Is molecular biology the best alternative for diagnosis of malaria to microscopy? A comparison between microscopy,antigen detection and molecular tests in rural Kenya and urban Tanzania

OBJECTIVE: To assess the agreement of different diagnostic methods for the diagnosis and confirmation of the clinical suspicion of Plasmodium infection in children in Tanzania and Kenya. METHOD: Blood samples were collected by the finger prick method from 338 children. Blood samples were collected from 338 children with the clinical suspicion of uncomplicated malaria in health clinics in Tanzania and Kenya. The presence of Plasmodium parasites was assessed with microscopy, rapid diagnostic tests (RDTs) and the molecular assays, quantitative nucleic acid sequence based amplification (QT-NASBA) and polymerase chain reaction (PCR). The results were compared and analysed for agreement. RESULTS: There was a high degree of agreement (88.6-100%) between RDTs or molecular tests and microscopy. In rural Kenya, with a high incidence of malaria cases, the correlation coefficient ranged from 0.94 for RDTs to 0.76 for PCR. In urban Tanzania, where there was a low incidence of cases, R for RDTs was 1.0 but only 0.25 for PCR and 0.33 for NASBA. CONCLUSION: Malaria is overestimated if the diagnosis is based solely on clinical signs. Therefore, laboratory confirmation is essential. Microscopy is a reliable method in rural areas where malaria is prevalent, but RDTs offer a good alternative with the advantage that it is an easy and rapid method. Molecular tests are more sensitive but difficult to implement in rural areas. In areas with lower incidence, molecular tests detect a significantly higher number of Plasmodium infections than RDTs or microscopy. Although implementation of molecular tools can be difficult, the prospect of an easy and cheap detection system makes them promising tools for the near future.     

Comparison of three antigen detection methods for diagnosis and therapeutic monitoring of malaria: a field study from southern Vietnam

OBJECTIVES: To compare the sensitivity, specificity and post-treatment persistence of three commonly used rapid antigen detection methods. METHOD: We studied 252 Vietnamese patients aged from 4 to 60 years, 157 with falciparum and 95 with vivax malaria and 160 healthy volunteers. An initial blood sample was taken for microscopy, and OptiMAL, immunochromatographic test (ICT) malaria P.f./P.v. and Paracheck-Pf tests. Patients with falciparum malaria were treated with an artesunate-based combination regimen and those with vivax malaria received chloroquine. Eighty-seven patients with falciparum malaria who were initially positive for one of the antigen tests and who remained blood smear-negative underwent follow-up testing over 28 days. RESULTS: Paracheck-Pf was the most sensitive test for Plasmodium falciparum (95.8% vs. 82.6% for ICT malaria P.f./P.v. and 49.7% for OptiMAL). Specificities were all 100%. For vivax malaria, OptiMAL performed better than ICT malaria P.f./P.v. (sensitivities 73.7% and 20.0%, respectively), with 100% specificity in both cases. All tests had low sensitivities (< or = 75.0%) at parasitaemias < 1000/microl regardless of malaria species. During follow-up, Paracheck-Pf remained positive in the greatest proportion of patients, especially at higher parasitaemias (> 10,000/microl). Residual OptiMAL positivity occurred only in a relatively small proportion of patients (< 10%) with parasitaemias > 10,000/microl during the first 2 weeks after treatment. CONCLUSIONS: Although microscopy remains the gold standard for malaria diagnosis, Paracheck-Pf may prove a useful adjunctive test in uncomplicated falciparum malaria in southern Vietnam. OptiMAL had the lowest sensitivity for P. falciparum but it might have a use in the diagnosis of vivax malaria and perhaps to monitor efficacy of treatment for falciparum malaria where microscopy is unavailable.     

Bedside diagnosis of imported malaria using the Binax Now malaria antigen detection test

Malaria may be misdiagnosed in non-endemic countries when the necessary experience for rapid expert microscopy is lacking. Rapid diagnostic tests may improve the diagnosis and may play a role as a bedside diagnostic tool. In a multicentre study we recruited patients suspected of malaria over a period of 14 months. The Binax Now Malaria rapid test was used at the bedside and in the clinical microbiology laboratory. The training of clinical staff was monitored and their experience with the use of the test was recorded. 542 patients were included, 80 of whom had malaria diagnosed by microscopy. The rapid test used at the bedside had a sensitivity of 88% for the detection of P. falciparum compared to 95% when the test was performed in the microbiology laboratory. The risk of technical problems and invalid tests was highest when the test was used at the bedside. The rapid diagnostic test may be useful for the diagnosis of P. falciparum malaria when used by routine laboratory staff, but could lead to misdiagnoses when used at the bedside. Microscopy is still essential in order to identify the few missed diagnoses, to determine the degree of parasitaemia, and to ensure species diagnosis, including mixed infections.     

