AUTHOR=Zhang Xuan , Jiang Jingjing , Sui Yuan , Yan Hui , Xia Jing , Liu Ying , Sun Lingcong , Wang Xiaoxiao , Marfurt Jutta , Lu Shenning , Li Shizhu , Ruan Wei , Wang Duoquan 

TITLE=Evaluation of performance for malaria diagnosis in health facilities by five provincial reference laboratories of China

JOURNAL=Frontiers in Public Health

VOLUME=11

YEAR=2023

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2023.1243642

DOI=10.3389/fpubh.2023.1243642

ISSN=2296-2565

ABSTRACT=<sec id="sec1"><title>Introduction</title><p>The provincial malaria diagnosis reference laboratories review and assess malaria cases diagnosed in health facilities for supporting the malaria elimination efforts and preventing re-transmission of imported malaria. The study aimed to evaluate the detection capability of malaria diagnosis in China from 2014 to 2021.</p></sec><sec id="sec2"><title>Methods</title><p>Data on malaria cases reported in the provincial-level administrative divisions (PLADs) of Anhui, Henan, Hubei, Guangxi, and Zhejiang from 2014 to 2021 were collected and analyzed.</p></sec><sec id="sec3"><title>Results</title><p>In total, 5,770 malaria cases were reported from 2014 to 2021, and 99.05% (5,715/5,770) were submitted to the provincial malaria diagnosis reference laboratories. The median time between malaria cases being reported and the samples being received by reference laboratories was 6 days (Interquartile range, IQR:3–12 days) from 2017 to 2021. Diagnosis of 5,680 samples in the laboratory were confirmed by provincial reference laboratories, including 3,970 cases of <italic>Plasmodium falciparum</italic>, 414 of <italic>P. vivax</italic>, 1,055 of <italic>P. ovale</italic>, 158 of <italic>P. malariae</italic>, 1 of <italic>P. knowlesi</italic>, and 82 of mixed infections. <italic>Plasmodium</italic> species of 5,141 confirmed cases were consistent with the initial diagnosis, with a species accuracy rate of 90.53% (5,141/5,679). The accuracy of <italic>P. falciparum</italic> diagnosis in health facilities was higher than that of non-falciparum species. The inconsistency between microscopy and nested polymerase chain reaction (nPCR) results of confirmatory diagnosis was mainly in malaria-positive versus malaria-negative cases, as well as in mixed versus single infection cases.</p></sec><sec id="sec4"><title>Conclusion</title><p>The provincial malaria diagnosis reference laboratories have played an important role in ensuring the accuracy and reliability of <italic>Plasmodium</italic> diagnosis in health facilities. However, the results of this study imply that capacity training for the identification of <italic>Plasmodium</italic> species in health facilities is warranted.</p></sec>