Volume 91, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Microscopic diagnosis of malaria is a well-established and inexpensive technique that has the potential to provide accurate diagnosis of malaria infection. However, it requires both training and experience. Although it is considered the gold standard in research settings, the sensitivity and specificity of routine microscopy for clinical care in the primary care setting has been reported to be unacceptably low. We established a monthly external quality assurance program to monitor the performance of clinical microscopy in 17 rural health centers in western Kenya. The average sensitivity over the 12-month period was 96% and the average specificity was 88%. We identified specific contextual factors that contributed to inadequate performance. Maintaining high-quality malaria diagnosis in high-volume, resource-constrained health facilities is possible.


Article metrics loading...

Loading full text...

Full text loading...



  1. Laveran A, , 1880. Deuxieme note relative a un nouveau parasite trouve dans le sang des malades atteints de la fievre paludisme. Bulletin de l'Academie medicale 2ieme serie, 13461347.
  2. Bruce-Chwatt LJ, , 1981. Alphonse Laveran's discovery 100 years ago and today's global fight against malaria. J R Soc Med 74: 531536.
  3. Bejon P, Andrews L, Hunt-Cooke A, Sanderson F, Gilbert S, Hill A, , 2006. Thick blood film examination for Plasmodium falciparum malaria has reduced sensitivity and underestimates parasite density. Malar J 5: 104.[Crossref]
  4. Payne D, , 1988. Use and limitations of light microscopy for diagnosing malaria at the primary health care level. Bull World Health Organ 66: 621626.
  5. Mbakilwa H, Manga C, Kibona S, Mtei F, Meta J, Shoo A, Amos B, Reyburn H, , Quality of malaria microscopy in 12 district hospital laboratories in Tanzania. Pathog Glob Health 106: 330334.[Crossref]
  6. Ohrt C, Obare P, Nanakorn A, Adhiambo C, Awuondo K, O'Meara WP, Remich S, Martin K, Cook E, Chretien JP, Lucas C, Osoga J, McEvoy P, Owaga ML, Odera JS, Ogutu B, , 2007. Establishing a malaria diagnostics centre of excellence in Kisumu, Kenya. Malar J 6: 79.[Crossref]
  7. Menya D, Logedi J, Manji I, Armstrong J, Neelon B, O'Meara WP, , 2013. An innovative pay-for-performance (P4P) strategy for improving malaria management in rural Kenya: protocol for a cluster randomized controlled trial. Implement Sci 8: 48.[Crossref]
  8. Endeshaw T, Graves PM, Ayele B, Mosher AW, Gebre T, Ayalew F, Genet A, Mesfin A, Shargie EB, Tadesse Z, Teferi T, Melak B, Richards FO, Emerson PM, , 2012. Performance of local light microscopy and the ParaScreen Pan/Pf rapid diagnostic test to detect malaria in health centers in Northwest Ethiopia. PLoS ONE 7: e33014.[Crossref]
  9. Harchut K, Standley C, Dobson A, Klaassen B, Rambaud-Althaus C, Althaus F, Nowak K, , 2013. Over-diagnosis of malaria by microscopy in the Kilombero Valley, southern Tanzania: an evaluation of the utility and cost-effectiveness of rapid diagnostic tests. Malar J 12: 159.[Crossref]
  10. Mukadi P, Gillet P, Lukuka A, Atua B, Kahodi S, Lokombe J, Muyembe JJ, Jacobs J, , 2011. External quality assessment of malaria microscopy in the Democratic Republic of the Congo. Malar J 10: 308.[Crossref]
  11. Mukadi P, Gillet P, Lukuka A, Atua B, Sheshe N, Kanza A, Mayunda JB, Mongita B, Senga R, Ngoyi J, Muyembe JJ, Jacobs J, Lejon V, , 2013. External quality assessment of Giemsa-stained blood film microscopy for the diagnosis of malaria and sleeping sickness in the Democratic Republic of the Congo. Bull World Health Organ 91: 441448.[Crossref]
  12. Barat L, Chipipa J, Kolczak M, Sukwa T, , 1999. Does the availability of blood slide microscopy for malaria at health centers improve the management of persons with fever in Zambia? Am J Trop Med Hyg 60: 10241030.
  13. Zurovac D, Midia B, Ochola SA, English M, Snow RW, , 2006. Microscopy and outpatient malaria case management among older children and adults in Kenya. Trop Med Int Health 11: 432440.[Crossref]
  14. Kahama-Maro J, D'Acremont V, Mtasiwa D, Genton B, Lengeler C, , 2011. Low quality of routine microscopy for malaria at different levels of the health system in Dar es Salaam. Malar J 10: 332.[Crossref]
  15. Kiggundu M, Nsobya SL, Kamya MR, Filler S, Nasr S, Dorsey G, Yeka A, , 2011. Evaluation of a comprehensive refresher training program in malaria microscopy covering four districts of Uganda. Am J Trop Med Hyg 84: 820824.[Crossref]
  16. Khan MA, Walley JD, Munir MA, Khan MA, Khokar NG, Tahir Z, Nazir A, Shams N, , 2011. District level external quality assurance (EQA) of malaria microscopy in Pakistan: pilot implementation and feasibility. Malar J 10: 45.[Crossref]
  17. Hemme F, Gay F, , 1998. Internal quality control of the malaria microscopy diagnosis for 10 laboratories on the Thai-Myanmar border. Southeast Asian J Trop Med Public Health 29: 529536.
  18. World Health Organization, 2010. Guidelines for the Treatment of Malaria. Second edition. Geneva: WHO.

Data & Media loading...

  • Received : 05 Mar 2014
  • Accepted : 21 May 2014

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error