Analysis on external competency assessment for malaria microscopists in China

In order to meet the requirement of malaria elimination (ME), three courses of the External Competency Assessment of Malaria Microscopists (ECAMM) were conducted during 2017-2018 in China by facilitators designated by the World Health Organization (WHO-ECAMM). A training course with a model copied from the WHO-ECAMM course was also held a week ahead of ECAMM in March 2018. Thirty-six participants completed these courses and obtained different results.

The slide structures, agendas, score calculations, and the levels of certifications of the four courses strictly adhered to the WHO guidelines. All the data were collected in Excel 2016 and analysed in Graphpad Prism5 or SPSS 23. Significant differences were evaluated in Graphpad Prism5 by two-tailed paired t tests between the pre-assessment and final-assessment for each of the four courses, as well as one-way ANOVAs with Kruskal-Wallis tests and Dunn's post hoc tests among the final assessments of the four courses. Correlations between participants' competency results and their ages, years working on malaria, and numbers of malaria cases reported in their provinces were evaluated by bivariate correlations (two-tailed) and linear regression (excluding cases pairwise) in SPSS 23. The Pearson correlation coefficients (r values), P values (two tailed), adjusted R square (Adjusted R²), standardized coefficients (β) and Sig. P values were recorded. The percentages of participants who gave the right answer to each slide (PPS) in the final assessments of the three WHO-ECAMM courses were calculated. Correlation analysis between PPS and parasitaemia (100-2000 parasites/μL) of Plasmodium falciparum slides used in species identification and parasite counting, were also evaluated via bivariate correlations (two-tailed) tests.

Among the 36 participants, 16 participants were certificated as Level 1 (two from NRL), 10 were certified as Level 2 (one from NRL). Within the same course, participants had improved their average scores from pre-assessments to final assessments. The numbers of malaria cases reported in participants' provinces were strongly correlated to their species identification (SI) scores; r = 0.45, P = 0.040, n = 21; r = 0.57, P = 0.001, n = 32; r = 0.56, P = 0.007). The parasitaemia of P. falciparum within 100-2000 parasites/μL was correlated significantly (r = 0.44, P = 0.008, n = 36) with the PPS of all counting slides but not with slides for identification (r = - 0.018, P = 0.93, n = 30).

The analysis and comparison of participants' competency results not only verified that the model of the WHO-ECAMM course had strong power in improving and assessing microscopists' competencies but also reflected the correlation between decreased numbers of indigenous malaria cases and microscopists' competencies in certain areas in China.