PERFORMANCE ASSESSMENT OF LABORATORY PROFESSIONALS ON MALARIA SMEAR MICROSCOPY AND ASSOCIATED FACTORS IN WEST OROMIA MALARIA EXTERNAL QUALITY ASSESSMENT CENTERS, ETHIOPIA 2024/2025

Abstract Background: External Quality Assessment (EQA) allows health facilities to assess their capabilities by comparing their results with those of other laboratories in the network. Maintaining a proper setting and competency standards for laboratory personnel to ensure skills and best practices are vital to malaria microscopy performance. Objective: This study evaluated the performance assessment of laboratory professionals in diagnosing malaria smear microscopy and associated factors in West Oromia 2024/25 Malaria External Quality Assessment Centers. Methods: A cross-sectional study design was employed among 131 laboratory professionals working at 25 Malaria EQA centers in the west Oromia region from January to March 2025. Information on demographic characteristics was collected using a self-administered questionnaire. A total of 10 pre-validated panels of malaria slides were used to assess laboratory professionals' performances on detection, differentiation of common species of malaria, and quantification of parasite density. Data were entered and cleaned using Epidata, then analyzed using SPSS version 20. Descriptive statistics were used to summarize the findings, and diagnostic performance metrics were calculated. Variables with a p-value < 0.25 in the bivariate analysis were included in the multivariate logistic regression, with a p-value < 0.05 considered statistically significant. Results: The acceptable proficiency test result was 62.6%, with high sensitivity (95.7%) and specificity (96.2%), with 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 3.4% counting parasites within the expected range. Multivariate analysis revealed that having a diploma/Level 4 education (AOR = 4.87; 95% CI: 1.5–15.6; p < 0.05) and Professionals who had not received training within the past three years (AOR = 27.3; 95% CI: 8.1–91.6, p< 0.001) were significantly associated with competency of laboratory professionals in diagnosing malaria smear microscopy. Conclusion and Recommendation: The study found that there were high unacceptable proficiency test results, among laboratory professionals; high parasite detection agreements, moderate species identification and poor parasite counts were observed. The performance status of laboratory professionals in diagnosing malaria smear microscopy was associated with educational level and recent malaria training. Training and promoting higher education among laboratory staff were important to enhance diagnostic accuracy of malaria microscopy in West Oromia. Keywords: Performance Assessment, Smear Microscopy, Malaria Microscopy, External Quality Assessment (EQA).