Diagnostic performance of malaria microscopy among laboratory professionals in Ethiopia: a systematic review
Bewket Mesganaw1, Ketema Misganaw2, Zigale Hibstu Teffera3
1Department of Medical Laboratory Sciences, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia. bewket_mesgnaw@dmu.edu.et.
Background:
Malaria remains a major public health concern in Ethiopia, where light microscopy serves as the primary diagnostic method. Accurate microscopy performance among laboratory professionals is critical for appropriate case management, rational antimalarial use, and malaria control efforts. This systematic review synthesized available evidence on the diagnostic performance of malaria microscopy in Ethiopia.
Methods:
This systematic review evaluated malaria microscopy performance in Ethiopia in accordance with PRISMA 2020 guidelines. Electronic databases and manual searches were used to identify cross-sectional studies published between 2014 and 2021 that evaluated malaria microscopy performance using External Quality Assessment (EQA) components. Extracted indicators included sensitivity, specificity, detection agreement, species identification agreement, and associated factors. Due to the absence of primary numerator and denominator data in most studies, quantitative meta-analysis was not feasible; therefore, findings were summarized descriptively using ranges and means.
Results:
Twelve cross-sectional studies involving 1173 laboratory professionals from 533 public health laboratories were included. Sensitivity ranged from 62 to 94.7% (mean: 78.9%), while specificity ranged from 79.7 to 100% (mean: 90.8%). Detection agreement averaged 85.2% (range: 71.4-97.3%). Species identification agreement was lower, averaging 70.6% (range: 43.8-95.0%). Frequently reported factors associated with suboptimal performance included inadequate refresher training, limited EQA participation, poor smear preparation and staining quality, insufficient supportive supervision, and high workload.
Conclusion:
Although malaria parasite detection and specificity by microscopy are relatively satisfactory in Ethiopia, sensitivity and species identification accuracy remain below WHO-recommended benchmarks. Strengthened competency-based training, structured EQA implementation, improved slide preparation practices, and enhanced supportive supervision are essential to improve diagnostic performance and support malaria elimination efforts.
