Rollins School of Public Health, Emory University, Georgia, USA.
Malar J. 2012 Oct 24;11:352. doi: 10.1186/1475-2875-11-352.
Malaria diagnosis has received renewed interest in recent years, associated with the increasing accessibility of accurate diagnosis through the introduction of rapid diagnostic tests and new World Health Organization guidelines recommending parasite-based diagnosis prior to anti-malarial therapy. However, light microscopy, established over 100 years ago and frequently considered the reference standard for clinical diagnosis, has been neglected in control programmes and in the malaria literature and evidence suggests field standards are commonly poor. Microscopy remains the most accessible method for parasite quantitation, for drug efficacy monitoring, and as a reference of assessing other diagnostic tools. This mismatch between quality and need highlights the importance of the establishment of reliable standards and procedures for assessing and assuring quality. This paper describes the development, function and impact of a multi-country microscopy external quality assurance network set up for this purpose in Asia.
Surveys were used for key informants and past participants for feedback on the quality assurance programme. Competency scores for each country from 14 participating countries were compiled for analyses using paired sample t-tests. In-depth interviews were conducted with key informants including the programme facilitators and national level microscopists.
External assessments and limited retraining through a formalized programme based on a reference slide bank has demonstrated an increase in standards of competence of senior microscopists over a relatively short period of time, at a potentially sustainable cost. The network involved in the programme now exceeds 14 countries in the Asia-Pacific, and the methods are extended to other regions.
While the impact on national programmes varies, it has translated in some instances into a strengthening of national microscopy standards and offers a possibility both for supporting revival of national microcopy programmes, and for the development of globally recognized standards of competency needed both for patient management and field research.
近年来，疟疾诊断受到了新的关注，这与通过引入快速诊断测试和世界卫生组织新指南（建议在抗疟治疗前进行寄生虫诊断）提高准确诊断的可及性有关。然而，在控制规划和疟疾文献中，建立了 100 多年且经常被认为是临床诊断参考标准的显微镜检查被忽视了，并且有证据表明现场标准通常很差。显微镜检查仍然是寄生虫定量、药物疗效监测以及评估其他诊断工具的参考方法。这种质量与需求之间的不匹配突出了建立可靠的评估和保证质量的标准和程序的重要性。本文描述了为实现这一目标在亚洲建立的多国家显微镜外部质量保证网络的发展、功能和影响。
调查用于征求关键信息提供者和过去参与者对质量保证计划的反馈。使用配对样本 t 检验对来自 14 个参与国家的每个国家的能力得分进行编译。对方案协调员和国家一级显微镜专家等关键信息提供者进行深入访谈。
通过基于参考载玻片库的正式方案进行外部评估和有限的再培训，在相对较短的时间内提高了高级显微镜检查人员的能力标准，而且成本具有潜在可持续性。参与该计划的网络现在在亚太地区已经超过 14 个国家，并且该方法已经扩展到其他地区。
虽然对国家方案的影响各不相同，但在某些情况下，它已经加强了国家显微镜标准，并为支持国家显微镜方案的复兴以及为患者管理和现场研究制定全球认可的能力标准提供了可能性。
