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MINISTRY OF HEALTH AND INFECTIOUS DISEASES INSTITUTE COLLABORATION

STOP MALARIA TRAINING PROGRAM

(First edition – February 2012)

MALARIA DIAGNOSIS USING MICROSCOPY AND RDTs COURSE

LABORATORY FACILITATOR’S GUIDE

FACILITATOR’S GUIDE

JUMP Course: Malaria diagnosis using Microscopy and RDTs

TABLE OF CONTENTSDescription Page1. Welcome remarks2. Introduction3. Justification for the training curriculum4. Aims, objectives and content of the malaria training curriculum5. Course content outline6. Target audience7. Course organization8. Teaching and learning experiences9. Assessment10.Award at the end of the course11.Administrative and logistical requirements12.Monitoring and evaluation strategies13.Course schedules14.Climate setting and course overview15.Pre-course assessment16.Laboratory use in malaria patient management Session 1: Good Laboratory Practice Session 2: Microscopy Session 3: The preparation and storage of different reagents/stains for Malaria microscopy Session 4: Laboratory diagnosis of Malaria Session 5: Quality Assurance/ Quality Control in Malaria microscopy Session 6: Performing and interpretation of rapid diagnostic tests Session 7: Facilitation and mentoring skills for a peer trainer of healthcare workers17.Practical laboratory placement: Microscopic and picture slide reading Visit to a laboratory service setting Preparation of reagents Laboratory diagnosis of malaria Review: Microscopic and picture slide reading Post-test: Microscopic and picture slide reading18.Post course assessment19.Concluding the course20.Closing ceremony21.Compiling the activity report

Facilitator’s guide 2


WELCOME REMARKS

Welcome to the JUMP facilitator’s guide. The JUMP team wishes to congratulate you upon your selection and acceptance to participate in the district based training of the Ministry of Health effort to scale up the STOP Malaria training as a facilitator. Note too that your selection was based on your excellent performance in management of patients with fever in your health facility as observed by the District health team.

The JUMP facilitator’s guide will give the competences you require to successfully implement the JUMP training within your district. Among others this guide will take you through how to do the following:

Compiling a JUMP training plan for the district Identifying and recruiting the right trainees or trainees Identifying and preparing the most appropriate training site Preparing the placement/practicum sites Orienting/introducing the trainees to the training programme Facilitating the sessions Supervising the course project Assessing learning Concluding the training Implementing the Monitoring and evaluation strategies

While efforts have been invested in ensuring that this facilitator’s guide is comprehensive enough to offer you the guidance you require to implement a successful training within your district, do not hesitate to raise and forward your concerns on how best it should be. JUMP will be more than ready to offer you any assistance possible and within its means.

Good luck!

INTRODUCTION:



The Joint Uganda Malaria Training Program (JUMP) was established through a partnership between Infectious Diseases Institute Ltd (IDI), Uganda Malaria Surveillance Program (UMSP) and Makerere University –University of California San Francisco (MU-UCSF).The Joint Uganda Malaria Training Program is funded by Exxon Mobil but additional funding has also been secured from the presidential malaria initiative.

JUMP thrives on the expertise of the two main partners; The Infectious Diseases Institute (IDI) whose mission is to build capacity in Africa for the delivery of sustainable, high quality care and prevention for HIV/AIDS and other infectious diseases through training and research. Beside HIV, malaria is the second major infectious disease addressed by the IDI. The Uganda Malaria Surveillance Program (UMSP), which is itself a partnership between the Uganda Ministry of Health (MOH), Makerere University-University of California San Francisco (MU-UCSF) Malaria Research Collaboration; the Makerere University Institute of Public Health; and the University Of California Berkeley School Of Public Health.

JUSTIFICATION FOR THE TRAINING CURRICULUM:

Malaria is the leading cause of morbidity and mortality in the Uganda. While Children under five, pregnant women and people living with HIV/AIDS bear the greatest burden of the disease, all people living in Uganda are at risk of being infected with malaria parasites and suffering from the resulting illness. Most attacks of malaria are uncomplicated and if treated promptly, full recovery of patients with no residual disabilities is expected. If treatment is delayed or inappropriate, uncomplicated malaria can quickly deteriorate to become complicated leading to death.