Informed decision-making before changing to RDT: a comparison of microscopy, rapid diagnostic test and molecular techniques for the diagnosis and identification of malaria parasites in Kassala, eastern Sudan

Objectives Rapid diagnostic tests (RDTs) are promoted for the diagnosis of malaria in many countries. The question arises whether laboratories where the current method of diagnosis is microscopy should also switch to RDT. This problem was studied in Kassala, Sudan where the issue of switching to RDT is under discussion. Methods Two hundred and three blood samples were collected from febrile patients suspected of having malaria. These were subsequently analysed with microscopy, RDT (SD Bioline P.f/P.v) and PCR for the detection and identification of Plasmodium parasites. Results Malaria parasites were detected in 36 blood samples when examined microscopically, 54 (26.6%) samples were found positive for malaria parasites by RDT, and 44 samples were positive by PCR. Further analysis showed that the RDT used in our study resulted in a relatively high number of false positive samples. When microscopy was compared with PCR, an agreement of 96.1% and k = 0.88 (sensitivity 85.7% and specificity 100%) was found. However, when RDT was compared with PCR, an agreement of only 81.2 and k = 0.48 (sensitivity 69% and specificity 84%) was found. Conclusion PCR has proven to be one of the most specific and sensitive diagnostic methods, particularly for malaria cases with low parasitaemia. However, this technique has limitations in its routine use under resource‐limited conditions, such as our study location. At present, based on these results, microscopy remains the best option for routine diagnosis of malaria in Kassala, eastern Sudan.     

The burden of pediatric HIV/AIDS in Constanta, Romania: a cross-sectional study

Background

Plasmodium falciparum malaria, is a major health problem in forested tribal belt of central India. Rapid and accurate methods are needed for the diagnosis of P. falciparum. We performed a blinded evaluation of the recently introduced Determine? malaria pf test (Abbott, Laboratories, Japan) compared with microscopy and splenomegaly in children in epidemic prone areas of district Mandla to assess the impact of intervention measures.

Methods

Children aged 2–10 yrs with and without fever were examined for spleen enlargement by medical specialist by establishing a mobile field clinic. From these children thick blood smears were prepared from finger prick and read by a technician. Simultaneously, rapid tests were performed by a field lab attendant. The figures for specificity, sensitivity and predictive values were calculated using microscopy as gold standard.

Results

In all 349 children were examined. The sensitivity and specificity for Determine rapid diagnostic test were 91 and 80% respectively. The positive predictive values (PPV), negative predictive values (NPV) and accuracy of the test were respectively 79, 91 and 85%. On the contrary, the sensitivity and specificity of spleen in detecting malaria infection were 57 and 74 % respectively with PPV of 73%, NPV 59 % and an accuracy of 65%.

Conclusions

Determine? malaria rapid diagnostic test is easier and quicker to perform and has other advantages over microscopy in not requiring prior training of personnel or quality control. Thus, highlighting the usefulness of a rapid antigen test in assessing prevailing malaria situation in remote areas.     

Diagnosis and management of malaria by rural community health providers in the Lao People's Democratic Republic (Laos)

We assessed the knowledge of malaria diagnosis and management by community health providers in rural Vientiane and Savannakhet Provinces, Lao PDR. Sixty health providers (17 pharmacy owners/drug sellers and 43 village health volunteers) were interviewed. All diagnosed malaria using symptoms and signs only; 14% were aware of >2 criteria for the diagnosis of severe malaria. Although chloroquine and quinine, the then recommended Lao national policy for uncomplicated malaria treatment, were the most common antimalarials prescribed - 65% gave incorrect doses and 70% did not know the side effects. Although not recommended by the then national policy, 27% of the health providers used combinations of antimalarials as they considered monotherapy ineffective. This study strongly suggests that further training of Lao rural health providers in malaria diagnosis and management is needed to improve the quality of health services in areas remote from district hospitals.     

