How E8 countries and partners will enhance diagnosis systems for malaria elimination
E8 countries, with strong technical guidance from WHO, are designing joint efforts to establish systems for quality assured diagnosis, which is a key requirement for elimination
Diagnosis is playing an increasingly central role in the malaria elimination strategies of the E8 countries, particularly because it is a critical input into the effective functioning of a “sensitive” surveillance system. Surveillance systems among the E8 countries (the front-line countries, and at a sub-national level in some of the second line countries such as Zimbabwe) are building up their surveillance systems to be able to detect and record all infections – that is, both symptomatic and asymptomatic cases. In these countries, the quality of diagnosis therefore becomes the rate-limiting factor in a system of activities designed to identify, report, and treat all infections, and to ultimately interrupt local transmission. As resources for elimination are constrained, the ability to accurately diagnose infections also supports efficient use of resources, as well as more rational allocation of resources.
However, the performance and quality of malaria diagnosis among the E8 countries remains a priority area for improvement. The eight countries are at various stages of renovating their diagnosis systems; they are working with WHO and technical partners to develop guidelines, determining the specific roles of the different diagnostic tools within their respective settings, training health care workers (HCWs) on the use of new diagnostic tools, and also reinforcing HCW confidence in new tools. While continued work is done globally to introduce new tools for diagnosis, significant systemic gaps remain in the objective to ensure quality assured diagnosis that supports case management, as well as surveillance for elimination.
The E8 partnership, guided by the WHO and E8 Diagnosis and Case Management Technical Working Group, is working towards a coordinated approach to establishment of the requisite skills to implement quality assurance according to common standards. Malaria microscopy QA programmes play a role where the need for reliable and accurate identification of malaria parasites in low density infections is critical. In addition, there is need for national core groups of certified, expert microscopists to spearhead quality assurance programmes, including validating of rapid diagnostic tests kits (RDTs), and conducting competence-based malaria microscopy refresher training.
World Health Organization is working with E8 countries to strengthen diagnosis capacity, including training and accreditation of expert technicians to lead quality assurance in countries, establishment of a regional slide bank, and development of local capacity for more advanced diagnostic techniques.