Comparación de los métodos de gota gruesa y tiras de diagnóstico rápido para el diagnóstico de la malaria en Luanda, Angola

Introducción: a pesar de que se ha logrado reducir la morbilidad y la mortalidad de la malaria en África, esta constituye aún un importante problema de salud en Angola, y su capital, Luanda. Objetivo: comparar la ejecución de la microscopía contra un método de tiras de diagnóstico rápido para el diagnóstico de la malaria. Material y Métodos: se llevó a cabo un estudio de corte transversal para evaluar la precisión de una prueba rápida para el diagnóstico del paludismo. Entre diciembre de 2013 y marzo  de 2014; se seleccionaron aleatoriamente 1 000 muestras de sangre de pacientes quienes acudieron a los laboratorios por diagnóstico sospechoso de malaria, las que fueron analizadas por gota gruesa, y una prueba de diagnóstico rápido (SD Bioline Malaria AntigenPf/Pv®). Se evaluó la concordancia, la validez y la seguridad de ambos métodos, y para ello las gotas gruesas, fueron consideradas como la "prueba de oro". Resultados: se obtuvo una mayor frecuencia de positividad con las TDR que con las gotas gruesas en dos de los centros de salud (p&lt;0,05).  Al comparar los valores de concordancia, validez y seguridad entre los métodos empleados para el diagnóstico de la malaria se obtuvieron valores de concordancia superiores con la gota gruesa que con las TDR. De la misma forma, la especificidad y los valores predictivos de los positivos también fueron superiores con las gotas gruesas (p&lt;0,01). Conclusiones: este estudio permite considerar esta técnica de diagnóstico rápido como un método adecuado y sensible para diagnosticar infecciones por P. falciparum en Luanda. Palabras clave: tiras de diagnóstico rápido, microscopía, gota gruesa, centros de salud de Angola.ABSTRACTIntroduction: despite of National programs for control have reduced the morbidity and mortality because of malaria in Africa, this parasitic disease is still an important public health problem in the continent, in the Republic of Angola, and its capital Luanda. Objective: to compare the skills of technicians on malaria microscopy and to compare the microscopy against a rapid diagnostic test (RTD) in health centers from Luanda. Material and Methods: among December 2013 y march 2014, one thousand samples were randomly selected from patients visiting laboratories because of suspected diagnosis of malaria. These samples were observed by 20 technicians in 10 health centers from Luanda. A blood sample was taken by every person in order to be examined by thick smear (TS) and a RTD (SD Bioline Malaria Antigen Pf/Pv®). The concordance, the validity, and safety of both methods were evaluated, and the gold standard was defined by thick smears observed by four malaria expert technicians. Results: the frequency of positivity obtained with RTD was higher than with TSin health centers from Kassequel, Samba, and Km 12 (p&lt;0.05). The comparison of concordance, validity, and safety between used methods for the diagnosis of malaria showed concordance values with TS higher than RTD. The specificity and predictive values for positives were upper with TS than RTD (p&lt;0,01). Conclusions: this study showed the RTDBioline Malaria Ag f/Pv®, is an adequate and sensible method for the diagnosis of P. falciparum infections in Luanda.Key words: rapid diagnostic tests, microscopy, Angola health centers, thick smear. 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Intervención Educativa para mejorar la calidad del Diagnóstico de la Malaria en la red de Laboratorios de Luanda, República de Angola

Introducción: La malaria continúa siendo uno de los más importantes problemas de salud  pública a nivel mundial que afecta con énfasis al continente africano y a Angola. Objetivos: Evaluar el nivel de conocimientos teóricos y prácticos en el diagnóstico de la malaria de un grupo de técnicos en Luanda antes y después de una intervención educativa. Material y Métodos: Entre abril y julio de 2013 se realizó un estudio experimental con grupo de control en 120 técnicos de la red de salud de Luanda; se hicieron dos evaluaciones teóricas y prácticas: una, al comienzo y otra, 3 meses después de una intervención educativa. Se incluyó un grupo adicional de control de 120 técnicos que fueron evaluados al mismo tiempo y en quienes no se hizo intervención. Los entrenamientos fueron de 10  días cumplimentando un programa de clases prácticas y teóricas. Resultados: Después de los entrenamientos en el grupo de Intervención, las notas ascendieron tras la segunda evaluación; mientras que en el grupo de control las calificaciones se mantuvieron sin cambios. Se observó que en el grupo de Intervención la probabilidad de estar desaprobado fue 129 veces mayor en la evaluación inicial para las pruebas teóricas y 108 veces mayor en los exámenes prácticos. Finalmente fueron identificados los principales aspectos en que fallaron los técnicos evaluados en los grupos de intervención y control. Conclusiones: Se demostró una mejoría en los conocimientos teóricos y prácticos de los técnicos de laboratorio dedicados al diagnóstico de la malaria después de la intervención educativa.Palabras clave: Malaria, conocimientos teóricos, evaluación práctica, diagnóstico microscópico.ABSTRACTIntroduction: The malaria still is one of the most important public health problems worldwide, specially the Africa as well as in Angola. Objectives: The aim was to evaluate the level of theoretical and practical knowledge in malaria diagnosis of a large group of technicians in Luanda before and after of an educational intervention. Material and Methods: Between April and July of 2013 an experimental study with a control group was carried out in 120 technicians from Luanda. The evaluations were applied previous and after (three months) of an educational intervention.  Another additional group of 120 technicians (control group) were evaluated too at the same period of time, but intervention was not made on them. Trainings were made during 10 days by completing a program with practical and theoretical classes. Results: after the trainings in the intervention group the scores increased in the theoretical and practical evaluations; while in the control group the scores of evaluations did not change after final evaluations. In the Intervention group the rate of disapproval was 129 times higher in the first evaluation than in final evaluation and this odd was 108 times higher in practical evaluations. Finally, the main topics with errors were identified in the evaluations from the beginning in the intervention and the control groups. Conclusions: In this study carried out in Luanda, Angola, an improvement of the evaluations was showed in theoretical and practical knowledge of the technicians after intervention in the network of laboratories of the capital province of the country.Keywords: Malaria, practical evaluation, theoretical knowledge, microscopic diagnosis. 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