After the failure of CQ and SP the Ministry of Health enforced a policy of treating every patient presenting with uncomplicated malaria with ACTs as the first line drugs. However, in the event of increasing costs for ACT’s and limited resources, it is important to use these new malaria medications in a proper sustainable manner. Unnecessary administration of anti-malarials increases health-care costs, adds to risks of drug toxicity, delays diagnosis of other causes of illness, and contributes to development of parasite drug resistance.

When a baseline analysis in the nine sentinel sites was conducted by UMSP and IDI it showed that the clinical and laboratory staff often work in isolation yet it has been observed that laboratory findings are very reliable (99.2% of patients with negative malaria slides from laboratories with the basic facilities, did not develop malaria, UMSP 2006). There was therefore a need to improve the quality of the management of patients with malaria through building capacity of Health workers in diagnosing, treating and preventing of malaria.

AIM, OBJECTIVES AND CONTENT OF THE MALARIA TRAINING CURRICULUM



Aim of the Malaria Training curriculum:

The aim of the curriculum is to improve the quality of the management of patients with malaria through building the capacity of health workers in the diagnosis, treatment, and prevention of malaria.

Objectives of the Malaria Training curriculum:As mentioned earlier, the training will target laboratory staff. The objectives spelt out here will focus on the discipline specific needs of the target audiences.

1. Correctly perform Laboratory Diagnosis of Malaria.2. Correctly use a microscope in the diagnosis of malaria. 3. Appropriately apply the principles of Good Laboratory Practices in the day to today

running of a health laboratory.4. Carry out effective quality assurance when performing laboratory investigation.5. Carry out effective quality control measures when performing laboratory

investigations6. Correctly diagnose malaria using RDTs7. Provide technical support to peers in malaria diagnosis using microscopy and

RDTs

COURSE CONTENT OUTLINE:

Malaria diagnosis using microscopy and RDTs:

This course has 7 sessions and targets Laboratory staff only. This course aims at building the capacity of laboratory staff in performing accurate and reliable malaria microscopy. The course enables laboratory staff to spend adequate time going through the steps involved in performing malaria blood smears so that their ability to correctly identify positive and negative blood slides is very good. The course is very important in our effort to ensure rational use of antimalarial drugs in health facilities. This is from the fact that when the clinicians don’t have trust in the competency of the laboratory staff then they treat patients regardless of the laboratory results. In addition, the course helps to have a laboratory that is concerned about Quality control and Quality assurance so that the clinical team is able to make the right final diagnosis and give the right treatment.

Course session outline: Session 1: Good Laboratory Practice Session 2: Microscopy Session 3: The preparation and storage of different reagents/stains for Malaria

Microscopy Session 4: Laboratory diagnosis of Malaria Session 5: Quality Assurance/ Quality Control in Malaria microscopy Session 6: Preparation and interpretation of RDT.



Session 7: Facilitation and mentoring skills for a peer trainer of healthcare providers.

TARGETAUDIENCE:

This course is intended for health cadres directly involved in providing laboratory services in all health facilities with a functional microscope. These healthcare workers should also be involved in training of healthcare workers in their respective district. The specific cadres of healthcare workers targeted for this course therefore, include the following: Laboratory technologists Laboratory technicians Laboratory assistants

You are encouraged to recruit trainees for the JUMP training from health facilities with laboratory services. These are usually the Hospitals and Health Centres IV and HC III facilities with functional microscopes. However, make an effort to establish the presence of functional microscopes and active laboratory units in lower levels health centres such as Health Centre IIs that. Ensure that these offer both these services and have the required facilities. You could then consider them for participation in this training.

COURSE ORGANISATION: The course on Diagnosis of Malaria using microscopy and RDT is scheduled to take a total of three days. During this period, 25% of the time will be devoted to introductory didactic sessions for all the identified content of the course. The remaining 75% of the time will be devoted to relevant skills building within a laboratory setting.

TEACHING AND LEARNING EXPERIENCES:

Your key role in this training programme is to facilitate the learning experience of your trainees. Remember that your trainees are adult for whom you should create an environment that enables them to accomplish the session specific and the overall course objectives. They should also be able to explore their own experiences to help them learn. For you to achieve this you will need to employ the right teaching methods. The table below provides you with a range of these teaching methods that you use in delivering your sessions:

Table 2: Teaching and learning methodsTeaching method

Approach Advantages Limitations

Modified lecture Keep it short Keep it to the point

Time saving Covers a large group of trainees

Keeps the trainees in a passive situation



Ask questions Gives a feeling of security Facilitator can present a large

amount of information in a short time

Does not allow for the individual pace of learning

Difficult to participate and take accurate notes

Limits level of stimulation

Small group discussion

Discuss clear objectives Combine with story, drama

and pictures etc

Allows free exchange of knowledge, ideas and opinion among the trainees and facilitators

Time consuming There may be unequal

participation among the trainees unless properly guided

Role play Clear objectives Make role and rules clear

and allow time to prepare Discuss the role play and

summarize the points learned.

