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SMS photograph-based external quality assessment of reading and interpretation of malaria rapid diagnostic tests in the Democratic Republic of the Congo.

Mukadi P, Gillet P, Barbé B, Luamba J, Lukuka A, Likwela J, Mumba D, Muyembe JJ, Lutumba P, Jacobs J - Malar. J. (2015)

Bottom Line: HW who were trained less than 12 months ago had best MCQ scores for 7/10 photographs as well as a significantly higher proportion of 10/10 scores, but absolute differences in MCQ scores were small.HW who had participated in a previous EQA performed significantly better for 4/10 photographs compared to those who had not.Problems in supply, distribution and training of RDTs were detected.

View Article: PubMed Central - PubMed

Affiliation: Institute of Tropical Medicine, Department of Clinical Sciences, Antwerp, Belgium. jjacobs@itg.be.

ABSTRACT

Background: The present External Quality Assessment (EQA) assessed reading and interpretation of malaria rapid diagnostic tests (RDTs) in the Democratic Republic of the Congo (DRC).

Methods: The EQA consisted of (i) 10 high-resolution printed photographs displaying cassettes with real-life results and multiple choice questions (MCQ) addressing individual health workers (HW), and (ii) a questionnaire on RDT use addressing the laboratory of health facilities (HF). Answers were transmitted through short message services (SMS).

Results: The EQA comprised 2344 HW and 1028 HF covering 10/11 provinces in DRC. Overall, median HW score (sum of correct answers on 10 MCQ photographs for each HW) was 9.0 (interquartile range 7.5 - 10); MCQ scores (the % of correct answers for a particular photograph) ranged from 54.8% to 91.6%. Most common errors were (i) reading or interpreting faint or weak line intensities as negative (3.3%, 7.2%, 24.3% and 29.1% for 4 MCQ photographs), (ii) failure to distinguish the correct Plasmodium species (3.4% to 7.0%), (iii) missing invalid test results (8.4% and 23.6%) and (iv) missing negative test results (10.0% and 12.4%). HW who were trained less than 12 months ago had best MCQ scores for 7/10 photographs as well as a significantly higher proportion of 10/10 scores, but absolute differences in MCQ scores were small. HW who had participated in a previous EQA performed significantly better for 4/10 photographs compared to those who had not. Except for two photographs, MCQ scores were comparable for all levels of the HF hierarchy and non-laboratory staff (HW from health posts) had similar performance as to laboratory staff. Main findings of the questionnaire were (i) use of other RDT products than recommended by the national malaria control programme (nearly 20% of participating HF), (ii) lack of training for a third (33.6%) of HF, (iii) high proportions (two-thirds, 66.5%) of HF reporting stock-outs.

Conclusions: The present EQA revealed common errors in RDT reading and interpretation by HW in DRC. Performances of non-laboratory and laboratory staff were similar and dedicated training was shown to improve HW competence although to a moderate extent. Problems in supply, distribution and training of RDTs were detected.

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Related in: MedlinePlus

Photograph with multiple choice questions of 10 SD malaria Ag Pf/Pan RDT results as presented to the participants. The photographs A – J (left) represent real-life results of the SD malaria Ag Pf/Pan rapid diagnostic test; at the right hand, the options of the multiple choice questions corresponding to each of the photographs are listed. The correct answer (option) for each photograph is grey-highlighted, the details for control and test lines are listed in Table 1.
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Fig1: Photograph with multiple choice questions of 10 SD malaria Ag Pf/Pan RDT results as presented to the participants. The photographs A – J (left) represent real-life results of the SD malaria Ag Pf/Pan rapid diagnostic test; at the right hand, the options of the multiple choice questions corresponding to each of the photographs are listed. The correct answer (option) for each photograph is grey-highlighted, the details for control and test lines are listed in Table 1.

Mentions: High-resolution photographs printed on glossy photographic paper (maco silk normal full colour CMYK, 300dpi, Bulckens, Herenthout, Belgium) were supplied; they depicted cassettes of the RDT recommended and distributed by the PNLP, the SD malaria Ag Pf/Pan (HRP2/ pLDH, Standard Diagnostics, Inc., Kyonggi-do, Korea) with different combinations and intensities of control and test lines in real-life dimensions (Figure 1). SD Bioline malaria Ag/Pan is a so-called three-band RDT (one control and two test lines) detecting Histidine-Rich Protein 2 (HRP-2) and pan-Plasmodium lactate dehydrogenase (pan-pLDH).Figure 1


SMS photograph-based external quality assessment of reading and interpretation of malaria rapid diagnostic tests in the Democratic Republic of the Congo.

