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. 2018 Apr 12;18(1):489.
doi: 10.1186/s12889-018-5307-y.

The challenge of maintaining microscopist capacity at basic levels for malaria elimination in Jiangsu Province, China

Guisheng Ding  1 , Guoding Zhu  2 , Caiqun Cao  1 , Ping Miao  3 , Yuanyuan Cao  2 , Weiming Wang  2 , Yaping Gu  2 , Sui Xu  2 , Shengqiang Wang  4 , Huayun Zhou  5 , Jun Cao  6   7
Affiliations

The challenge of maintaining microscopist capacity at basic levels for malaria elimination in Jiangsu Province, China

Guisheng Ding et al. BMC Public Health. .

Abstract

Background: Local malaria transmission has decreased rapidly since the National Malaria Elimination Action Plan was launched in China in 2010. However, imported malaria cases from Africa and Southeast Asia still occur in China due to overseas laborers. Diagnosis by microscopy is the gold standard for malaria and is used in most hospitals in China. However, the current capacity of microscopists to manage malaria cases in hospitals and public health facilities to meet the surveillance needs to eliminate and prevent the reintroduction of malaria is unknown.

Methods: Malaria diagnoses were assessed by comparing the percentage of first visit and confirmed malaria diagnoses at Centers for Disease Control and Prevention (CDCs) and hospitals. The basic personnel information for public health departments and hospitals at different levels was investigated. The skills of microscopists for blood smear preparation and slide interpretation were also examined at the county and township levels.

Results: Inaccurate rate with 13.49% and 7.32%, respectively, in 2013 and 2014, from 341 and 355 reported cases from sub-provincial levels in Jiangsu province. Most of the 523 malaria cases reported in Nantong Prefecture from 2000 to 2014 involved patients who first visited county CDCs seeking treatment, however, none of these cases received confirmed diagnosis of malaria in townships or villages.The staff at county CDCs and hospitals with a higher education background performed better at making and interpreting blood smears than staff from townships.

Conclusions: The network for malaria elimination in an entire province has been well established. However, an insufficient capacity for malaria diagnosis was observed, especially the preparing and reading the blood smears at the township and village levels, which is a challenge to achieving and maintaining malaria elimination.

Keywords: Diagnosis; Malaria elimination; Microscopy.

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Conflict of interest statement

Ethics approval and consent to participate

This study was reviewed and approved by the Institutional Ethics Committee of Jiangsu Institute of Parasitic Diseases (JIPD). The written informed consent was obtained from all participants before the interview or evaluation.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Public health system for malaria control and elimination in China. *CDC: Centers for Disease Control and Prevention; **PHC: Public health center in townships
Fig. 2
Fig. 2
Study site in China
Fig. 3
Fig. 3
Malaria in Jiangsu Province (a) and Nantong Prefecture (b), 2000–2014. Columns of different colors show changes in the trend of cases imported from other countries (green), cases imported from other provinces (red) and indigenous cases (blue). The line (black) shows the change in the number of blood smear examinations
Fig. 4
Fig. 4
The distribution of malaria patient treatment and confirmation diagnosis in Nantong, Jiangsu Province. (a) refers to malaria patients who first sought treatment for febrile-related symptoms, and (b) refers to the confirmation of malaria infection
See this image and copyright information in PMC

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