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. 2023 Sep 28:11:1243642.
doi: 10.3389/fpubh.2023.1243642. eCollection 2023.

Evaluation of performance for malaria diagnosis in health facilities by five provincial reference laboratories of China

Xuan Zhang  1 , Jingjing Jiang  2 , Yuan Sui  3 , Hui Yan  4 , Jing Xia  5 , Ying Liu  6 , Lingcong Sun  5 , Xiaoxiao Wang  1 , Jutta Marfurt  7   8 , Shenning Lu  9 , Shizhu Li  9 , Wei Ruan  1 , Duoquan Wang  9
Affiliations

Evaluation of performance for malaria diagnosis in health facilities by five provincial reference laboratories of China

Xuan Zhang et al. Front Public Health. .

Abstract

Introduction: The provincial malaria diagnosis reference laboratories review and assess malaria cases diagnosed in health facilities for supporting the malaria elimination efforts and preventing re-transmission of imported malaria. The study aimed to evaluate the detection capability of malaria diagnosis in China from 2014 to 2021.

Methods: Data on malaria cases reported in the provincial-level administrative divisions (PLADs) of Anhui, Henan, Hubei, Guangxi, and Zhejiang from 2014 to 2021 were collected and analyzed.

Results: In total, 5,770 malaria cases were reported from 2014 to 2021, and 99.05% (5,715/5,770) were submitted to the provincial malaria diagnosis reference laboratories. The median time between malaria cases being reported and the samples being received by reference laboratories was 6 days (Interquartile range, IQR:3-12 days) from 2017 to 2021. Diagnosis of 5,680 samples in the laboratory were confirmed by provincial reference laboratories, including 3,970 cases of Plasmodium falciparum, 414 of P. vivax, 1,055 of P. ovale, 158 of P. malariae, 1 of P. knowlesi, and 82 of mixed infections. Plasmodium species of 5,141 confirmed cases were consistent with the initial diagnosis, with a species accuracy rate of 90.53% (5,141/5,679). The accuracy of P. falciparum diagnosis in health facilities was higher than that of non-falciparum species. The inconsistency between microscopy and nested polymerase chain reaction (nPCR) results of confirmatory diagnosis was mainly in malaria-positive versus malaria-negative cases, as well as in mixed versus single infection cases.

Conclusion: The provincial malaria diagnosis reference laboratories have played an important role in ensuring the accuracy and reliability of Plasmodium diagnosis in health facilities. However, the results of this study imply that capacity training for the identification of Plasmodium species in health facilities is warranted.

Keywords: China; accuracy; laboratory diagnosis; malaria; reference laboratory.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of samples submitted to the reference laboratories for confirmation of malaria diagnosis in the five PLADs in China from 2014 to 2021.
Figure 2
Figure 2
Box plot representing time interval between cases being reported and samples being received by the reference laboratories from 2017 to 2021.
See this image and copyright information in PMC

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