Dorkenoo Ameyo M, Kouassi Kafui Codjo, Koura Adjane K, Adams Martin L, Gbada Komivi, Katawa Gnatoulma, Yakpa Kossi, Charlebois Remi, Milgotina Ekaterina, Merkel Michele O, Aidoo Michael
Ministère de la Santé et de l'Hygiène Publique, Lomé, Togo.
Faculté des Sciences de la Santé, Université de Lomé, BP1515, Lomé, Togo.
Malar J. 2021 Jan 20;20(1):50. doi: 10.1186/s12936-020-03569-y.
The use of rapid diagnostic tests (RDTs) to diagnose malaria is common in sub-Saharan African laboratories, remote primary health facilities and in the community. Currently, there is a lack of reliable methods to ascertain health worker competency to accurately use RDTs in the testing and diagnosis of malaria. Dried tube specimens (DTS) have been shown to be a consistent and useful method for quality control of malaria RDTs; however, its application in National Quality Management programmes has been limited.
A Plasmodium falciparum strain was grown in culture and harvested to create DTS of varying parasite density (0, 100, 200, 500 and 1000 parasites/µL). Using the dried tube specimens as quality control material, a proficiency testing (PT) programme was carried out in 80 representative health centres in Togo. Health worker competency for performing malaria RDTs was assessed using five blinded DTS samples, and the DTS were tested in the same manner as a patient sample would be tested by multiple testers per health centre.
All the DTS with 100 parasites/µl and 50% of DTS with 200 parasites/µl were classified as non-reactive during the pre-PT quality control step. Therefore, data from these parasite densities were not analysed as part of the PT dataset. PT scores across all 80 facilities and 235 testers was 100% for 0 parasites/µl, 63% for 500 parasites/µl and 93% for 1000 parasites/µl. Overall, 59% of the 80 healthcare centres that participated in the PT programme received a score of 80% or higher on a set of 0, 500 and 1000 parasites/ µl DTS samples. Sixty percent of health workers at these centres recorded correct test results for all three samples.
The use of DTS for a malaria PT programme was the first of its kind ever conducted in Togo. The ease of use and stability of the DTS illustrates that this type of samples can be considered for the assessment of staff competency. The implementation of quality management systems, refresher training and expanded PT at remote testing facilities are essential elements to improve the quality of malaria diagnosis.
在撒哈拉以南非洲的实验室、偏远的基层卫生机构及社区中，使用快速诊断检测（RDT）来诊断疟疾很常见。目前，缺乏可靠的方法来确定卫生工作者准确使用RDT进行疟疾检测和诊断的能力。干管标本（DTS）已被证明是疟疾RDT质量控制的一种可靠且有用的方法；然而，其在国家质量管理计划中的应用一直有限。
培养并收获恶性疟原虫菌株，以创建不同寄生虫密度（0、100、200、500和1000个寄生虫/微升）的DTS。以干管标本作为质量控制材料，在多哥的80个代表性卫生中心开展了能力验证测试（PT）项目。使用5个盲法DTS样本评估卫生工作者进行疟疾RDT的能力，每个卫生中心的多个检测人员以检测患者样本的相同方式对DTS进行检测。
在PT前的质量控制步骤中，所有寄生虫密度为100个/微升的DTS以及50%寄生虫密度为200个/微升的DTS被归类为无反应性。因此，来自这些寄生虫密度的数据未作为PT数据集的一部分进行分析。所有80个机构和235名检测人员在寄生虫密度为0个/微升时的PT分数为100%，500个/微升时为63%，1000个/微升时为93%。总体而言，参与PT项目的80个医疗中心中有59%在一组寄生虫密度为0、500和1000个/微升的DTS样本上获得了80%或更高的分数。这些中心60%的卫生工作者记录了所有三个样本的正确检测结果。
在多哥，将DTS用于疟疾PT项目尚属首次。DTS的易用性和稳定性表明，这类样本可用于评估工作人员的能力。在偏远检测机构实施质量管理系统、进修培训和扩大PT是提高疟疾诊断质量的关键要素。
