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The Unmet Need: Low Performance of Laboratory Professionals in Malaria Microscopy, Oromia Regional State, Ethiopia.

ABSTRACT: Ethiopia aims to diagnose and treat all clinical malaria within 24 hours of fever onset in its stride to eliminate the disease by 2030. Microscopy remains to be the mainstay for diagnosis at the health center and hospital level. Continuous evaluation and performance upgrading of malaria microscopists is one of the cornerstones in this effort. We assessed the performance of malaria microscopists compared with reference readers in diagnosing, identifying the species, and quantifying parasitemia. A total of 174 microscopists were enrolled from health facilities located in 86 districts in Oromia region (Ethiopia) from January 2017 to June 2018. Panel slides with known Plasmodium species, diagnostic blood stage, and parasite density were prepared by the reference readers. Sociodemographics, education, in-service training, and routine practice of participants were captured. Sensitivity, specificity, percent agreement, and kappa score were calculated. An overall low performance was observed that could threaten the malaria diagnostic service. Of all the slides distributed (1,218), only 17.0% of the positive and 30.0% of the negative slides were correctly identified and 22.4% were correctly quantified. Compared with the reference readers, participants had lower competence in diagnosing (74.3% agreement and kappa 0.45) and identifying the species (71.2% agreement and kappa 0.40). Two-fifths of the participants were graded as "in training" with respect to identifying the species (41.0%) and the diagnostic stages (40.0%). An in-service training/retraining and supportive supervision are needed to raise and maintain the competence of microscopists in settings with a recent decline in malaria transmission and aiming for ultimate elimination of the disease.

SUBMITTER: Challi S

PROVIDER: S-EPMC6947793 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Project description:BackgroundIn Ethiopia, malaria transmission is seasonal and unstable, with both Plasmodium falciparum and Plasmodium vivax endemic. Such spatial and temporal clustering of malaria only serves to underscore the importance of regularly collecting up-to-date malaria surveillance data to inform decision-making in malaria control. Cross-sectional school-based malaria surveys were conducted across Oromia Regional State to generate up-to-date data for planning malaria control interventions, as well as monitoring and evaluation of operational programme implementation.MethodsTwo hundred primary schools were randomly selected using a stratified and weighted sampling frame; 100 children aged five to 18 years were then randomly chosen within each school. Surveys were carried out in May 2009 and from October to December 2009, to coincide with the peak of malaria transmission in different parts of Oromia. Each child was tested for malaria by expert microscopy, their haemoglobin measured and a simple questionnaire completed. Satellite-derived environmental data were used to assess ecological correlates of Plasmodium infection; Bayesian geostatistical methods and Kulldorff's spatial scan statistic were employed to investigate spatial heterogeneity.ResultsA total 20,899 children from 197 schools provided blood samples, two selected schools were inaccessible and one school refused to participate. The overall prevalence of Plasmodium infection was found to be 0.56% (95% CI: 0.46-0.67%), with 53% of infections due to P. falciparum and 47% due to P. vivax. Of children surveyed, 17.6% (95% CI: 17.0-18.1%) were anaemic, while 46% reported sleeping under a mosquito net the previous night. Malaria was found at 30 (15%) schools to a maximum elevation of 2,187 metres, with school-level Plasmodium prevalence ranging between 0% and 14.5%. Although environmental variables were only weakly associated with P. falciparum and P. vivax infection, clusters of infection were identified within Oromia.ConclusionThese findings demonstrate the marked spatial heterogeneity of malaria in Oromia and, in general, Ethiopia, and provide a strong epidemiological basis for planning as well as monitoring and evaluating malaria control in a setting with seasonal and unstable malaria transmission.

Project description:BACKGROUND: Malaria transmission in Ethiopia is unstable and variable, caused by both Plasmodium falciparum and Plasmodium vivax. The Federal Ministry of Health (FMoH) is scaling up parasitological diagnosis of malaria at all levels of the health system; at peripheral health facilities this will be through use of rapid diagnostic tests (RDTs). The present study compared three RDT products to provide the FMoH with evidence to guide appropriate product selection. METHODS: Performance of three multi-species (pf-HRP2/pan-pLDH and pf-HRP2/aldolase) RDTs (CareStart, ParaScreen and ICT Combo) was compared with 'gold standard' microscopy at three health centres in Jimma zone, Oromia Regional State. Ease of RDT use by health extension workers was assessed at community health posts. RDT heat stability was tested in a controlled laboratory setting according to WHO procedures. RESULTS: A total of 2,383 patients with suspected malaria were enrolled between May and July 2009, 23.2% of whom were found to be infected with Plasmodium parasites by microscopy. All three RDTs were equally sensitive in detecting P. falciparum or mixed infection: 85.6% (95% confidence interval 81.2-89.4). RDT specificity was similar for detection of P. falciparum or mixed infection at around 92%. For detecting P. vivax infection, all three RDTs had similar sensitivity in the range of 82.5 to 85.0%. CareStart had higher specificity in detecting P. vivax (97.2%) than both ParaScreen and ICT Combo (p < 0.001 and p = 0.05, respectively). Health extension workers preferred CareStart and ParaScreen to ICT Combo due to the clear labelling of bands on the cassette, while the 'lab in a pack' style of CareStart was the preferred design. ParaScreen and CareStart passed all heat stability testing, while ICT Combo did not perform as well. CONCLUSIONS: CareStart appeared to be the most appropriate option for use at health posts in Ethiopia, considering the combination of quantitative performance, ease of use and heat stability. When new products become available, the choice of multi-species RDT for Ethiopia should be regularly re-evaluated, as it would be desirable to identify a test with higher sensitivity than the ones evaluated here.