Trial of the ParaSight‐F test for malaria diagnosis in the primary health care system, Zimbabwe

Rapid diagnosis of Plasmodium falciparum malaria remains one of the main limitations to prompt treatment. Diagnosis based on clinical symptoms is decidedly unreliable, especially in areas of seasonal transmission like Zimbabwe. In view of this, the Plasmodium falciparum histidine‐rich protein (HRP‐II) antigen detection assay ( Para Sight‐F test) was tried at 10 health centres in 3 malaria endemicity zones of Zimbabwe, as a malaria diagnostic tool for primary health care. Parasitological evaluations were conducted using thick and thin film microscopy as gold standard, and ease of test operation and practicability to nurses were ascertained by questionnaire. The sensitivity of the test did not vary substantially by endemicity zone and was ≈93%. Specificities were 85, 72 and 92% in the hyperendemic, mesoendemic and hypoendemic zones, respectively. Positive predictive values varied considerably with endemicity, the lowest being in the hypoendemic zone (56%). However, negative predictive values did not change significantly, with a mean of 94%. It was found that the Para Sight‐F test reduced mistreatment for malaria, relative to clinical diagnosis, by up to 81%, especially in the hypoendemic region. Test acceptability evaluations were good.     

Paracheck-Pf: a new, inexpensive and reliable rapid test for P. falciparum malaria

We compared the performance of Paracheck-Pf, a new and cheap rapid malaria test, with ICT-Pf/PvR and microscopy in two malaria surveys in Thai villages on the Thai-Burmese border. The specificity, sensitivity, predictive positive and negative values of the Paracheck-PfR and ICT-PfR tests were calculated taking microscopy results as the gold standard. The 294 ICT-Pf/Pv tests resulted in two invalid (no control line) and 11 doubtful results. Both the ICT-Pf/PvR and Paracheck-PfR tests reliably detected P. falciparum infections. However, Paracheck-PfR failed to detect three P. falciparum cases and likewise, ICT-Pf/PvR failed to detect the same three cases and an additional four cases. These seven cases were detected by microscopy and had a parasitaemia under 150 parasites/microl. At a cost of c. US $1.00, the Paracheck-PfR test, based on the detection of the P. falciparum specific HRP-2 protein, is a reliable, easy to use and affordable tool for the diagnosis of P. falciparum malaria.     

Health workers' use of malaria rapid diagnostic tests (RDTs) to guide clinical decision making in rural dispensaries, Tanzania

Rapid diagnostic tests (RDTs) were developed as an alternative to microscopy for malaria diagnosis. The RDTs detect malaria parasite antigen(s) in whole blood with high sensitivity and specificity. We assessed health worker malaria treatment practices after the introduction of RDTs in peripheral health facilities without microscopy. From December 2007 to October 2008, we introduced histidine-rich protein II (HRP-2)-based ParaHIT RDTs for routine use in 12 health facilities in Rufiji District, Tanzania. Health workers received training on how to perform RDTs for patients 5 years of age or older with fever or suspected malaria. Children < 5 years of age were to be treated empirically per national guidelines. Among the 30,195 patients seen at these 12 health facilities, 10,737 (35.6%) were tested with an RDT for malaria. 88.3% (9,405/10,648) of tested patients reported fever or history of fever and 2.7% (289/10,677) of all tested individuals were children < 5 years of age. The RDT results were recorded for 10,650 patients (99.2%). Among the 5,488 (51.5%) RDT-positive patients, 5,256 (98.6%) were treated with an appropriate first-line antimalarial per national guidelines (artemether-lumefantrine or quinine). Among the 5,162 RDT-negative patients, only 205 (4.0%) were treated with an antimalarial. Other reported treatments included antibiotics and antipyretics. Implementation of RDTs in rural health facilities resulted in high adherence to national treatment guidelines. Patients testing negative by RDT were rarely treated with antimalarials. Unapproved antimalarials were seldom used. Health workers continued to follow guidelines for the empiric treatment of febrile children.     

