Following the External Competency Assessment of Malaria Microscopists (ECAMM) conducted in September 2022, the World Health Organization (WHO) Representative Office in Viet Nam continues to support the capacity assessment of laboratory technicians from three institutes of malariology, parasitology and entomology (IMPE) in Ha Noi, Quy Nhon and Ho Chi Minh city. This support was provided from 13 -17 March, 2023 in Quy Nhon city.
The assessment course was conducted under the guidance of Ma'am Bina Srivastava, external facilitator designated by WHO. Twelve laboratory technicians from three institutes of malariology, parasitology and entomology were nominated to participate in this assessment course.The opening ceremony of the ECAMM was highly honored by the presence of Assoc.Prof. Dr. Ho Van Hoang - Director of IMPE-QN, and Mrs. Pham Lien Dai, Officer of WHO Viet Nam.
In his speech at the opening ceremony of ECAMM 2023, Assoc. Prof. Dr. Ho Van Hoang, Director of IMPE Quy Nhon, highly appreciated the efforts made by the World Health Organization (WHO) in maintaining a network of laboratory technicians for the detection and management of malaria cases. Up to now, microscopy-based diagnosis remains a simple and reliable method for detecting malaria worldwide, and it is considered the gold standard by the World Health Organization for malaria diagnosis. The accuracy of microscopy-based testing relies heavily on the skills of laboratory technicians. Therefore, there is a need for a high-standard assessment program to ensure the quality of malaria diagnosis.
Assoc. Prof. Dr. Ho Van Hoang, Director of IMPE Quy Nhon in his opening speech at ECAMM 2023
Participants to ECAMM 2023
Speaking at the ceremony, Ma'am Bina Srivastava hoped that through the ECAMM 2023, microscopists will update their technical expertise and improve their skills in diagnosing and detecting malaria parasites, differentiate between different species of malaria parasites, and determine parasite density. This would ultimately improve the accuracy, sensitivity, and specificity of microscopy-based malaria diagnosis. This is also an important step in certifying the competence of central-level laboratory technicians for the detection, identification and quantification of malaria parasites.
Ma'am Bina Srivastava, WHO's expert on ECAMM in her speech at the opening ceremony
During the 5-day interactive course, the participants were assessed for their proficiency in parasite detection, species identification, and parasite density calculation through a standard set of 56 validated slides from the WHO Malaria Slide Bank. These slides were of 4 malaria parasite species, including Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae, Plasmodium ovale and some mixed-species infections.
Participants in their microscopic examination
Theoretical review sessions also helped microscopists to consolidate knowledge about all aspects of malaria microscopy. The refresher modules included overview of malaria: global malaria situation and epidemiology of malaria; microscope use and care; malaria parasite species (P.f, P.v, P.o, P.m and P.k) microscopically; malaria parasite counting; blood elements and artefacts; quality assurance in malaria laboratory diagnosis, and training-revision options.
Before each round of test slide examination (9-10 slides), the facilitator reviewed the previous day's microscopic examination results, identified key factors to exactly distinguish different species and accurately count malaria parasite density, and drew lessons for next examination session. Based on the examination results, the laboratory technicians' competency was evaluated, and they were certified at corresponding competency levels from 1 to 4.
Ma'am Bina Srivastava reviewing the results of the previous day's microscopic examination
Table 1. WHO Competence Levels
Competence Level | Parasite Detection | Species Identification | Parasite Counting (within 25% of the true count) |
Level 1 | ³ 90% | ³ 90% | ³ 50% |
Level 2 | ³ 80% | ³ 80% | ³ 40% |
Level 3 | ³ 70% | ³ 70% | ³ 30% |
Level 4 | < 70% | < 70% | < 30% |
Level 1 certification is the highest level of competence that a microscopist can obtain if they achieve 90% or more accuracy for species detection and species identification, and 50% or more accuracy in parasite count which must be within 25% of the true count. The assessments resulted in eight microscopists certified level 1 and four certified level 2. All the participants were awarded with the certificates that are valid for the next three (3) years.
Reassessing and certifying malaria microscopists is essential to maintain their competence in microscopy-based malaria diagnosis. This serves malaria diagnosis, treatment, as well as antimalarial drug efficacy studies and clinical trials. Additionally, this activity ensures the technical expertise of national microscopists in conducting training, inspections, and monitoring activities of microscopic points nationwide, particularly in Central Vietnam.
Assoc.Prof. Ho Van Hoang, Director of IMPE-QN and participants to ECAMM 2023Some images at the closing ceremony of the ECAMM course:
Assoc.Prof. Ho Van Hoang and Ma'am Bina Srivastava presenting the provisional certificates to the participants of ECAMM 2023