ABSTRACT
Objetivos. Evaluar la competencia de los microscopistas en el diagnóstico de la malaria mediante paneles de láminas estandarizados en la Amazonía peruana. Materiales y métodos. Estudio transversal, realizado entre los meses de julio y septiembre de 2007, en 122 establecimientos de salud de primer nivel de atención de la Amazonía peruana. En el marco del Proyecto PAMAFRO, se evaluó las competencias en el diagnóstico de malaria en 68 microscopistas sin experiencia (
Objectives. To assess the competency of microscopists for malaria diagnosis using standardized slide sets in the Peruvian Amazon. Material and methods. Cross-sectional study carried out in 122 first level health facilities of the Peruvian Amazon, between July and September 2007. Within the frame of the project "Control Malaria in the border areas of the Andean Region: A community approach" (PAMAFRO), we evaluated the malaria diagnosis performance in 68 microscopists without expertise (< 1 year of expertise) and 76 microscopists with expertise (> 1 year) using standardized sets of 20 blood smear slides according to the World Health Organization (WHO) recommendations. A correct diagnosis (correct species identification) was defined as "agreement", a microscopist was qualified as an "expert" if they have an agreement ≥90 percent (≥ 18 slides with correct diagnosis), as a "referent" with an agreement between 80 percent and <90 percent, "competent" if they are between 70 and <80 percent and "in training" if they have <70 percent. Results. Microscopists with expertise (68.6 percent) had more agreement than those without expertise (48.2 percent). The competency assessment was acceptable (competent, referent, or experts levels) in 11.8 percent of the microscopists without expertise and in 52.6 percent from those with expertise. The agreement was lower using blood smear slides with P. falciparum with low parasitaemia, with P. malariae and with mixed infections. Conclusions. Is the first assessment, we found only one of three microscopists from the Peruvian Amazon is competent fro malaria diagnosis according to the WHO standards. From this baseline data, we have to continue working in order to improve the competency assessment of the microscopists within the frame of a quality assurance system.
Subject(s)
Humans , Malaria/blood , Malaria/diagnosis , Professional Competence/standards , Clinical Laboratory Techniques , Cross-Sectional Studies , Microscopy/standards , Parasitology/standards , PeruABSTRACT
A latex agglutination test to detect urinary antigens for visceral leishmaniasis [VL] was studied. In 204 patients with suspected VL, KAtex had a sensitivity of 95.2% with good agreement with microscopy smears but poor agreement with 4 different serology tests. It was also positive in 2 confirmed VL cases co-infected with HIV. In all KAtex-positive confirmed cases actively followed up after treatment, the test became negative 1 month after completion of treatment. While KAtex had a specificity of 100% in healthy endemic and non-endemic controls, the direct agglutination test [DAT] was positive in 14% of the KAtex-negative healthy endemic controls. KAtex is a simple addition to the diagnostics of VL particularly at field level and as a complementary test for the diagnosis of VL in smear-negative cases with positive DAT results
Subject(s)
Humans , Antigens, Protozoan/urine , Case-Control Studies , Child, Preschool , Endemic Diseases/statistics & numerical data , Enzyme-Linked Immunosorbent Assay/standards , Fluorescent Antibody Technique, Indirect/standards , Immunoblotting/standards , Latex Fixation Tests/methods , Leishmania donovani/immunology , Parasitology/standardsABSTRACT
En México son muchos los laboratorios clínicos que ya realizan su control de calidad analítica, pero generalmente sólo abarcan la química clínica. En otras áreas como hematología y parasitología, la situación se agrava por la carencia de materiales de control o de sistemas definidos para hacerlos. Para contribuir a mejorar la calidad analítica en parasitología, en junio de 1995 se incluyó en el programa de evaluación de la Calidad entre Laboratorios Clínicos (ECEL) esta área. Durante seis ciclos de evaluación se les enviaron a los laboratorios participantes muestras de materia fecal de humano, inoculada cuantitativamente con un determinado parásito. Se valoró el resultado y la técnica empleada para el análisis coproparasitoscópico. Los resultados señalaron que hay variados y diferentes problemas en este estudio, debido en parte a la gran variación en las técnicas utilizadas y a diferencias para la identificación de quistes y huevecillos. Se encontro que la técnica más utilizada por los laboratorios participantes era la de Faust en un 90 por ciento y el resto emplea: Faust modificado, Ritchie, eter-formol, concentración por sedimentación y la observación directa. Para uniformar la técnica de análisis, se propuso a los participantes utilizar la recomendada por el National Committee for Clinical Loboratory Standards, de los Estados Unidos, a la cual denominamos técnica del NCCLS. En ella se utiliza sulfato de zinc con densidad de 1.18 y se debe leer tanto el sedimento como la película superficial. Varios participantes señalaron, que al adoptar esta técnica mejoró su calidad en el diagnóstico