Background: In Angola, malaria is an endemic disease having a major impact on the economy. The WHO
recommends testing for all suspected malaria cases, to avoid the presumptive treatment of this disease. In malaria
endemic regions laboratory technicians must be very comfortable with microscopy, the golden standard for malaria
diagnosis, to avoid the incorrect diagnosis. The improper use of medication promotes drug resistance and undesirable
side effects. The present study aims to assess the impact of a three-day refresher course on the knowledge of
technicians, quality of blood smears preparation and accuracy of microscopy malaria diagnosis, using qPCR as
reference method.
Methods: This study was implemented in laboratories from three hospitals in different provinces of Angola: Bengo,
Benguela and Luanda. In each laboratory samples were collected before and after the training course (slide with thin
and thick blood smears, a dried blood spot and a form). The impact of the intervention was evaluated through a
written test, the quality of slide preparation and the performance of microscopy.
Results: It was found a significant increase on the written test median score, from 52.5% to 65.0%. A total of 973 slides
were analysed to evaluate the quality of thick and thin blood smears. Considering all laboratories there was a
significant increase in quality of thick and thin blood smears. To determine the performance of microscopy using qPCR
as the reference method we used 1,028 samples. Benguela presented the highest values for specificity, 92.9% and
98.8% pre and post-course, respectively and for sensitivity the best pre-course was Benguela (75.9%) and post-course
Luanda (75.0%). However, no significant increase in sensitivity and specificity after the training course was registered in
any laboratory analysed.
Discussion: The findings of this study support the need of continuous refresher training for microscopists and other
laboratory staff. The laboratories should have a quality control programme to supervise the diagnosis and also to assess
the periodicity of new training. However, other variables needed to be considered to have a correct malaria diagnosis,
such as adequate equipment and reagents for staining and visualization, good working conditions, motivated and
qualified personnel.