Effect of Supportive Supervision on Malaria Microscopy Competencies in Sub-Saharan Africa

Fozo Alombah President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Washington, District of Columbia;

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M. James Eliades President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Washington, District of Columbia;
Malaria, Asia: Population Services International, Yangon, Myanmar;
Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York;

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Jolene Wun President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Washington, District of Columbia;

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Seraphine Kutumbakana President’s Malaria Initiative (PMI) MalariaCare Project, Medical Care Development International, Kinshasa, The Democratic Republic of the Congo;

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Rodgers Mwinga President’s Malaria Initiative (PMI) MalariaCare Project, Medical Care Development International, Kisumu, Kenya;

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Renion Saye President’s Malaria Initiative (PMI) MalariaCare Project, Medical Care Development International, Bamako, Mali;

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Pharath Lim President’s Malaria Initiative (PMI) MalariaCare Project, Medical Care Development International, Silver Spring, Maryland

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Sarah M. Burnett President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Washington, District of Columbia;

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Troy Martin President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Washington, District of Columbia;

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Paul Hamilton President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Washington, District of Columbia;

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Although light microscopy is the reference standard for diagnosing malaria, maintaining skills over time can be challenging. Between 2015 and 2017, the U.S. President’s Malaria Initiative–funded MalariaCare project supported outreach training and supportive supervision (OTSS) visits at 1,037 health facilities in seven African countries to improve performance in microscopy slide preparation, staining, and reading. During these visits, supervisors observed and provided feedback to health-care workers (HCWs) performing malaria microscopy using a 30-step checklist. Of the steps observed in facilities with at least three visits, the proportion of HCWs that performed each step correctly at baseline ranged from 63.2% to 94.2%. The change in the proportion of HCWs performing steps correctly by the third visit ranged from 16.7 to 23.6 percentage points (n = 916 observations). To assess the overall improvement, facility scores were calculated based on the steps performed correctly during each visit. The mean score at baseline was 85.7%, demonstrating a high level of performance before OTSS. Regression analysis predicted an improvement in facility scores of 3.6 percentage points (P < 0.001) after three visits across all countries. In reference-level facilities with consistently high performance on microscopy procedures and parasite detection, quality assurance (QA) mechanisms could prioritize more advanced skills, such as proficiency testing for parasite counting and species identification. However, in settings with high staff turnover and declining use of microscopy in favor of rapid diagnostic tests, additional supervision visits and/or additional QA measures may be required to improve and maintain performance.

Author Notes

Address correspondence to Paul Hamilton, PATH, 455 Massachusetts Ave. NW, Suite 1000, Washington, DC 20001. E-mail: phamilton@path.org

Financial support: Financial support was provided by the U.S, President’s Malaria Initiative under the terms of Cooperative Agreement AID-OAA-A-12-00057.

Authors’ addresses: Fozo Alombah, Jolene Wun, Sarah M. Burnett, and Paul Hamilton, PATH, Washington, DC, E-mails: rfalombah@yahoo.com, jwun@path.org, sburnett@path.org, and phamilton@path.org. M. James Eliades, Population Services International, Yangon, Myanmar, E-mail: jeliades@psi.com. Seraphine Kutumbakana, Medical Care Development International, Kinshasa, The Democratic Republic of Congo, E-mail: skutumbakana@mcd.org. Rodgers Mwinga, Medical Care Development International, Kisumu, Kenya, E-mail: rmwinga@mcd.org. Renion Saye, Medical Care Development International, Bamako, Mali, E-mail: rsaye@mcd.org. Pharath Lim, President’s Malaria Initiative (PMI) MalariaCare Project, Medical Care Development International, Silver Spring, MD, E-mail: plim@mcd.org. Troy Martin, PATH, Seattle, WA, E-mail: troymmartin@gmail.com.

  • 1.

    World Health Organization, 2016. Malaria Microscopy Quality Assurance Manual–Ver. 2. Available at: http://www.who.int/malaria/publications/atoz/9789241549394/en/. Accessed January 9, 2018.

    • PubMed
    • Export Citation
  • 2.

    Reyburn H, Mbakilwa H, Mwangi R, Mwerinde O, Olomi R, Drakeley C, Whitty CJM, 2007. Rapid diagnostic tests compared with malaria microscopy for guiding outpatient treatment of febrile illness in Tanzania: randomised trial. BMJ 334: 403.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Abreha T et al. 2014. Malaria diagnostic capacity in health facilities in Ethiopia. Malar J 13: 292.

  • 5.

    Petti CA, Polage CR, Quinn TC, Ronald AR, Sande MA, 2006. Laboratory medicine in Africa: a barrier to effective health care. Clin Infect Dis 42: 377382.

  • 6.

    Odhiambo F et al. 2017. Factors associated with malaria microscopy diagnostic performance following a pilot quality-assurance programme in health facilities in malaria low-transmission areas of Kenya, 2014. Malar J 16: 110.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Burnett SM, Mbonye MK, Martin R, Ronald A, Zawedde-Muyanja S, Willis KS, Colebunders R, Manabe YC, Weaver MR, 2016. Effect of on-site support on laboratory practice for human immunodeficiency virus, tuberculosis, and malaria testing. Am J Clin Pathol 146: 469477.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Eliades MJ, Alombah F, Wun J, Burnett S, Martin T, Kutumbakana S, Dena R, Saye R, Lim P, Hamilton P, 2019. Operational considerations and costs of malaria case management supportive supervision. Am J Trop Med Hyg 100: 861867.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Burnett S, Wun J, Evance I, Davis K, Smith G, Lussiana C, Tesha G, Quao A, Robertson M, Hamilton P, 2019. Introduction of an electronic tool for improved data quality and data use during malaria case management supportive supervision. Am J Trop Med Hyg 100: 889898.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Marinucci F, Majigo M, Wattleworth M, Paterniti AD, Hossain MB, Redfield R, 2013. Factors affecting job satisfaction and retention of medical laboratory professionals in seven countries of sub-Saharan Africa. Hum Resour Health 11: 38.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Eliades MJ, Wun J, Burnett S, Alombah F, Amoo-Sakyi F, Chirambo P, Tesha G, Davis K, Hamilton P, 2019. Effect of supportive supervision on performance of malaria rapid diagnostic tests in sub-Saharan Africa. Am J Trop Med Hyg 100: 876881.

    • PubMed
    • Search Google Scholar
    • Export Citation
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