It should teach as well entertain

Strengthens the skill of human interaction, planning, decision making, thinking and communication

Good for teaching attitude change Provides immediate feedback to

both facilitator and the trainees Gives trainees confidence when

faced with the same situation

Requires plenty of time and preparation

May not be played seriously

Critiquing of the role play can embarrass the trainee unless properly guided

Supervised practice

Describe the basic steps in performing the skill/task

Demonstrate the task Arrange for practice

Trainee actively participate Useful in developing problem

solving skills Time consuming Trainee develops qualities of

observation and decision making Trainee develops self confidence Permits closer contact with reality

Needs careful planning and coordination

Field visit Develop clear objectives Describe the steps for

achieving the objectives Discuss the observations

Develops qualities of observation and confidence building

Ensures close contact with reality Permits comparison between

practice and reality

Needs careful planning and often involves transport costs

May be taken as an ordinary visit if not properly conducted

Simulation and games

Discuss the procedure for the game or simulation

Discuss what has been learned

Permits learning and practice of different techniques

Can be made with local materials Can be used by small groups It is near to reality

May lead to faulty learning

Simulation models may be expensive to procure

Demonstration State clear objectives Describe steps for

demonstration Allow repeat demonstration

Puts trainees in active situation Develops qualities of observation,

decision making and self confidence

Good for teaching skill and reinforcing theory

Permits giving and receiving immediate feedback

Ensures closer contact with reality

Time consuming Can lead to incorrect

practice if the demonstration is not correctly done

Trainees take time to get used to handling things and this may inhibit effective learning for the shy trainees

ASSESSMENT:

Your trainees will require some form of assessment. This is to enable you establish the level of learning attainment in terms of competences acquired. This is envisaged to be in form of abilities in Knowledge, Skills and Attitudes than they were before the



course. The following are the various approaches provided for you in the programme to enable you assess your trainees: Written Pre-test and Post-test. Practical assessment in the practicum sites. Attendance of at least 90% of all the sessions

AWARD AT THE END OF THE COURSE:

At the end of the training, trainees who pass all the assessment tasks are awarded a certificate of successful completion of the course. This will ascertained through a trainee’s attainment of 60% and above in the Post-test and certificate of attendance if you attained below 60% in the same test. This certificate shall be awarded by the STOP Malaria Project.

ADMISTRATIVE AND LOGISTICAL REQUIREMENTS:

In organizing the training in your district, you will require administrative and logistical support. This section outlines for you what these are expected to be:

FacilitatorsThe JUMP course emphasizes a team approach to malaria patient management. This implies a composition of a facilitation team that also demonstrates a team approach to the training aspect. You will work as a team of four facilitators as follows: Laboratory staff course and four facilitators

Ensure that your facilitators have the following important aspects of implementing the training within your districts: Attended the training of trainers course at the IDI Attended the basic course on Malaria diagnosis using RDTs and microscopy Recommended by the district to participate in the district trainings as facilitators.

You will be assisted by one of the JUMP team members during the training

Teaching aids and other resourcesTo enable you facilitate effectively, the following items are relevant: Power point presentation relevant for each of the sessions to be delivered Computer and preferably a Lap-top Liquid Display Projector (LCD) RDT job aids WHO charts and guidelines RDT kits Functional microscopes Picture slides Pre-prepared slides for trainees to practice on. Cameras for preparing visual aids on slides for the trainees to practice.



Didactic session presentation facilities:You will need at least a large room to accommodate your trainees. Ensure that such accommodation facility meets the following criteria: Close to the practicum sites and with out implications for the transport costs The sitting arrangement that can be made appropriate for both formal and

interactive sessions Adequate ventilation Adequate lighting Free from distracters such as noise and entertainment Is clean and free from dust and bad smells Has good facilities for wash rooms and washing of hands

Practicum sites:This is a competence based course that requires the trainee to have opportunities for “hands on” practice. You therefore, need to ensure that the practicum sites you identify provide the following: An active laboratory with relevant facilities for performing a blood slide

examination for malaria parasites. Relevant facilities for carrying out other simple investigations in patients presenting

with fever due to causes other than malaria.

