Evaluating ECAMM-based training efficacy for malaria microscopists in Hunan Province, China

Abstract

Background: 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.

Methods: 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.

Results: 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 Plasmodium ovale (P. ovale) as Plasmodium malariae (P. malariae)(20.8% of errors). Trainee competency showed no significant correlation with age, gender, or educational background (p > 0.05). Participant satisfaction ratings consistently reached "very satisfied" with almost all training components.

Conclusion: 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.

Keywords: ECAMM; competency; malaria; microscopist; training course.

Figure 1

Course setup and implementation flowchart.

Figure 2

The qualitative and species identification accuracy of negative or positive smears.

Figure 3

Heatmap of factors related to the improvement of participants’ abilities. Gen, Gender; Ag, Age; EB, Educational Background; PB, Professional Background; PT, Professional Title; UL, Unit Level; RToPTp5, Received Theoretical or Practical Training in the past 5 years; FoTp5, Frequency of Training received in past 5 years; ASRp5, Annual Slides Reading over the past 5 years; TESLSR, Time Elapsed Since the Last Seamer Reading; OMMoFPT, Observed the Microscopic Morphology of Four Types of Parasite; OMMoAP, Observed the Microscopic Morphology of All Parasite stages; PQA, Pre-test qualitative accuracy; AQA, after-training qualitative accuracy; QAI, Improvement in qualitative accuracy; PA,Pre-test species identification accuracy; AA, after-training species identification accuracy; AI, Improvement in species identification accuracy.

Figure 4

Error categories relationship diagram.

Figure 5

Distribution of learning motivation among training participants.

Figure 6

Participant satisfaction levels across various aspects of the training program.