Early diagnosis and rapid treatment is one of the key interventions to reduce mortality and morbidity from malaria. According to the World Malaria Report 2019, Indonesia has succeeded in reducing the number of malaria cases from 465 764 cases in 2010 to 190 522 in 2018, and the number of malaria deaths from 432 to 34 in the same period. Parasitology confirmation using light microscopy examination is still the gold standard for malaria diagnosis. To ensure accurate diagnosis, WHO recommends conducting regular competency assessment for microscopists from malaria healthcare facilities from district to national level. On 10-14 and 17-21 February 2020, WHO supported the Indonesia Ministry of Health (MoH) to conduct two batches of External Competency Assessment for Malaria Microscopists (ECAMM) to examine a core group of 24 national microscopists from across the country.
Twelve microscopists were assessed in Jakarta from 10-14 February and a further 12 participants were assessed in Denpasar from 17-21 February 2020. An external certified assessor from MoH Malaysia conducted the ECAMM, which resulted in 17 microscopists certified level 1, six certified level 2 and one certified level 3.
Level 1 certification is the highest level of competence that a microscopist can obtain if they achieve 90% or more accuracy for species detection and species identification, and 50% or more accuracy in parasite count which must be within 25% of the true count. This level is a pre-requisite for microscopy diagnosis in clinical trial studies or monitoring antimalarial drug efficacy.
Microscopists who are certified level 1 or 2 are eligible through the National Malaria Control Program to become national trainers or assessors. This level is also considered gold standard for cross checking blood smears in their respective provinces. The newly certified microscopists of this level will now participate in further training of trainers to junior malaria microscopists at province and district health facilities.
Caption: ECAMM 2020 is held in two batches, one in Jakarta on 10-14 Feb 2020 and one in Bali on 17-21 Feb 2020, respectively. Total 24 top microscopists all over the country were assessed for their competency level. Credit: WHO/Jessica/2020
To maintain the competency level of microscopists, it is essential to have effective skill-based trainings and periodic assessment or monitoring of performance. As per WHO standards, WHO has supported ECAMM activities in Indonesia annually from 2015, during which time 83 microscopists from health laboratories and national institutes of research and development have been successfully assessed. Over four years, 38 microscopists have achieved level 1 (expert), 27 have achieved level 2 (references), and 18 microscopists have received certificates of participation.
In accordance with the guidelines of malaria microscopy quality assurance, which were introduced by WHO in 2016, the certification of the microscopists is valid for 3 years. In collaboration with WHO, the MoH of Indonesia plans to continue strengthening the quality assurance system of malaria diagnosis, thereby maximizing diagnostic accuracy across the country and further reducing cases of malaria-related deaths.
Main image caption: A microscopists reads malaria slides during the External Competency Assessment for Malaria Microscopists (ECAMM). Credit: WHO/Jessica/2020