conducted consisting of 16 and 55 well characterised slides respectively. Slides included the four malaria species found in Africa, mixed parasite species and negative slides. Slides containing P. falciparum were used to assess parasite density.
Results: Twenty four training courses were conducted with participants from 19 countries. A total of 513 microscopist training events took place; some participants attended more than once. Overall, parasite detection, species identification, parasite quantification, sensitivity and specificity of microscopy improved in posttest assessments. However, not all re-attending participants showed sustained performance. Only twelve participants in Africa achieved the WHO Level One Expert grade.
Conclusion
Participation in competency assessment programmes improves performance in malaria parasite detection, species identification and parasite quantification. However, other training strategies are needed to sustain high grades and improve performance of lower grades.