Challenges in routine implementation and quality control of rapid diagnostic tests for malaria--Rufiji District, Tanzania

Rapid diagnostic tests (RDTs) represent an alternative to microscopy for malaria diagnosis and have shown high sensitivity and specificity in a variety of study settings. Current World Health Organization (WHO) guidelines for quality control of RDTs provide detailed instructions on pre-field testing, but offer little guidance for quality assurance once RDTs are deployed in health facilities. From September 2006 to April 2007, we introduced a histidine-rich protein II (HRP2)-based RDT (Paracheck) for suspected malaria cases five years of age and older in nine health facilities in Rufiji District, Tanzania, to assess sensitivity and specificity of RDTs in routine use at rural health facilities. Thick blood smears were collected for all patients tested with RDTs and stained and read by laboratory personnel in each facility. Thick smears were subsequently reviewed by a reference microscopist to determine RDT sensitivity and specificity. In all nine health facilities, there were significant problems with the quality of staining and microscopy. Sensitivity and specificity of RDTs were difficult to assess given the poor quality of routine blood smear staining. Mean operational sensitivity of RDTs based on reference microscopy was 64.8%, but varied greatly by health facility, range 18.8-85.9%. Sensitivity of RDTs increased with increasing parasite density. Specificity remained high at 87.8% despite relatively poor slide quality. Institution of quality control of RDTs based on poor quality blood smear staining may impede reliable measurement of sensitivity and specificity and undermine confidence in the new diagnostic. There is an urgent need for the development of alternative quality control procedures for rapid diagnostic tests that can be performed at the facility level.     

Malaria self-testing by travellers: opportunities and limitations

Accurate and timely treatment of imported malaria requires rapid and reliable diagnosis. The availability of a rapid and reliable diagnostic test could improve the quality of malaria diagnosis in febrile travelers after their return to non-endemic countries. Rapid and simple immuno-chromatographic tests have been marketed for several years. Dipstick tests for malaria diagnosis are still a potentially very useful additional tool. Trained laboratory personal have in general no problems in doing the tests. Also, the dipsticks are very valuable tools for use in epidemiological field studies. However, sensitivity and specificity of dipstick tests are still below that of trained microscopists. Exclusion of malaria should never be based on a negative dipstick test alone. Self-use of dipstick tests for malaria diagnosis by travelers should not be recommended routinely as there is enough evidence that performance and interpretation of results by the traveler is uncertain. Dipstick tests can only be recommended to travelers for specific situations (i.e. long term stay, far away from medical assistance, expedition-type travel) after appropriate instruction and training, including a successful performance of the test procedure.     

中缅边境缅方瓦族村寨疟疾病例的主动侦察

目的 探讨通过主动病例侦察,加强资源匮乏高疟区的疟疾监测和防治服务.方法 逐个访问高疟村寨,寻找1周内发过烧的"四热"患者,使用疟疾快速诊断检测疟原虫抗原.结果 发现和血检发热患者453例,2年疟史率77.92%;确诊疟疾270例,其中恶性疟243例,问日疟20例和三日疟7例;阳性率59.6%,恶性疟比例90.00%;当地仍为高度地方性疟疾流行区.结论 在缺乏基本医疗卫生服务的高疟区,主动病例侦察应该是有效的疟疾监测和防治方法之一.     

Effects of revised diagnostic recommendations on malaria treatment practices across age groups in Kenya

Objective The recent change of treatment policy for uncomplicated malaria from sulfadoxine‐pyrime‐thamine to artemether‐lumefantrine (AL) in Kenya was accompanied by revised malaria diagnosis recommendations promoting presumptive antimalarial treatment in young children and parasitological diagnosis in patients 5 years and older. We evaluated the impact of these age‐specific recommendations on routine malaria treatment practices 4–6 months after AL treatment was implemented. Methods Cross‐sectional, cluster sample survey using quality‐of‐care assessment methods in all government facilities in four Kenyan districts. Analysis was restricted to the 64 facilities with malaria diagnostics and AL available on the survey day. Main outcome measures were antimalarial treatment practices for febrile patients stratified by age, use of malaria diagnostic tests, and test result. Results Treatment practices for 706 febrile patients (401 young children and 305 patients ≥5 years) were evaluated. 43.0% of patients ≥5 years and 25.9% of children underwent parasitological malaria testing (87% by microscopy). AL was prescribed for 79.7% of patients ≥5 years with positive test results, for 9.7% with negative results and for 10.9% without a test. 84.6% of children with positive tests, 19.2% with negative tests, and 21.6% without tests were treated with AL. At least one antimalarial drug was prescribed for 75.0% of children and for 61.3% of patients ≥5 years with a negative test result. Conclusions Despite different recommendations for patients below and above 5 years of age, malaria diagnosis and treatment practices were similar in the two age groups. Parasitological diagnosis was under‐used in older children and adults, and young children were still tested. Use of AL was low overall and alternative antimalarials were commonly prescribed; but AL prescribing largely followed the results of malaria tests. Malaria diagnosis recommendations differing between age groups appear complex to implement; further strengthening of diagnosis and treatment practices under AL policy is required.     

