External quality assessment of malaria microscopy in the Democratic Republic of the Congo

<p>Abstract</p> <p>Background</p> <p>External quality assessments (EQA) are an alternative to cross-checking of blood slides in the quality control of malaria microscopy. This study reports the findings of an EQA of malaria microscopy in the Democratic Republic of the Congo (DRC).</p> <p>Methods</p> <p>After validation, an EQA slide panel and a questionnaire were delivered to diagnostic laboratories in four provinces of DRC. The panel included three samples for diagnosis (sample 1: <it>Plasmodium falciparum</it>, 177,000/μl, sample 2: <it>P. falciparum</it>, 2,500/μl, sample 3: no parasites seen), one didactic sample (Howell-Jolly bodies) and one sample for assessing the quality of staining. Participating laboratories were addressed and selected through the network of the National Tuberculosis Control Programme. Participants were asked to return the responses together with a stained thin and thick blood film for evaluation of Giemsa stain quality.</p> <p>Results</p> <p>Among 174 participants (response rate 95.1%), 26.2% scored samples 1, 2 and 3 correctly and 34.3%, 21.5% and 5.8% of participants reported major errors in one, two or three samples respectively. Major errors included reporting "no malaria" or "non-<it>falciparum </it>malaria" for <it>Plasmodium falciparum</it>-positive samples 1 and 2 (16.1% and 34.9% of participants respectively) and "<it>P. falciparum</it>" for <it>Plasmodium </it>negative sample 3 (24.0%). Howell-Jolly bodies (didactic sample) were not recognized by any of the participants but reported as "<it>P. falciparum</it>" by 16.7% of participants. With parasite density expressed according to the "plus system", 16.1% and 21.5% of participants scored one "+" different from the reference score for samples 1 and 2 respectively and 9.7% and 2.9% participants scored more than two "+" different. When expressed as counts of asexual parasites/μl, more than two-thirds of results were outside the mean ± 2SD reference values. The quality of the Giemsa stain was poor, with less than 20% slides complying with all criteria assessed. Only one quarter of participants purchase Giemsa stain from suppliers of documented reliability and half of participants use a buffered staining solution. One third of participants had participated in a formal training about malaria diagnosis, half of them earlier than 2007.</p> <p>Conclusion</p> <p>The present EQA revealed a poor quality of malaria microscopy in DRC.</p

SD Bioline malaria antigen Pf (HRP-2/pLHD) for assessing efficacy of artemisinin combination therapy against Plasmodium falciparum in pediatric patients in the Democratic Republic of the Congo

Introduction: The emergence of Plasmodium falciparum resistance to artemisinin combination therapy (ACT) is a worrying development. It calls for close surveillance to monitor the efficacy of the drugs. The objectives of this study were to determine the performance of SD Bioline malaria AgPf(HRP-2/pLDH) 3  band Rapid Diagnostic Test (RDT) against Giemsa-stained blood smear and evaluate the suitability of this test in assessing the therapeutic efficacy of ACT in pediatric malaria patients in the Democratic Republic of the Congo (DRC). Methods: Five hundred and one patients with malaria symptoms were screened for P. falciparum in  Kinshasa, DRC. Of the 166 patients who tested positive for P. falciparum at recruitment (day 0), 103 consented to participate in this study and were followed up and retested for P. falciparum on day 3, day 7, day 14, day 21 and day 28. Results: Sensitivity and specificity of the test were significantly high on day 0 and so were their positive and negative predictive values. Higher proportions of false positive cases were observed on the HRP-2 band irrespective of patient parasite densities during the follow up but these were barely seen on the pLDH band. Some patients turned positive during follow up but pLDH readings remained consistent with bloodsmear readings. Conclusion: SD Bioline malaria AgPf(HRP-2/pLDH) RDT demonstrated high performance in DRC. Thus, the test can be employed to assess the efficacy of ACT in pediatric malaria patients and prioritize areas that require the deployment of advanced testing like polymerase chain reaction (PCR).Key words: Malaria, AgPf(HRP-2/pLDH) RDT, artemisinin combination therapy, Democratic Republic of the Cong

SD Bioline malaria antigen Pf (HRP-2/pLHD) for assessing efficacy of artemisinin combination therapy against Plasmodium falciparum in pediatric patients in the Democratic Republic of the Congo

Abstract Introduction: The emergence of Plasmodium falciparum resistance to artemisinin combination therapy (ACT) is a worrying development. It call

Modeling of information recording and selective etching processes in inorganic resists