Project description:BackgroundEven though health care seeking interventions potentially reduce child mortality from easily treatable diseases, significant numbers of children die without ever reaching a health facility or due to delays in seeking care in Ethiopia. This study aimed to assess health care seeking behavior for common childhood illnesses and associated factors.MethodsA community-based cross-sectional study was conducted in Jeldu District from January to February 2011. A systematic sampling method was used for sample selection. Data were collected from 422 caregivers with under-five children who experienced diseases within six weeks before the survey. Interviewer administered structured and pre-tested questionnaire which were used to collect data. Data entry and cleaning were carried out using Epi Info version 3.5.1 and analyzed using SPSS version 16. Descriptive analysis was done to determine the magnitude of health care seeking behavior. Multivariate logistic regression analyses were performed to identify associated factors.ResultsA total of 422 caregivers of under-five children were participated in the study giving an overall response rate of 97.5%. Three hundred fifteen (74.6%) children sought care from health facilities for all conditions. However, only 55.4% of them were taken to health facilities as first source treatment during their illness and prompt care was also very low (13.7%). Marital status of the caregivers (AOR = 2.84; 95%CI: 1.62-4.98), number of symptoms experienced by the child (AOR = 2.04; 95%CI: 1.24-3.36) and perceived severity of the illness (AOR = 3.20; 95%CI: 1.96-5.22) were predictors of health care seeking behavior.ConclusionHealth care seeking behavior for childhood illnesses was delayed and decision to seek care from health facilities was influenced by worsening of the illnesses. Thus, community level promotion of prompt health care seeking is essential to enhance the health care seeking behavior for child hood illnesses in the locality.

Project description:BackgroundAdherence to preventive measures of Coronavirus disease 2019 (COVID-19) was among the means to tackle the transmission of the virus. However, reluctance to implement the recommended preventive measures has been reported to be a major problem everywhere including Oromia Regional State.PurposeThis research was aimed to assess the level of adherence to COVID-19 preventive measures and associated factors in the study area.Participants and methodsCommunity based cross-sectional study was conducted. Sample of 2751 adults aged ≥ 18 years were used for the quantitative study. Also, 20 FGDs and 30 KIIs were conducted in the qualitative approach. The collected data were entered into Epi info version 7.2.0.1 and analyzed using STATA 15. The qualitative data were entered into NVivo version 12 for its organization. Bivariate and multivariable binary logistic regression analyses were conducted to determine the association between the study variables. Odds Ratio with its 95%CI was calculated and P- Value < 0.05 was used as a cut off points to declare the significance.ResultsThe level of adherence to COVID-19 preventive measure was 8.3. Age [AOR, 4.00; 95% CI: 1.50, 10.45], Illiterate AOR, 0.38; 95% CI: 0.15, 0.93], read and write [AOR, 0.26; 95% CI: 0.10, 0.72], attended primary [AOR, 0.30; 95% CI: 0.13, 0.70], occupation (AOR; 95% CI: 0.29, 0.96] and knowledge [AOR, 0.20; 95% CI: 0.01, 0.11] were factors associated with level of adherence to COVID-19 preventive measures. Political context, unemployment, livelihoods, and social events were mentioned as reasons for the poor adherence to COVID-19 preventive measures.ConclusionsThe overall level of adherence to COVID-19 preventive measures in the study area was low. Age, level of education, occupation, and knowledge were factors associated with level of adherence to COVID-19 preventive measures. Activities to increase the adherence to COVID-19 preventive measures should be implemented by the concerned bodies.

Project description:A survey was undertaken from December 2017 to April 2018 to assess the biosecurity status of 44 commercial chicken farms established in Bishoftu town, Ethiopia, by interviewing farm owners using a structured questionnaire. The obtained data were summarized using frequency tables and analyzed with Pearson's chi-square test and Fischer's exact value using Stata 14 statistical software. From the assessed chicken farms, 31 (70.45%) were located within 0-50 m from the main road, 39 (88.64%) situated 500 m from the nearest farms, and 27 (61.36%) placed within 0-20 m from the residential areas. Forty-one (93.18%) participants disclosed that their employees did not receive training on biosecurity. From the assessed chicken farms, 30 (68.18%) had fences, 40 (90.91%) had footbaths at their gates, 31 (70.45%) prohibited visitors entrance, and 39 (88.64%) did not exchange equipment with other farms. In addition, 26 (59.09%) farms were easily accessed by wild birds, each of 42 (95.45%) farms purchased day-old chicks and feed, and 40 (90.91%) shared trucks with other farms as well. Among the assessed farms, only 2 (4.55%) had signages to restrict people's access, 9 (20.45%) had isolation rooms for diseased chickens, 14 (31.82%) disposed of dead birds properly, and 10 (22.73%) kept various types of records. Occupation (Fischer's exact value = 8.40; P=0.019), previous training (Fischer's exact value = 4.40; P=0.044), source of the premises (χ 2 = 5.50; P=0.019), and farm capacity (Fischer's exact value = 13.50; P=0.002) were found statistically significantly associated with the farm biosecurity status. The farm biosecurity status was found to be good in farms that were run by civil servants, had trained employees, are owned premises, and were of large and medium scales. In conclusion, the higher poor biosecurity status on chicken farms calls for the implementation of good biosecurity practices in each farm as well as the provision of training to the farm owners and their employees.

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The Unmet Need: Low Performance of Laboratory Professionals in Malaria Microscopy, Oromia Regional State, Ethiopia.

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