Establishing a China malaria diagnosis reference laboratory network for malaria elimination

Jian-hai Yin, He Yan, Fang Huang, Mei Li, Hui-hui Xiao, Shui-sen Zhou, Zhi-gui Xia

BackgroundIn China, the prevalence of cases from malaria has reduced dramatically due to the malaria elimination programme. The continued success of the programme will depend upon the accurate diagnosis of the disease in the laboratory. The basic requirements for this are a reliable malaria diagnosis laboratory network, quality management system to support case verification and source tracking.MethodsThe baseline information of provincial malaria laboratories in the China malaria diagnosis reference laboratory network was collected and analysed, and a quality-assurance activity was carried out to assess the accuracy of malaria diagnosis by microscopy using WHO standards and PCR.ResultsAt the end of 2013, 19 of 24 provincial laboratories were included in the network. In total, 168 laboratory staff registered in the study and there was no bias in their age, gender, education level, and position. The staff generally identified Plasmodium species with great accuracy by microscopy and PCR. However, Plasmodium ovale was likely to be misdiagnosed as Plasmodium vivax by microscopy.ConclusionsChina has established a laboratory network for primary malaria diagnosis. However, this network should cover a larger area. Currently, Plasmodium species can be identified fairly accurately by microscopy and PCR. However, laboratory staff need additional training to accurately identify P. ovale microscopically and perform PCR operations for future quality control activities.