Pilot assessment of malaria diagnosis and education using virtual microscopy for laboratories in Africa and developing nations

Microscopy remains the internationally recognised gold standard for diagnosing malaria; however the ability to reach a correct diagnosis is affected by training, experience and availability of laboratory resources. With the aim of improving the accuracy of diagnosis, an interactive training programme is being developed using ‘‘Virtual slides’’ delivered via the internet, which aim to replicate the microscope experience. These will be used to assess current diagnostic accuracy, provide annotated feedback, create training materials and assess the effectiveness of the pilot training scheme. The programme is supported by the World Health Organization (WHO). Forty-two participants were recruited from 14 laboratories recommended by the WHO, UK National External Quality Assessment Scheme for general haematology (UKNEQAS (H)) and the Liverpool School of Tropical Medicine. Participants are in Kenya, Nigeria, Chile, Colombia, Hong Kong, India and Lebanon. After the initial training programme an internet based training package was delivered over four months, providing annotated feedback along with detailed information and images of cells containing parasites from the different species and stages of infection. Quizzes were also used to allow immediate feedback throughout the training. Results from the initial assessment indicate that the correct diagnosis was made in 74.5% of cases, with the correct species being identified in 53.4%. The results returned were influenced by the Plasmodium species present, the parasite density of the image, the use of a thick or thin film to generate the image, the presence of staining artefact and other haematological disorders. The comparison of the individual’s results after the completion of the final assessment stage will be compared with the initial assessment results to see what effect the training has on the diagnosis of malaria. The training is currently being distributed to UK participants.