Theoretical consideration and computer modeling of information pit recording and etching processes in chalcogenide vitreous semiconductors are proposed, namely we demonstrate how to record and develop information pits with the necessary shape and sizes in the inorganic resist using focused Gaussian laser beam and selective etching. It has been shown that phototransformed region cross-section could be almost trapezoidal or parabolic depending on the resist material optical absorption, recording beam power, exposure, etchant selectivity and etching time. Namely, during the laser illumination and thermal heating caused by it, photosensitive material is the quasi-equilibrium microscopic mixture of the transformed and nontransformed phases with different optical absorption coefficients: temperature dependent near the absorption edge «transformed» coefficient бe and almost independent coefficient α0 . If αe ≤ α0 e after thermal heating, the photo-transformed region «bleaches» and the pit depth increases more rapidly under the following laser power increasing. If αe > α0 , the phototransformed region «darkens» and the pit depth increases sub-linearly or even saturates under the following laser power increasing. Thus, almost parabolic or flattened pits appear when αe ≥ α0, whereas the pits with elongated tops appear when αe << α0. After illumination, the spatial distribution of photo-transformed material fraction was calculated using the Kolmogorov-Awrami equation. Analyzing obtained results, we derived a rather simple approximate analytical expression for the dependence of the phototransformed region width and depth on the recording Gaussian beam power, radius and exposure time. Then the selective etching process was simulated numerically. The obtained results quantitatively describe the characteristics of pits recorded by the Gaussian laser beam in thin layers of As₄₀S₆₀ chalcogenide semiconductor. Our model open possibilities how to select the necessary recording procedure and etching conditions in order to obtain pits with the optimum shape and sizes.Запропоновано теоретичний розгляд та комп’ютерне моделювання процесів запису інформації та селективного травлення в халькогенідних напівпровідниках. Змодульовано процес одержання інформаційних питів необхідної форми та розміру у неорганічному резисті, використовуючи сфокусований гаусівський лазерний пучок та селективне травлення. Показано, що переріз фототрансформованої області змінюється від майже трапецієвидного до параболічного в залежності від коефіцієнта оптичного поглинання, потужності лазерного пучка, експозиції, селективності травника та часу травлення. Просторовий розподіл долі фототрансформованого матеріалу розраховано з рівняння Колмогорова-Аврами. Проаналізовано одержані результати й виведено досить простий наближений аналітичний вираз для залежності ширини та висоти фототрансформованої області від потужності лазерного пучка, його радіусу, часу експонування та селективності травника. Одержані результати добре описують характеристики пітів, записаних у тонких шарах халькогеніду As₄₀S₆₀. Модель відкриває реальну можливість добору умов запису та травлення резисту, необхідних для одержання пітів з оптимальними розмірами.Предложено теоретическое рассмотрение и компьютерное моделирование процессов записи информации и селективного травления в халькогенидных полупроводниках. Смоделирован процесс получения информационных питов необходимой формы и размеров в неорганическом резисте, используя сфокусированный гауссовский лазерный пучок и селективное травление. Показано, что сечение фототрансформированной области может изменяться от практически трапециевидного до параболического в зависимости от коэффициента оптического поглощения, мощности лазерного пучка, экспозиции, селективности травителя и времени травления. Пространственное распределение доли фототрансформированного материала рассчитано из уравнения Колмогорова-Аврами. Проанализированы полученные результаты и выведено достаточно простое приближенное аналитическое выражение для зависимости ширины и высоты фототрансформированной области от мощности лазерного пучка, его радиуса, времени экспонирования и селективности травителя. Полученные результаты хорошо описывают характеристики питов, записанных в тонких слоях халькогенида As₄₀S₆₀. Модель открывает реальную возможность выбора условий записи и травления резиста, необходимых для получения питов с оптимальными размерами

Performance of Microscopy for the Diagnosis of Malaria and Human African Trypanosomiasis by Diagnostic Laboratories in the Democratic Republic of the Congo: Results of a Nation-Wide External Quality Assessment

The present External Quality Assessment (EQA) assessed microscopy of blood parasites among diagnostic laboratories in the Democratic Republic of the Congo. The EQA addressed 445 participants in 10/11 provinces (October 2013-April 2014). Participants were sent a panel of five slides and asked to return a routinely stained slide which was assessed for quality of preparation and staining. Response rate was 89.9% (400/445). For slide 1 (no parasites), 30.6% participants reported malaria, mostly Plasmodium falciparum. Only 11.0% participants reported slide 2 (Plasmodium malariae) correctly, 71.0% reported "malaria" or "Plasmodium falciparum" (considered acceptable). Slide 3 contained Plasmodium falciparum (109/μl) and Trypanosoma brucei brucei trypomastigotes: they were each reported by 32.5% and 16.5% participants respectively, 6.0% reported both. Slide 4 (Trypanosoma) was recognised by 44.9% participants. Slide 5 (Plasmodium ovale) was correctly reported by 6.2% participants, another 68.8% replied "malaria" or "Plasmodium falciparum" (considered acceptable). Only 13.6% of routine slides returned were correctly prepared and stained. The proportion of correct/acceptable scores for at least 4/5 slides was higher among EQA-experienced participants compared to first time participants (40.9% versus 22.4%, p = 0.001) and higher among those being trained < 2 years ago compared to those who were not (42.9% versus 26.3%, p = 0.01). Among diagnostic laboratories in Democratic Republic of the Congo, performance of blood parasite microscopy including non-falciparum species and Trypanosoma was poor. Recent training and previous EQA participation were associated with a better performance.status: publishe

Competence of individual end-users to read and interpret RDT test results expressed as a score on 10.

<p>Competence of individual end-users to read and interpret RDT test results expressed as a score on 10.</p

Study population and reference test results.

<p>IQR: interquartile range, CI: confidence interval.</p