Sensitive detection and accurate monitoring of Plasmodium vivax parasites on routine complete blood count using automatic blood cell analyzer (DxH800(TM))

Introduction: Plasmodium vivax malaria is one of the most important infectious diseases plaguing humanity and causes significant mortality and morbidity worldwide. The gold standard of P. vivax malaria diagnosis is the microscopy of blood smears. Although microscopy is a rapid, cost‐effective, and readily applicable method, it has many disadvantages, including low sensitivity, specificity, and precision. Therefore, there is a clear need for an effective screening test for P. vivax malaria detection both in high‐prevalence areas and developed countries. Methods: A total of 1761 complete blood count (CBC) samples generated by the automated hematology analyzer (DxH 800?; Beckman Coulter Inc., Miami, FL, USA) were retrospectively analyzed. The sample pool contained 123 samples from 52 P. vivax malaria patients and 1504 nonmalarial samples including 509 patients with leukopenia (white blood cell <2000/μL) and 134 normal subjects. Results: The P. vivax malaria samples exhibited easily recognizable typical malaria signals on the nucleated red blood cell (nRBC) plots (sensitivity 100%) in DxH 800?. All 1504 samples without P. vivax infection were negative for malaria signal (specificity 100%). The size of P. vivax malaria signals correlated roughly with the parasite burden. Conclusion: DxH800? provides very sensitive and specific, easily recognizable P. vivax malaria signals on routine CBC without need for the additional reagents or special procedures.     

2012-2013年扬州市输入性疟疾防治管理效果评估

的 评估扬州市输入性疟疾防治管理效果,为制定输入性疟疾防控策略提供参考依据。方法 统计2012-2013年扬州市劳务输出及回国发热人员疟原虫血检率、疟疾病例中实验室确诊病例比例、恶性疟病例发病24 h内得到规范治疗的比例以及劳务输出信息平台建立情况等,对扬州市输入性疟疾防治管理效果进行综合分析评价。结果 2012-2013年扬州市共报告输入性疟疾82例。全市7个县（市、区）均开展了劳务输出及回归人员监测,覆盖率为100%。2012-2013年共有劳务输出人员5 808人次,其中接受医学提醒5 575人次,服务覆盖率达95.99%;5 808名劳务输出人员中有5 525人接受健康行为,健康行为养成率达95.13%。对全市153个镜检站以及医疗、疾控专业人员进行疟疾镜检培训,两年累计达410人,培训覆盖率达100%。82例输入性疟疾病人从发病到初诊时间平均为2.5 d,从发病到确诊时间平均为2.75 d;所有病人均治愈出院,救治康复率为100%;初诊血检78人,初诊血检率为95.12%。78例初检血检均检出疟原虫,血检确诊率为100%;69例恶性疟报告病例均得到实验室确诊。69例恶性疟病例在初诊后24 h内得到规范治疗的有58例,占84.06%。结论 扬州市输入性疟疾防治管理效果明显,但仍需加强对劳务输出人员的健康教育以及对医务人员的培训,以进一步防控输入性恶性疟。     

合肥市1例输入性卵形疟病例分析

目的　对合肥市1例输入性卵形疟病例进行流行病学调查和实验室诊断分析,为今后预防控制输入性疟疾提供参考依据。方法　对该例输入性卵形疟患者的流行病学史、诊疗经过等资料进行收集、整理和分析。结果　患者从非洲莫桑比克务工返乡,回国数月后因反复发热就医。快速诊断试纸条法（RDT）提示为非恶性疟原虫感染;镜检见被感染红细胞正常大小或略胀大、锯齿状不明显,大滋养体胞浆增多、形态不规则、基本无空泡。荧光定量PCR确诊该病例为卵形疟原虫感染。结论　临床医务人员应加强对有境外流行区生活及工作史人员的疟疾诊断意识,及时早期合理用药,防止疟疾疫情扩散。     

Nonmalarial acute undifferentiated fever in a rural hospital in central India: diagnostic uncertainty and overtreatment with antimalarial agents