Mukadi P, Gillet P, Barbé B, Luamba J, Lukuka A, Likwela J, Mumba D, Muyembe JJ, Lutumba P, Jacobs J - Malar. J. (2015)

Photograph with multiple choice questions of 10 SD malaria Ag Pf/Pan RDT results as presented to the participants. The photographs A – J (left) represent real-life results of the SD malaria Ag Pf/Pan rapid diagnostic test; at the right hand, the options of the multiple choice questions corresponding to each of the photographs are listed. The correct answer (option) for each photograph is grey-highlighted, the details for control and test lines are listed in Table 1.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4318196&req=5

Fig1: Photograph with multiple choice questions of 10 SD malaria Ag Pf/Pan RDT results as presented to the participants. The photographs A – J (left) represent real-life results of the SD malaria Ag Pf/Pan rapid diagnostic test; at the right hand, the options of the multiple choice questions corresponding to each of the photographs are listed. The correct answer (option) for each photograph is grey-highlighted, the details for control and test lines are listed in Table 1.
Mentions: High-resolution photographs printed on glossy photographic paper (maco silk normal full colour CMYK, 300dpi, Bulckens, Herenthout, Belgium) were supplied; they depicted cassettes of the RDT recommended and distributed by the PNLP, the SD malaria Ag Pf/Pan (HRP2/ pLDH, Standard Diagnostics, Inc., Kyonggi-do, Korea) with different combinations and intensities of control and test lines in real-life dimensions (Figure 1). SD Bioline malaria Ag/Pan is a so-called three-band RDT (one control and two test lines) detecting Histidine-Rich Protein 2 (HRP-2) and pan-Plasmodium lactate dehydrogenase (pan-pLDH).Figure 1

Bottom Line: HW who were trained less than 12 months ago had best MCQ scores for 7/10 photographs as well as a significantly higher proportion of 10/10 scores, but absolute differences in MCQ scores were small.HW who had participated in a previous EQA performed significantly better for 4/10 photographs compared to those who had not.Problems in supply, distribution and training of RDTs were detected.

View Article: PubMed Central - PubMed

Affiliation: Institute of Tropical Medicine, Department of Clinical Sciences, Antwerp, Belgium. jjacobs@itg.be.

ABSTRACT

Background: The present External Quality Assessment (EQA) assessed reading and interpretation of malaria rapid diagnostic tests (RDTs) in the Democratic Republic of the Congo (DRC).

Methods: The EQA consisted of (i) 10 high-resolution printed photographs displaying cassettes with real-life results and multiple choice questions (MCQ) addressing individual health workers (HW), and (ii) a questionnaire on RDT use addressing the laboratory of health facilities (HF). Answers were transmitted through short message services (SMS).

Results: The EQA comprised 2344 HW and 1028 HF covering 10/11 provinces in DRC. Overall, median HW score (sum of correct answers on 10 MCQ photographs for each HW) was 9.0 (interquartile range 7.5 - 10); MCQ scores (the % of correct answers for a particular photograph) ranged from 54.8% to 91.6%. Most common errors were (i) reading or interpreting faint or weak line intensities as negative (3.3%, 7.2%, 24.3% and 29.1% for 4 MCQ photographs), (ii) failure to distinguish the correct Plasmodium species (3.4% to 7.0%), (iii) missing invalid test results (8.4% and 23.6%) and (iv) missing negative test results (10.0% and 12.4%). HW who were trained less than 12 months ago had best MCQ scores for 7/10 photographs as well as a significantly higher proportion of 10/10 scores, but absolute differences in MCQ scores were small. HW who had participated in a previous EQA performed significantly better for 4/10 photographs compared to those who had not. Except for two photographs, MCQ scores were comparable for all levels of the HF hierarchy and non-laboratory staff (HW from health posts) had similar performance as to laboratory staff. Main findings of the questionnaire were (i) use of other RDT products than recommended by the national malaria control programme (nearly 20% of participating HF), (ii) lack of training for a third (33.6%) of HF, (iii) high proportions (two-thirds, 66.5%) of HF reporting stock-outs.

Conclusions: The present EQA revealed common errors in RDT reading and interpretation by HW in DRC. Performances of non-laboratory and laboratory staff were similar and dedicated training was shown to improve HW competence although to a moderate extent. Problems in supply, distribution and training of RDTs were detected.

Show MeSH
Related in: MedlinePlus