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Author Notes:

Correspondence: Eva Christophel; christophele@wpro.who.int

Authors’ contributions AK and SA jointly led the evaluation of the programme, analysis and the writing of this paper.

BF and DB coordinated the review process.

KL acted as the key facilitator/trainer and technical expert from the commencement of the international assessment process, and provided the reports upon which much of the data here is based.

DB, KL, EMC, CH, JL jointly conceived and led programme development, JL, CH, EMC and DB led development of the regional slide bank.

All authors reviewed and revised the manuscript. All authors read and approved the final manuscript.

We acknowledge the work of the Cambodian national malaria control programme (CNM), including Dr Duong Socheat and Dr Muth Sinoun, in development of the regional slide bank on which the assessment is based, and the Institut Pasteur, Cambodia, and expert validators in multiple countries, for support in bank characterization.

The evaluation of the microscopy accreditation programme was conducted by the WHO Regional Office for the Western Pacific, with support from the United States Agency for International Development (USAID), the Foundation for Innovative New Diagnostics (FIND), Rollins School of Public Health at Emory University (USA) and the School of Nursing and Health Studies at Georgetown University (USA); the authors gratefully acknowledge this support.

We also acknowledge the considerable involvement of the 14 national malaria control programmes and past participants in the ECA exercises for their valuable cooperation and feedback.

Thanks to John Storey for assistance with the manuscript. In particular, we acknowledge the contribution of the Australian Army Malaria Institute for continuing support of the project from its inception with release of personnel (KL) as facilitator, and support for slide bank validation.

Competing interests The authors declare they have no competing interests.



  • Science & Technology
  • Life Sciences & Biomedicine
  • Infectious Diseases
  • Parasitology
  • Tropical Medicine
  • Malaria microscopy
  • Diagnostics
  • Quality assurance programmes

Developing standards for malaria microscopy: external competency assessment for malaria microscopists in the Asia-Pacific


Journal Title:

Malaria Journal


Volume 11, Number 1


, Pages 352-352

Type of Work:

Article | Final Publisher PDF


Background: Malaria diagnosis has received renewed interest in recent years, associated with the increasing accessibility of accurate diagnosis through the introduction of rapid diagnostic tests and new World Health Organization guidelines recommending parasite-based diagnosis prior to anti-malarial therapy. However, light microscopy, established over 100 years ago and frequently considered the reference standard for clinical diagnosis, has been neglected in control programmes and in the malaria literature and evidence suggests field standards are commonly poor. Microscopy remains the most accessible method for parasite quantitation, for drug efficacy monitoring, and as a reference of assessing other diagnostic tools. This mismatch between quality and need highlights the importance of the establishment of reliable standards and procedures for assessing and assuring quality. This paper describes the development, function and impact of a multi-country microscopy external quality assurance network set up for this purpose in Asia. Methods. Surveys were used for key informants and past participants for feedback on the quality assurance programme. Competency scores for each country from 14 participating countries were compiled for analyses using paired sample t-tests. In-depth interviews were conducted with key informants including the programme facilitators and national level microscopists. Results: External assessments and limited retraining through a formalized programme based on a reference slide bank has demonstrated an increase in standards of competence of senior microscopists over a relatively short period of time, at a potentially sustainable cost. The network involved in the programme now exceeds 14 countries in the Asia-Pacific, and the methods are extended to other regions. Conclusions: While the impact on national programmes varies, it has translated in some instances into a strengthening of national microscopy standards and offers a possibility both for supporting revival of national microcopy programmes, and for the development of globally recognized standards of competency needed both for patient management and field research.

Copyright information:

© 2012 Ashraf et al.; licensee BioMed Central Ltd.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 2.0 Generic License (https://creativecommons.org/licenses/by/2.0/).
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