Performance of Microscopy for the Diagnosis of Malaria and Human African Trypanosomiasis by Diagnostic Laboratories in the Democratic Republic of the Congo: Results of a Nation-Wide External Quality Assessment

• Published in: PloS one 2016-01, Vol.11 (1), p.e0146450-e0146450
• Main Authors: Mukadi, Pierre, Lejon, Veerle, Barbé, Barbara, Gillet, Philippe, Nyembo, Christophe, Lukuka, Albert, Likwela, Joris, Lumbala, Crispin, Mbaruku, Justin, Vander Veken, Wim, Mumba, Dieudonné, Lutumba, Pascal, Muyembe, Jean-Jacques, Jacobs, Jan
• Format: Article
• Language: English
• Subjects: African trypanosomiasis; Biology and Life Sciences; Biomedical research; Blood; Blood parasites; Care and treatment; Democratic Republic of the Congo; Diagnosis; Diagnostic systems; Female; Humans; Laboratories; Malaria; Malaria, Falciparum - blood; Male; Medical diagnosis; Medicine; Medicine and Health Sciences; Methods; Microscopy; Microscopy - methods; Microscopy - standards; Parasites; Peacekeeping forces; Plasmodium; Plasmodium falciparum; Plasmodium ovale; Quality assessment; Quality Assurance, Health Care; Quality control; Research and Analysis Methods; Trypanosoma; Trypanosoma brucei; Trypanosoma brucei brucei; Trypanosomiasis, African - blood; Trypomastigotes; Vector-borne diseases
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0146450

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.