The challenge of maintaining microscopist capacity at basic levels for malaria elimination in Jiangsu Province, China.

BACKGROUND: Local malaria transmission has decreased rapidly since the National Malaria Elimination Action Plan was launched in China in 2010. However, imported malaria cases from Africa and Southeast Asia still occur in China due to overseas laborers. Diagnosis by microscopy is the gold standard for malaria and is used in most hospitals in China. However, the current capacity of microscopists to manage malaria cases in hospitals and public health facilities to meet the surveillance needs to eliminate and prevent the reintroduction of malaria is unknown. METHODS: Malaria diagnoses were assessed by comparing the percentage of first visit and confirmed malaria diagnoses at Centers for Disease Control and Prevention (CDCs) and hospitals. The basic personnel information for public health departments and hospitals at different levels was investigated. The skills of microscopists for blood smear preparation and slide interpretation were also examined at the county and township levels. RESULTS: Inaccurate rate with 13.49% and 7.32%, respectively, in 2013 and 2014, from 341 and 355 reported cases from sub-provincial levels in Jiangsu province. Most of the 523 malaria cases reported in Nantong Prefecture from 2000 to 2014 involved patients who first visited county CDCs seeking treatment, however, none of these cases received confirmed diagnosis of malaria in townships or villages.The staff at county CDCs and hospitals with a higher education background performed better at making and interpreting blood smears than staff from townships. CONCLUSIONS: The network for malaria elimination in an entire province has been well established. However, an insufficient capacity for malaria diagnosis was observed, especially the preparing and reading the blood smears at the township and village levels, which is a challenge to achieving and maintaining malaria elimination.

Analysis of malaria cases re-examination results of malaria diagnostic reference laboratory in Nantong, Jiangsu / 中国热带医学

@#Abstract: Objective　To analyze the laboratory microscopic re-examination results of malaria cases in Nantong of the National Notifiable Disease Report System from 2014 to 2021 by Nantong Malaria Diagnostic Reference Laboratory, so as to evaluate the malaria diagnosis ability of Nantong Malaria Diagnostic Reference Laboratory. Methods　The blood smear and blood samples of malaria cases in Nantong from 2014 to 2021 of the National Notifiable Disease Report System were collected. Nantong Malaria Diagnostic Reference Laboratory and Jiangsu Institute of Parasitic Diseases carried out the re-examination of municipal and provincial laboratories, taking the results of provincial laboratory as the standard to compare and analyze the re-examination results of Nantong Malaria Diagnostic Reference Laboratory. Results　From 2014 to 2021, the two-level laboratories in Nantong city and Jiangsu Province re-examined the blood samples of 297 malaria cases. The microscopic examination and PCR re-examination results at the provincial level were the same：292 positive cases and 5 negative cases. The qualitative coincidence rate between Nantong microscopic re-examination results and the provincial re-examination results was 100% (297/297), without misjudgment and omission. The coincidence rate of Plasmodium typing was 96.23% (281/292). The coincidence rate of P. falciparum, P. vivax, P. ovale and P. malaria were 99.57% (234/235), 62.50% (5/8), 89.47% (34/38) and 72.73% (8/11) respectively. The consistency test results showed that the Kappa value of Plasmodium typing results between municipal and provincial laboratories was 0.89. The Kappa values of P. falciparum, P. vivax， P. ovale and P. malaria were 0.98, 0.58, 0.87 and 0.79 respectively. Conclusion　The malaria diagnosis ability of Nantong Malaria Diagnostic Reference Laboratory is generally good, and it is necessary to improve the ability of Plasmodium typing.

[Analysis of construction of microscopy ability for malaria in Nantong City, 2011].

OBJECTIVE: To understand the construction of the examination ability with microscopy for malaria at the beginning of the malaria elimination project in Nantong City, Jiangsu Province. METHODS: At all the medical and health institution levels, the construction of microscopy stations, the blood slide examiners, the hardware equipment, the microscopy skill training, and so on were investigated in 2011. RESULTS: There were 204 microscopy stations, 228 blood slide examiners, and 255 microscopes in Nantong City, 2011. Among 228 examiners, 225 persons (98.7%) received the theory and technical training, and the rate of eligibility was 98.4%. A total of 57 893 people received the blood examinations for malaria and the total population blood examination rate was 0.76%. In the re-examination in the microscopy stations of townships, the mean pass rates of blood slide making, dyeing, and cleanliness were 87.1%, 86.7% and 85.6%, respectively. Among 57 medical institutions, the mean pass rates were 86.8%, 86.0% and 85.0%, respectively. CONCLUSION: Most of the microscopy stations in Nantong City could well carry out the blood slide examinations for malaria. However, the construction of the examination ability and supervision still need to be enhanced.

[Analysis of imported falciparum malaria cases of Nantong City from 2001 to 2010].

OBJECTIVE: To analyze the characteristics of imported falciparum malaria cases of Nantong City in the recent ten years so as to provide the evidence for improving prevention and control of malaria in the future. METHODS: The data about imported falciparum malaria cases of Nantong City from 2001 to 2010 were collected and analyzed for the characteristics and distribution of the patients by the retrospective method. RESULTS; There were 79 imported falciparum malaria cases in the last 10 years. Totally 96.2% of patients were infected in Africa. Most of them were young people and worked for the construction services. Seasonal distribution difference was not obvious. CONCLUSIONS; The imported falciparum malaria epidemic is rising in Nantong City. Therefore, we should strengthen the anti-malaria health education to increase the self-protection of labors, and strengthen the training of medical stuff and also strengthen the monitoring of malaria epidemic.