The remote diagnosis of malaria using telemedicine or e-mailed images

We determined the ability of blinded remote expert microscopy to identify malaria parasites through transmission of malaria smear images via telemedicine and as e-mail attachments. Protocols for malaria smear transmission included: (1) transmission of sender-selected televised smears at various bandwidths (Bw), (2) transmission of remote reader-directed televised smears at various Bw, and (3) transmission of digital photomicrographs as e-mail attachments. Twenty (14%) of 147 sender-selected, and 13 (6%) of 221 reader-directed, images were deemed unreadable by slide readers. The presence or absence of malaria was correctly identified in 98% of the remaining images. Sixty-four (34%) of 190 digital microphotographs were deemed unreadable, while the presence or absence of malaria was correctly identified in 100% of the remaining images. Correct speciation ranged from 45% to 83% across various transmission methods and Bw. The use of telemedicine and e-mail technology shows promise for the remote diagnosis of malaria.