1. The malaria IQC serves as a milestone to improved accuracy in diagnosis of malaria parasites At Webuye District Hospital. INTRODUCTION The malaria microscopy training is the basis for ensuring control of malaria to a level that is not a public health problem. Epidemiologically pregnant women /under five children are at greatest risk of malaria. 20-45% of admissions in Kenya are due to malaria.25-35% of clinic /OPD (Out patient ) are due to malaria.96 Children die from malaria in Kenya daily. Each family spent kshs. 1400-1500 in treatment of malaria. 170 million days are lost annually each year.The broad objective of the study was to enhance quality results. The specific objective was to minimize errors in diagnosis of malaria.

2. METHOD The study site- Webuye District Hospital The study design – Cross sectional study Study method – Random sampling of 10 slides per week for a period of 3 months March –May 2014.Data presentation was in excel for window 2010 Data analysis was done in SPSS V 22 Data collection form was used as a research instrument

3. RESULTS Results of the first readers : was 27 positive then 93 negative. Results of the 2 nd readers:30 slides positive 90 negative Result of 3 rd reader: The 30 slides were confirmed positive,90 negative as for second reader. Malaria). The three slides were confirmed positive hence the second reader was correct.

4. MATERIALS / REAGENTS Microscope Mains electricity Slides oil immersion 2 tally counters – one for parasites and one for WBCS Electronic calculation A lab timer Record forms Pen Control slides Sops

5. Thick film examination 1.Placed the slide to be examined on the stage and positioned thick film in line with objective lens. 2.Placed a drop of immersion oil on the thick film and allowed it to spread 3.Using a pair x1- oculars and x40 objective scanned the film for microfilariae, other large parasites and obvious debris. Ensured flood instead of jar system of staining 4.Examined the thick film systematically starting at the X mark as shown below. + = 1- 10 parasites per 100 oil immersion fields ++= 11-100 parasites per 100 oil immersion thick film fields +++= 1-10 parasites per single oil immersion field ++++ = more than 10 parasites per single oil immersion field 5.Routine examination of a thick film is based on the examination of 100 good fields i.e a slide can be pronounced negative only when a minimum of 100 fields have been examined for presence of parasites.TIME allowed = 10 mins x

6. Examining the thin film 1.Placed the slide on the stage, sitting the x 100 oil immersion objective over the edge of middle of the thin film, shown by the x, mark on the diagram below. 2. Examined the film following the pattern of movement shown in the diagram,moving along inwards by one field, returning in a lateral movement. NB : Continue examining until the presence and species of malaria parasites have been identified, or up to 800 fields before declaring the slide negative. To obtain the same sensitivity as that of thick film at high power fields ( with x 100 oil immersion objective) for 10 min, you must examine a thin film for atleast 30 mins. Parasite count : Formular = number of parasites counted x 8000 No. of leucocytes = parasites per microlitre Mixed infection p.f +p.m 593 X 8000 = 23720µl 200 x

7. DISCUSSION The result above shows that of the 120 patients studied 30 were correctly diagnosed as positive and 90 as negative but there were 3 times discrepancy results as done by first reader whose sensitivity in 3 slides were poor. RECOMMEDATION 1.The Government should provide funding to all health facilities to change from old plus system reporting to current species identification. 2.All Lab technician /technologist should be trained in malaria microscopy 3.Should change from 15,12, 2µl to 12,6 & 2µl for thick and thin films respectively. 4.Preservation of +ve /- ve slides is essential i.e. 40 slides per month 5.Confirmation by 1 st and 2 nd readers is mandatory to ensure accurate diagnosis of malaria. 6.Should use flooding system in staining of mps instead of jar system 7.Change completely from field stain to Giemsa stain as way of life.

8. REFERENCES 1.WHO. Basic Malaria Microscopy : Part 1 learners guide : Part II Tutors Guide. Geneva, World Health Organization, 1991. 2.WHO, Malaria Microscopy quality assurance manual. Manila Western Pacific Regional Office, 2009