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The Role of Laboratory Supervision in Improving the Quality of Malaria Diagnosis: A Pilot Study in Huambo, Angola

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  • Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; The MENTOR Initiative Huambo, Angola and West Sussex, United Kingdom; Direccao Provincial de Saude, Ministerio de Saude, Huambo, Angola

In 2006, the Angolan National Malaria Control Program introduced clinical guidelines for malaria case management, which included diagnostic confirmation of malaria before administration of treatment; however, diagnostic practices were inconsistent and of unknown quality. In 2009, a laboratory supervision program was implemented in Huambo Province, with the goal of assessing and improving diagnosis of malaria within the confines of available in-country resources. Supervisions were carried out from 2009 to 2014 using a standardized supervision tool by national laboratory trainers. Data from the first supervision were compared with that from the final supervision. Over the study period, the number and level of training of laboratory technicians increased, and there was a nonstatistically significant trend toward improved laboratory conditions. There was a significant reduction in false-positive microscopy slide reading (P = 0.0133). Laboratory infrastructural capacity to diagnose other communicable diseases, including syphilis, human immunodeficiency virus and hepatitis B virus infections (P = 0.0012, 0.0233 and 0.0026, respectively), also improved significantly. Laboratory supervision for malaria diagnosis found significant areas for improvement, and in combination with concurrent capacity-building activities, it improved the diagnostic capacity for malaria and other diseases. Importantly, this study demonstrates that locally available resources can be used to improve the accuracy of malaria diagnosis.

Author Notes

* Address correspondence to Rebecca Luckett, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215. E-mail: rluckett@aphmfp.com

Financial support: Laboratory supervisions were financially supported through programmatic activities funded by President's Malaria Initiative/USAID.

Authors' addresses: Rebecca Luckett, Beth Israel Deaconess Medical Center, Harvard Medical School Teaching Hospital, Boston, MA, E-mail: rluckett@aphmfp.org. Rukaaka Mugizi and Richard Allan, The MENTOR Initiative, Huambo, Angola, and The MENTOR Initiative, West Sussex, United Kingdom, E-mails: rukaaka@mentor-initiative.net and richard@mentor-initiative.net. Sergio Lopes, The MENTOR Initiative, Huambo, Angola, E-mail: sergiooolopes@gmail.com. R. Cacilda Etossi, Direcção Provincial de Saúde, Ministério de Saúde, Huambo, Angola, E-mail: cacildaetossi@live.com.

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