Performance assessment of laboratory professionals on malaria smear microscopy and associated factors in West Oromia malaria external quality assessment centers, Ethiopia 2025

Ensuring competency among laboratory personnel is crucial for accurate malaria microscopy. Accurate laboratory diagnosis is essential for effective treatment, reducing drug resistance, and guiding proper care. Yet, with malaria diagnostic responsibilities for laboratory professionals, concerns have emerged about their proficiency, especially in regions like West Oromia. Misdiagnosis and poor diagnostic quality of malaria microscopy in the area pose significant risks to patient outcomes and public health efforts. A cross-sectional study design was conducted among 131 laboratory professionals from 25 external quality assessment centers in West Oromia between January and March 2025. Demographic data were collected using a self-administered questionnaire. Each professional was assessed using 10 pre-validated malaria slide panels focusing on malaria parasite detection, species differentiation, and parasite quantification. Data were entered in EpiData and analyzed using SPSS version 20. Descriptive statistics summarized the findings, and diagnostic performance metrics were calculated. Bivariate analysis (p < 0.25) identified candidates for multivariate logistic regression, where p < 0.05 indicated statistical significance. The acceptable proficiency test result was 62.6%, with high sensitivity (95.7%) and specificity (96.2%), strong overall agreement (95%) and a high kappa value (k = 0.91). Agreement in the identification of different malaria species was 69%, with a kappa value of 0.52, reflecting moderate concordance. Parasite quantification by laboratory professionals was very low, with only 3.1% counting parasites within the expected range. Multivariate analysis revealed that holding a Diploma/Level 4 education in Medical Laboratory Technology (AOR = 4.87; 95% CI 1.5–15.6; p < 0.05) and the lack of training among professionals within the past three years (AOR = 27.3; 95% CI 8.1–91.6; p < 0.001) were significantly associated with the unacceptable diagnostic performance of laboratory professionals in diagnosing malaria smear microscopy. Malaria microscopy diagnostic assessments conducted by laboratory professionals demonstrated high accuracy in parasite detection, moderate agreement in species identification, and very low accuracy in parasite quantification. Unacceptable diagnostic performance was associated with Diploma/Level 4 education in Medical Laboratory Technology and lack of recent malaria microscopy training. These findings highlight the need for targeted refresher training and promotion of higher education to improve the diagnostic accuracy of malaria microscopy.