Joint Malaria Programme, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
Pathog Glob Health. 2012 Oct;106(6):330-4. doi: 10.1179/2047773212Y.0000000052.
The WHO recommendation for parasitological diagnosis of malaria wherever possible is challenged by evidence of poor-quality microscopy in African hospitals but the reasons are not clear.
All 12 of the busier district hospital laboratories from three regions of Tanzania were assessed for quality of the working environment and slide readers read 10 reference slides under exam conditions. Slides that had been routinely read were removed for expert reading.
Of 44 slide readers in the study, 39 (88.6%) correctly read >90% of the reference slides. Of 206 slides that had been routinely read, 33 (16%) were judged to be unreadable, 104 (51%) were readable with difficulty, and 69 (34%) were easily readable. Compared to expert reading of the same slide, the sensitivity of routine slide results of easily readable slides was 85.7% (95% confidence interval: 77.4-94.0), falling to 44.4% (95% confidence interval: 34.5-54.4) for slides that were 'readable with difficulty'.
The commonest cause of inaccurate results was the quality of the slide itself, correction of which is likely to be achievable within existing resources. A minority of slide readers were unable to read slides even under ideal conditions, suggesting the need for a 'slide reading licence' scheme.
世卫组织建议在任何可能的情况下进行寄生虫学诊断疟疾，但在非洲医院，显微镜质量差的证据对这一建议提出了挑战，但原因尚不清楚。
对坦桑尼亚三个地区的 12 家较繁忙的地区医院实验室的工作环境质量进行了评估，并在检查条件下由 10 位阅片者阅读了 10 张参考载玻片。移除了常规阅片的载玻片，由专家进行阅读。
在研究中的 44 位阅片者中，有 39 位（88.6%）正确阅读了>90%的参考载玻片。在 206 张常规阅片的载玻片中有 33 张（16%）被认为无法阅读，104 张（51%）阅读困难，69 张（34%）容易阅读。与专家对同一张载玻片的阅读结果相比，容易阅读的载玻片的常规阅片结果的灵敏度为 85.7%（95%置信区间：77.4-94.0），而阅读困难的载玻片的灵敏度则下降至 44.4%（95%置信区间：34.5-54.4）。
最常见的不准确结果的原因是载玻片本身的质量，纠正这一问题可能在现有资源内实现。即使在理想条件下，仍有少数阅片者无法阅读载玻片，这表明需要一个“载玻片阅读许可证”计划。
