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Supportive Supervision and Training Improves Quality Management of Severe Malaria at Health Center

Martina Ndimbo is the only laboratory technician at Mtambaswale Health Center. Working with three clinicians and six nurses, her job is critical. Every day she puts her training and microscope to use, analyzing patient blood samples to accurately diagnose malaria, a leading cause of death in her native Tanzania. Accurate diagnosis of malaria helps her colleagues – the clinicians and nurses – offer immediate care and effective treatment plans to their patients that can be lifesaving. Accurate diagnosis is especially important for severe malaria cases where prognosis, accurate parasite counting, and identification of the malaria species are all essential to offering timely, critical care.

To enhance her skills and grow in her profession, Martina participated in a 5-day basic malaria Microscopy Diagnostic Refresher Training in February 2022 supported by the U.S. President’s Malaria Initiative (PMI) through the PMI Impact Malaria project. Despite malaria microscopy being mandatory at all admitting facilities in Tanzania, the clinicians at Martina’s health center were not requesting microscopy, even for suspected severe malaria cases. As a result, she had not been regularly using her malaria microscopy skills. “During this training, we were reminded when and why we perform malaria microscopy.” After the training, “the PMI Impact Malaria-supported Malaria Service and Data Quality Improvement team visited our facility [for regular supportive supervision]...and shared the importance of performing malaria microscopy. We set up an action plan that, from that day onwards, our health center will perform microscopy for each admitted case of suspected severe malaria.”

Martina (center) and her coworkers outside Mtambaswala Health Center together with District Malaria supervisors. Photo credit: PMI Impact Malaria Tanzania

When the Mtambaswala Health Center was re-visited during the second round of supportive supervision from the PMI Impact Malaria Tanzania team and Nanyumbu District Council malaria supervisors, the clinicians had shifted to abide by the current national guidelines for malaria diagnosis and treatment. They were conducting a blood smear for malaria parasites at the time that patients were admitted with suspected severe malaria and tests at 24-hour intervals until the patient was discharged. One of the clinicians, Herbert Kingazi, credited the shift to Martina’s knowledge gained from the training and the follow-up visit from the supervision team. “Once we made this shift, we realized this practice helps us to manage patients properly. We can monitor their response to treatment more effectively and we can think of other diagnoses when malaria parasite density is reduced.”

Clinical notes of a patient admitted with malaria. Photo credit: PMI Impact Malaria Tanzania

Upon making these changes to improve patient outcomes and expertise among staff at the health center, the Mtambaswala Health Center is now among the facilities to be used as a certified source for blood slides in collaboration with National Institute for Medical Research Public Health Laboratory. This raises the profile of the health center and elevates it as a respected research site for monitoring malaria species development and learnings to provide national and international guidance. 

In the follow up visit after she received training, the supervision team crosschecked Martina's sample slides to evaluate progress and found 90% agreement with her results, compared to zero before the refresher training. “I am proud of how attending the refresher training not only improved my own skillset and professional experience, but how it improved the outcomes my health center can provide the community.” 

PMI Impact Malaria is funded and technically assisted by the U.S. President's Malaria Initiative (PMI) and is led by Population Services International (PSI) in partnership with JhpiegoMCD Global Health, and the Malaria Elimination Initiative (MEI) at the University of California, San Francisco. 

Posted by Taylor Prochnow at 00:00
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