SOP â Malaria Microscopy - NVBDCP

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Quality Assurance of Malaria Diagnostic testsMicroscopy skill PHC District ROH & NationalFW/ZMOSensitivity: trophozoitedetection 85% 90% 95% 99%Specificity: trophozoitedetection 85% 90% 95% 99%Accuracy of reporting Pfwhen present 90% 90% 99% 99%Quantitation-accuratelydistinguishing Pf at 85% 90% 99% 99% 10/field8.8.4.2 Indirect supervisionIn indirect supervision, a supervisor can judge how well the LTs are working only from therecords that are being submitted regularly. However, the supervisor also needs to see thatthe LTs are performing in terms of providing diagnostic services. The supervisor will beassessing the quality of staining, check the filter papers and also see the microscopes,whether these are in working order or not. This will help him/her to assess how accuratelyslides are being examined. For this purpose, the supervisor will need to re-examine or crosschecka number of slides already examined.8.8.5 FrequencyFor this, a supervisory LT from District/Zonal/State laboratories should visit every PHC atleast twice in a year.8.8.6 Competence and performance8.8.6.1 CompetenceIn microscopy, competence is the skill of a LT for performing an accurate examination andreporting of a malaria blood film.8.8.6.2.1 Assessment of competenceCompetency assessment is required at each level of the laboratories in the QA chain. A LTat PHC (primary level), District (secondary level) or ROH & FW (Regional level) would beassessed by specific tasks required at each level of the services as given in the Form no 11.The supervisor must carry the above form during the visit, fill it and send it to the respectivelaboratory superior to the assessed laboratory (e.g. if PHC is assessed then to the DMO, ifat District to ROH & FW, and ROH & FW is assessed, then the result is sent to NIMR).Besides, a copy would be endorsed to the Dte of NVBDCP.8.8.6.1.2 Setting competence standardsFor measuring competency standard, training courses/ materials and assessments at theend of training are essential. After assessing the competence level by above criteria there isSOP – Malaria Microscopy© Copyright to Dte. NVBDCP Only. Any modification are prohibited
Quality Assurance of Malaria Diagnostic testsa need for setting standards of competence at various levels. Under the National QAprogramme Dte. of NVBDCP envisages that the following minimum competence levelsshould be achieved at the four levels of health careNational = Nodal referral laboratory: NIMR; Pf- Plasmodium falciparum8.8.6.2 Performance of a laboratory technicianThis refers to the accuracy of a LT examining malaria slides in routine practice. Forassessment of the performance of a LT, setting standards of performance is a requisite.Under the NVBDCP, EQAS is proposed in terms of standardizing unbiased cross-checkingof slides routinely examined by the LTs at peripheral laboratories (Chapter 4) as well as byassessing the LT by allowing them to examine coded panel slides. Besides, performancecan be improved through effective response to problems locally by consultation visits bysupervisors, re-orientation training, etc.8.8.6.2.1 Assessment of performanceThe minimum level of performance that has to be achieved at the four levels of malariamicroscopy after implementing QA programme as shown in the table given below:Microscopy Skill PHC Dist ROH & NationalFW/ZMOSensitivity- trophozoitedetection 80% 90% >95% >99%Accuracy of reporting Pfwhen present 85% 90% >95% 99%Quantitation- accuratelydistinguishing Pf at 95% 99%8.8.6.3 Log book• each laboratory should have a log book to record all activities carried out. Theremarks and assessment of supervisor should be entered in the log book.• the visiting supervisor/ consultant should enter details of the visit andcomments in this log.• the log book will contain duplicate pages containing the details of thechecklist, as above. Besides, there would be a column for the over all remarkof the supervisor.8.8.6.4 Consultative visits8.8.6.4.1 ImportanceStaff competence is only one of many factors that can affect performance. For example, themajority of poor examination results do not always relate directly to the diagnostic capabilityof the LT. Rather, poor results are often due to the following:SOP – Malaria Microscopy© Copyright to Dte. NVBDCP Only. Any modification are prohibited
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SOP â Malaria Microscopy - NVBDCP