Nonmalarial acute undifferentiated fever (NMAUF) refers to a febrile illness with no indication of an organ-specific disease after diagnosis of malaria has been excluded. In developing countries, the empirical treatment of NMAUFs with antimalarial drugs continues even in the era of highly specific rapid diagnostic tests (RDTs) for malaria. We carried out a retrospective review of patients with fever admitted to a rural teaching hospital in central India. We categorized patients with NMAUF into different clinical syndromes and determined their demographic profile, inhospital course, and the pattern of antimalarial use. The study sample included 1,197 adult patients who were investigated for malaria; 1,053 (88%) of them had NMAUF, and use of further diagnostics in this group was limited. Despite one or more negative tests for malaria, many patients (39.9%, 95% CI 37.0-43.3) received antimalarial drugs. These results suggest a need for guidelines and training to improve empirical treatment of NMAUF.     

Cost-Effectiveness Analysis of Introducing RDTs for Malaria Diagnosis as Compared to Microscopy and Presumptive Diagnosis in Central and Peripheral Public Health Facilities in Ghana

Cost-effectiveness information on where malaria rapid diagnostic tests (RDTs) should be introduced is limited. We developed incremental cost-effectiveness analyses with data from rural health facilities in Ghana with and without microscopy. In the latter, where diagnosis had been presumptive, the introduction of RDTs increased the proportion of patients who were correctly treated in relation to treatment with antimalarials, from 42% to 65% at an incremental societal cost of Ghana cedis (GHS)12.2 (US$8.3) per additional correctly treated patients. In the “microscopy setting” there was no advantage to replacing microscopy by RDT as the cost and proportion of correctly treated patients were similar. Results were sensitive to a decrease in the cost of RDTs, which cost GHS1.72 (US$1.17) per test at the time of the study and to improvements in adherence to negative tests that was just above 50% for both RDTs and microscopy.     

Performance of OptiMAL-IT® compared to microscopy, for malaria detection in Burkina Faso

Objective  To compare the performance of OptiMAL-IT^®, a rapid diagnostic test for malaria, with that of microscopy in Burkina Faso.
Method  Finger-prick blood samples of 464 children attending hospital for suspected malaria were tested for malaria by microscopy and OptiMAL-IT^®.
Results  The sensitivity and specificity of OptiMAL-IT^® were 98.7% (CI 95% = 97.6–99.8) and 96.2% (CI 95% = 94.3–98.1) respectively, with a high positive likelihood ratio (25.97).
Conclusion  OptiMAL-IT^® can be considered a good method to diagnose malaria in Burkina Faso, particularly in remote areas with little or no access to microscopy services.     

2015-2016年云南省疟疾实验室诊断质量及影响因素分析

目的 对云南省2015-2016年网报疟疾病例的实验室诊断质量和影响因素进行分析。方法 收集云南省2015-2016年疟疾网报病例,使用显微镜检法和nested-PCR法对样本进行疟原虫诊断核实。计算收样率、符合率、病例就诊所需时间和血片制作评分,利用卡方检验、单因素方差分析对率或均数的差异进行统计分析,分析网报病例质量;利用单因素Logistic回归对影响病例诊断质量的因素进行分析。结果 2015-2016全省疟疾网报病例的收样率为92.15%,收样覆盖全省15个州市。疟疾病例发病到就诊所需要的平均时间为(5.1±6.6)d。全省2015和2016年疟疾网报病例检测与省级疟疾参比诊断实验室镜检和nested-PCR检测阳性的符合率分别为97.1%, 95.1%,95.1%, 95.1%;虫种检测符合率分别为93.1%, 92.3%,91.3%和91.3%。位于边境地区的报告单位诊断水平较高,乡镇卫生院对虫种的诊断结果较为准确,省级疟疾诊断参比实验室较其他报告单位更易检出恶性疟和间日疟的混合感染。全省各级报告单位的血涂片制作平均分为79.18±8.84,且2016年的平均得分高于2015年。单因素Logistic回归结果表明,疟疾病例发病到就诊所需的时间,报告单位的类型及报告单位是否位于边境地区都影响疟疾病例诊断的质量。结论 2015-2016年云南省疟疾网报病例的诊断质量总体较高,各级诊断水平比较稳定。但是,在消除疟疾阶段,应该探讨以防治带动培训,以培训促进提高为目的 的多种方式结合的疟疾防治手段,重视持续加强和保持各地各级疾病防治部门对疟疾的综合防治能力。