Abstract:
Abstract. Microscopic diagnosis of malaria is a well-established and inexpensive technique that has the potential to
provide accurate diagnosis of malaria infection. However, it requires both training and experience. Although it is
considered the gold standard in research settings, the sensitivity and specificity of routine microscopy for clinical care in
the primary care setting has been reported to be unacceptably low. We established a monthly external quality assurance
program to monitor the performance of clinical microscopy in 17 rural health centers in western Kenya. The average
sensitivity over the 12-month period was 96% and the average specificity was 88%. We identified specific contextual
factors that contributed to inadequate performance. Maintaining high-quality malaria diagnosis in high-volume,
resource-constrained health facilities is possible.