Pan African Vivax and Ovale Network (PAVON) Malaria Diagnostic Competency Training: Offering Training Opportunities to Impact Malaria Elimination Strategies in Sub-Saharan Africa

Abstract

PAVON has developed a malaria microscopy competency training scheme to augment competency in malaria microscopy. Here, data accrued from training activities between 2020 and 2023 in Botswana are presented. Three trainings were done for 37 central and peripheral level technicians for a two-week period. The scheme consisted of basic theory on Plasmodium parasites, malaria epidemiology and diagnosis. The practicals focused on standard slide preparation, staining, parasite detection, speciation and counting. Scores were assessed by the Wilcoxon signed rank test. Participants who excelled joined the WHO External Competency Assessment for Malaria Microscopy (ECAMM). The median competency scores for the three trainings were detection: 100 (IQR = 94-100), 100 (IQR = 94-100) and 92 (IQR = 92-100), respectively, from pre-test scores of 40 (IQR = 27-54), 44 (IQR = 32-52) and 20 (IQR = 10-40) (z = 2.937, p < 0.003, z = 3.110, p = 0.002 and (z = 2.251, p = 0.024), respectively. Speciation: 93 (IQR = 86-96), 81 (IQR = 73-96) and 88, (IQR = 88-100) from pre-test scores of 50 (IQR = 30-50), 36 (IQR = 20-45) and 17 (IQR = 17-50) (z = 2.936, p < 0.003, z = 3.152, p = 0.002 and z = 3.237, p = 0.001). The competency scores achieved in the ECAMM were 98/98 and 97/98 for sensitivity and specificity pre- and post-tests detection. The training was effective in raising the competency skills of participants and is open to NMPs (National Malaria Programs) for critical capacity building.

Keywords: diagnostic capacity; malaria diagnosis; microscopy competency.

Figure 1

Scheme for basic guidelines on slide preparation and scores for competency.

Figure 2

Criteria for defining the quality of the blood smears.

Figure 3

Comparing writing theory test scores before and after training. The median values are highlighted in yellow bounded by the upper and lower quartiles. A filled dot is an outlier.

Figure 4

Comparing identification test scores before and after the trainings. Two post-tests were conducted in the November 2022 and November 2023 trainings. The median values are highlighted in yellow bounded by the upper and lower quartiles. Filled dots are outliers.

Figure 5

Comparing the speciation test scores before and after the trainings. Two post-tests were conducted in the November 2022 and November 2023 trainings. The median values are highlighted in yellow bounded by the upper and lower quartiles. Filled dots are outliers.

Figure 6

Comparing counting test scores before and after the trainings. Two post-tests were conducted in the November 2022 and November 2023 trainings. The median values are highlighted in yellow bounded by the upper and lower quartiles. Filled dots are outliers.

Figure 7

Comparing mixed infection detection test scores before and after the trainings. The median values are highlighted in yellow bounded by the upper and lower quartiles.