Ning Wei, Zhuang Shi-Feng, Wen Lan, Xu Ming-Zhong, Wang Miao-Miao, Peng Fang, Huang Fei-Fan, Tian Bin
Department of Clinical Laboratory, Changsha Municipal Center for Disease Control and Prevention, Changsha, China.
Department of Endemic and Parasitic Diseases Control, Hunan Center for Disease Control and Prevention, Changsha, China.
Front Public Health. 2025 Jun 6;13:1598917. doi: 10.3389/fpubh.2025.1598917. eCollection 2025.
The rapid and accurate diagnosis of malaria has contributed to China's remarkable achievement in malaria elimination. In the post-elimination phase, microscopic examination remains crucial for preventing the reintroduction of imported malaria. This study developed and validated a 4-day external competency assessment training program for malaria microscopists based on the External Competency Assessment for Malaria Microscopists (ECAMM) framework, to enhance diagnostic proficiency among laboratory personnel in public health institutions.
Course design, blood smear selection, evaluation methods, and scoring criteria strictly adhered to WHO guidelines. Participants underwent one pre-training test and four post-training assessments involving 48 blood smears to evaluate diagnostic accuracy in qualitative identification and species differentiation. A comprehensive analysis was conducted on training needs, skill improvement trajectories, diagnostic error patterns, competency predictors, and participant satisfaction. 24 participants from public health institutions across 14 prefecture-level jurisdictions in Hunan Province completed the program with heterogeneous performance outcomes.
75% of participants had received no formal malaria microscopy training in the preceding 5 years. Post-training assessments demonstrated significant improvements: negative smear recognition accuracy increased by 29.86%, positive smear identification by 25.52%, and species differentiation accuracy by 48.96%. The predominant diagnostic error was interspecies confusion, notably the misidentification of () as ()(20.8% of errors). Trainee competency showed no significant correlation with age, gender, or educational background ( > 0.05). Participant satisfaction ratings consistently reached "very satisfied" with almost all training components.
This external capacity assessment training program effectively enhanced short-term malaria microscopy proficiency. We propose institutionalizing this model as a national certification program to maintain diagnostic competency through regular training and quality monitoring, particularly targeting primary healthcare facilities at the township level.
疟疾的快速准确诊断助力中国在疟疾消除方面取得了显著成就。在消除疟疾后的阶段，显微镜检查对于预防输入性疟疾的重新传播仍然至关重要。本研究基于疟疾显微镜检查人员外部能力评估（ECAMM）框架，开发并验证了一项针对疟疾显微镜检查人员的为期4天的外部能力评估培训计划，以提高公共卫生机构实验室人员的诊断水平。
课程设计、血涂片选择、评估方法和评分标准严格遵循世界卫生组织的指南。参与者进行了一次培训前测试和四次培训后评估，涉及48张血涂片，以评估定性识别和物种区分方面的诊断准确性。对培训需求、技能提升轨迹、诊断错误模式、能力预测因素和参与者满意度进行了全面分析。来自湖南省14个地级行政区公共卫生机构的24名参与者完成了该计划，表现各异。
75%的参与者在过去5年中未接受过正式的疟疾显微镜检查培训。培训后评估显示有显著改善：阴性涂片识别准确率提高了29.86%，阳性涂片识别率提高了25.52%，物种区分准确率提高了48.96%。主要的诊断错误是物种间混淆，特别是将（）误鉴定为（）（占错误的20.8%）。学员能力与年龄、性别或教育背景无显著相关性（>0.05）。参与者对几乎所有培训内容的满意度评分均持续达到“非常满意”。
该外部能力评估培训计划有效提高了短期疟疾显微镜检查水平。我们建议将该模式制度化，作为一项国家认证计划，通过定期培训和质量监测来维持诊断能力，尤其针对乡镇级基层医疗机构。
