Improving malaria microscopy performance through structured refresher training: evidence from India for diagnosis of malaria

Microscopy is widely considered as the gold standard for malaria diagnosis. Qualified microscopists play an essential role in the timely diagnosis, treatment of malaria infections, and the subsequent management programs, their confidence in diagnosis for malaria microscopy immensely depends on the training programs they are attending during their services. Deprived of regular training programs as per standard guidelines by WHO could result in misdiagnosis of malaria infections, which could subvert any nationwide elimination endeavors. Hence, it is mandatory to scrutinize these programs on their capacity to upscale the competence of the laboratory technicians. We conducted a Multi-Site Pre- and Post- Evaluation of a Standardized 5-Days National Refresher Training (NRT) programme in Malaria Microscopy for the Laboratory professionals. Participants (N = 130) competency was assessed before and immediately after the training on the three modules such as Parasite Detection, Species Identification, and Parasite Counting. Descriptive statistics were performed with performance scores and p-values ≤ 0.05, were considered significant. Shapiro–Wilk test was used to assess normality. Wilcoxon’s Signed-rank test was performed to determine the significance between the groups. Grading of the performance was conducted according to the WHO Guidelines. McNemar-Bowker test was utilized to determine the significance and symmetry among the grades across the pre- and post- training groups. The performance scores (%) (Median [Q1-Q3]) for parasite detection, species identification and counting were 71.00 [56.75–86.00], 46.00 [31.00–60.00] and 8.50 [0.00–33.00], respectively, before the training, and 88.00 [80.00–94.50], 69.00 [54.00–84.00] and 40.00 [20.00–50.25], respectively, after the training program. The Wilcoxon’s signed-rank test indicates that the NRT program had a positive impact upon the participant’s performance scores in the Parasite Detection (Z=− 8.026, p ≤ 0.001, r = 0.70), Species Identification (Z = − 8.360, p ≤ 0.001, r = 0.73) and Counting (Z=− 5.644, p ≤ 0.001, r = 0.49) modules. McNemar-Bowker Test on performance Grades indicate improvements both in Parasite Detection (χ 2 [6, 130] = 61.489, p ≤ 0.001) and Species Identification (χ 2 [5130] = 58.108, p ≤ 0.001) modules. Structured refresher training significantly improved malaria microscopy competency, particularly in parasite detection and species identification. However, additional practical training, periodic competency assessment, and continued quality assurance are needed to strengthen the diagnostic accuracy of the trainees.