{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T23:07:25Z","timestamp":1788217645633,"version":"build-2803163510"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"vor","delay-in-days":39,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Malar J"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Although rapid diagnostic tests (RDTs) are widely used for malaria diagnosis, they have notable limitations. Blood smear (BS) microscopy remains the gold standard, yet its reliability in public health facilities (HFs) across malaria-endemic regions of Kenya can be compromised by limited infrastructure, technical capacity, and quality assurance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We assessed the quality of malaria microscopy in 29 HFs in Siaya County, western Kenya, from January\u2013July 2024 by evaluating the concordance of routine HF BS results with expert microscopy. We evaluated the availability and quality of reagents, standard operating procedures, and infrastructure using the National Malaria Control Program (NMCP) technical supervision checklist which follows WHO-certified microscopy standards. Up to 60 participant slides were randomly selected over three visits and two slides were prepared for each participant. Slide 1 was prepared and read on-site as per routine HF practice, then re-examined by an expert microscopist using the HF microscope and again at the Kenya Medical Research Institute (KEMRI). Slide 2 was stained and read at KEMRI, serving as the gold standard. We evaluated factors and characteristics associated with accurate diagnosis using logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 1,494 blood smears examined, 501 (34%) were positive. Concordance between routine microscopy and expert re-reading was 91% (1,289\/1,414), ranging from 55% (6\/11) to 100% (60\/60) across health facilities. Percent agreement between HF slide 1 and slide 2 was 86% (1,276\/1,485), with a range from 55% (6\/11) to 98% (39\/40) by HF. Compared to slide 2, sensitivity and specificity of HF results was 76% and 92%, respectively, resulting in undertreatment of 24% and overtreatment of 8% of patients. Those with parasitemia 1\u2013100\u00a0p\/\u03bcL had lower odds of accurate diagnosis (OR\u2009=\u20090.12; 95% CI: 0.05\u20130.29; p\u2009&lt;\u20090.001) while specimens with parasite densities &gt;\u200910,000\u00a0p\/\u03bcL had higher odds of accurate diagnosis (OR\u2009=\u20096.08; 95% CI: 2.22\u201325.1; p\u2009=\u20090.002), indicating a positive association between parasite density and diagnostic accuracy. Six (21%) of HFs had poor quality BS with debris or contamination.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>While overall concordance was high, the variability in results by HF, limited accuracy at low parasite densities, and challenges with required infrastructure highlight the need for ongoing malaria microscopy quality assurance to ensure proper case management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12936-026-05886-0","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T17:34:17Z","timestamp":1775756057000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Malaria microscopy evaluation and quality assurance in rural clinics of Rarieda and Alego Usonga sub-counties of Siaya County, western Kenya"],"prefix":"10.1186","volume":"25","author":[{"given":"Jonathan S.","family":"Schultz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Towett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kizito","family":"Obiet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Seda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kephas","family":"Otieno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dennis","family":"Omondi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wycliffe","family":"Odongo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Seffren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philemon","family":"Wafula","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eunice","family":"Oreri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel P.","family":"McDermott","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah G.","family":"Staedke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Titus K.","family":"Kwambai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Kariuki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie R.","family":"Gutman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,9]]},"reference":[{"key":"5886_CR1","volume-title":"World malaria report 2023","author":"WHO","year":"2023","unstructured":"WHO. World malaria report 2023. Geneva: World Health Organization; 2023."},{"key":"5886_CR2","volume-title":"World malaria report 2024","author":"WHO","year":"2024","unstructured":"WHO. World malaria report 2024. Geneva: World Health Organization; 2024."},{"key":"5886_CR3","unstructured":"Kenya Malaria Policy 2024. Second edition: Ministry of Health, National Malaria Control Programme; 2024."},{"key":"5886_CR4","unstructured":"Kenya Malaria Indicator Survey 2020. Nairobi, Kenya and Rockville, Maryland, USA: DNMP and ICF: Division of National Malaria Programme (DNMP) [Kenya] and ICF; 2020."},{"key":"5886_CR5","unstructured":"Global technical strategy for malaria 2016\u20132030, 2021 update. Geneva: World Health Organization; 2021."},{"key":"5886_CR6","unstructured":"WHO \u2013 Global Malaria Programme. https:\/\/www.who.int\/teams\/global-malaria-programme\/case-management\/diagnosis\/microscopy."},{"key":"5886_CR7","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00250-20","volume":"34","author":"M Plucinski","year":"2021","unstructured":"Plucinski M, Aidoo M, Rogier E. Laboratory detection of malaria antigens: a strong tool for malaria research, diagnosis, and epidemiology. Clin Microbiol Rev. 2021;34:e0025020.","journal-title":"Clin Microbiol Rev"},{"key":"5886_CR8","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-017-2018-2","volume":"16","author":"F Odhiambo","year":"2017","unstructured":"Odhiambo F, Buff AM, Moranga C, Moseti CM, Wesongah JO, Lowther SA, et al. Factors associated with malaria microscopy diagnostic performance following a pilot quality-assurance programme in health facilities in malaria low-transmission areas of Kenya, 2014. 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Geneva: World Health Organization; 2018."}],"container-title":["Malaria Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12936-026-05886-0","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12936-026-05886-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12936-026-05886-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T02:11:04Z","timestamp":1779070264000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12936-026-05886-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,9]]},"references-count":26,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["5886"],"URL":"https:\/\/doi.org\/10.1186\/s12936-026-05886-0","relation":{},"ISSN":["1475-2875"],"issn-type":[{"value":"1475-2875","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,9]]},"assertion":[{"value":"18 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"Informed and written consent was obtained from all participants (or parent\/guardian of participants aged <\u200918) and written assent was obtained from all participants aged 13 to 17. Consent\/assent was obtained in either English, Kiswahili, or DhuLuo languages according to the participant\u2019s preference. The health facility surveillance protocol was reviewed and approved by KEMRI (#2809), CDC (#6733) and LSTM (#15-003) Institutional Review Boards.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the U.S. Centers for Disease Control and Prevention.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclaimer"}}],"article-number":"211"}}