AUTHOR=Fei Luo , Shuang Zhou , Yi Yuan , Shan-Shan Li , Yan Tan , Jing-Ru Xu , Yang Zhou 

TITLE=Assessment of Malaria Microscopy Competency at Primary Health Institutions in the Chongqing Municipality

JOURNAL=Frontiers in Medicine

VOLUME=Volume 8 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.602442

DOI=10.3389/fmed.2021.602442

ISSN=2296-858X

ABSTRACT=Abstract
Background: In April 2019, Chongqing has passed the national malaria elimination assessment. However, around 30 imported malaria cases were still reported every year, and the Anopheles sinensis were widely distributed in Chongqing, the risk of malaria resurgence was still existed. Early diagnosis and treatment for malaria cases were effective measures to prevent malaria resurgence. The primary health institutions were the first station where the potential malaria cases may seek for treatment. The malaria diagnosis competence of the primary health institutions will directly affect the timeliness of malaria diagnosis . Nowadays, most of the primary health institutions in Chongqing use microscopy to confirm malaria cases. This study assessed the microscopy competence of primary health institutions, studied and analyzed the results, and provided scientific basis for malaria prevention and control after malaria elimination in Chongqing.
 Methods:  According to the stratified sampling principle, 4 plasmodium microscopy technicians (156 in total) were selected from each of the 39 districts/counties of Chongqing to test the plasmodium microscopy competence. Descriptive statistical analysis, correlation analysis, spatial self-correlation analysis and ROC curve analysis were carried out on the test results.
 Result: The average of the technicians’ test scores were 4.33±0.47 (min: 3, mid:4.5, max:5), The spatial clustering of the scores is significant (MoranI = 0.338, Z = 3.618, P <0.01). The test scores were positively correlated with the “level of work institutions” (R = 0.21, P < 0.01), however were negatively correlated with “age” (R = -0.31, P < 0.01). The highest Sensitivity of the technicians’ microscopy was in qualitative diagnosis (98.92%, CI: 98.00%-99.69%). The Delong’s test show that the diagnostic efficiency of the technicians’ microscopy to the P. falciparum was the best (P <0.01), however to the P. ovale was the worst (P <0.01).
 Conclusion: The microscopy technicians in primary health institutions of Chongqing have good microscopy competence in qualitative diagnosis, but there were deficiencies in the identification of plasmodium species. Township level health institutions in Central China have weaker microscopy than those in other areas. 
Key words: Malaria, Microscopy, Competency assessment of malaria microscopy, plasmodium species identification, Chongqing Municipality