Validation of automated malaria parasite diagnostic machines based on first principle: A pre-requisite for acceptable results and treatment monitoring in resource limited settings

Background: Following the very recent introduction of automated malaria parasite diagnostic machines; the need to validate these high technology machines based on the first principle protocol in malaria parasite density determination for acceptable results and treatment monitoring cannot be over-emphasized. The aim of this review is to update Medical Laboratory Scientists, Medical Laboratory Technicians, and researchers alike on the first principle in the diagnosis of malaria using Giemsa stained thick and thin blood films and to build their capacity on how to validate any automated malaria parasite diagnostic machine. Methods: The first principle protocol in malaria parasite density determination was used. With 8 µL of blood spread within 18 mm diameter of circle (thick film), the volume of blood in one thick film field (0.002 µL) is obtained; which when multiplied by a factor (500) gives 1 µL. The number of parasites seen per 100 thick film fields or average number per each thick film field multiplied by 500 gives the number of parasites / µL of blood. Results: Malaria parasites counts of 5 – 50 parasites (1+), 50 – 500 parasites (2+), 500 – 5000 parasites (3+), and (4+) > 5000 parasites / µL of blood, and with the results obtained from the automated machine which when entered into a 2 x 2 table reveal the performance evaluation of automated machine. Conclusion: With several results obtained, any automated malaria diagnostic machine can be validated for its ability to detect disease (sensitivity, specificity, positive and negative predictive values). Commencement of the use of automated malaria parasites diagnostic machines in parasitology laboratory should not lead to discontinuity in the use of thick and thin blood films in malaria diagnosis as it remains the gold standard in resource limited settings.