| Summary: | Microscopy is regarded by many healthcare professionals as the international gold standard for diagnosing malaria; however, the ability to reach a correct diagnosis is affected by training, experience and availability of laboratory resources including adequate quality assurance procedures. In the work reported in this thesis we have generated virtual microscope slides from patients, with malaria for use as external quality assurance specimens. These virtual microscope slides were also incorporated into a training programme to improve the diagnosis of malaria in UK and International laboratories. In addition a novel gallery of photomicrographs taken from blood smears from various patients was used in the training programme. Internationally, 40 participants were recruited from 14 laboratories recommended by the WHO, UKNEQAS (H) and the Liverpool School of Tropical Medicine. In the UK, a group of laboratory individuals was contacted through UK NEQAS (H) and 34 interested individuals were recruited. Participants were initially asked to make a diagnosis on 40 electronically generated blood smear images to determine the presence, or absence, of malaria and to identify the species present. These participants were then given access to an Internet based training and quality assessment programme over a six-month period, aiming to improve malaria diagnosis by microscopy, before completing another assessment of 40 images. In the initial assessment, 24 participants completed all 40 cases in the international and UK groups. In the final assessment 21 participants in the international group completed all 40 cases and 18 participants in the UK group. For the comparison of the initial and final assessments the results of 18 and 13 participants from the international and UK groups respectively were analysed. In the initial assessment, the international group achieved the correct diagnosis in 76.4% of cases, and the correct species in 48.9%. The UK group achieved the correct diagnosis in 90.1% of cases and the correct species in 58.4%. In the final assessment the international group achieved the correct diagnosis in xxii 72.7% and the correct species in 46.9% of cases. The UK group achieved the correct diagnosis in 95.6% of cases and the correct species in 73.8%. The training programme resulted in a significant improvement (p≤0.05) in malarial diagnosis in the UK group, but the difference was not significant for the International group. The reasons for not being effective in Developing Nations could be due to difficulties in understanding English, speed of Internet connection, computers being used or the compliance of the participants.
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