Ensure that each participant: Has a good view of every skill demonstrated Is given enough time and facilities for return demonstration and practice of the

desired skills.

StationeryYou will the following stationery for your course for use by the trainees and the facilitators: Pens Pencils Note pads Felt pens (markers) Flip charts Training manual.

The quantities of each will depend on usage and number of users. Ensure that you have enough of each item to last you the whole training period and without wastage.

Health learning materials:You will make your session presentations according to the course schedule provided for this training. Give your trainees a set of course materials appropriate for this training: “Fever patient management with RDTs and microscopy”. This course has 7 major Sessions.

Trainees’ welfare:



You will invite eligible trainees and from only the recommended health facilities within your district. Note that some of your trainees will be commuting from their respective homes. You however need to cater for those who may be coming from far places and not able to return at the end of the day’s work. On these and related issues note the following:

Accommodation Give your trainees funds and they find their own accommodation. Consider only those eligible for this facilitation.

MealsThe STOP Malaria training programme will offer trainees midmorning break refreshment and lunch throughout the three days training period.

Transport refundReimburse transport costs to and from the training venue to trainees according to public means.

Daily attendance and evaluationUsing relevant forms ensure that on daily basis participant do the following:

Sign the attendance form in the morning Complete evaluation questionnaires at the end of everyday’s activities.

You should also use a relevant form to sign the daily attendance.

Time keeping:This is a busy course involving class, group and individual activities. The success of this training therefore depends on the active participation and involvement of the trainees in each of these activities. Ensure that you and your trainees keep time all through the training period. This will enable you to accomplish a great deal within the stipulated period.



MONITORING AND EVALUATION STRATEGIES FOR THE CASCADE TRAINING:

The training will have a monitoring and evaluation strategy with the following components:

Baseline data assessment of the targeted trainees using the M & E tools as well as collecting the surveillance data before the training. The tools to be used will include; Laboratory performance monitoring tools:

30 Slides read by each laboratory staff at baseline, first follow up and second follow up.

Quality assurance/Quality control. The lab trainers will collect 250 slides from the health facility from each laboratory staff before the training and after the training.

Assessment of performance of the trainees during the course through pre-test and post test. These will mainly be knowledge assessment test. They will include picture and actual slide tests.Post training follow up assessment using the M & E tools above.

The pre-training malaria blood slides will be collected by only lab staffs who qualify for the training while those after the training will be collected by those who will have attended the training. These blood slides will be read by JUMP expert lab technicians in Kampala to assess the sensitivity and specificity of the lab staff.

Indicators for monitoring the effect of the training.

As mentioned earlier on, this is an evidence based course. What this means is that the course should demonstrate impact on the practices of the trainees in the significant areas for which it was designed. Below is an outline of the different indicators that will be used to determine the relevance of this course. Performance indicators refer to the things or happenings that will show you that something is going on what ever you are doing. This might be negative or positive depending on what and how you set your indicators.

Laboratory staff performance indicators Proportion of blood slides prepared correctly by each laboratory staff. (%). Proportion of negative blood slides read correctly (specificity). Proportion of positive blood slides read correctly (sensitivity) Proportion of laboratories that participate in external quality assurance for

malaria Proportion of target laboratories that are functional.(A functional laboratory

should have a functional microscope / s, qualified laboratory personnel and availability of consumables)

Proportion of laboratories with appropriately filled microscope maintenance logs.



Proportion of laboratories that received external assurance results /feedback in the last three months.



COURSE SCHEDULES

8.30 – 9.00

Registration and applications, overview

Review of Day 1 Review of Day 2 Review of Day 3

9.00 – 10.30

Pre-testsPicture reading pre testSlide pre test.

Quality Control / Quality Assurance

Picture slide reviewSlide reading review.

Introduction to the facilitators guide.

10.30 – 11.00

Midmorning tea/coffee

11.00 – 13.00

Good Laboratory Practice

Microscopy

Laboratory diagnosis of malaria

Performance and interpretation of RDTs

Skills development in Slide reading

Facilitation.mentoring and coachingDemonstration of coaching and mentoring skills

13.00 – 14.00

Lunch break

14.00 – 15.30

Preparation and storage of reagents for malaria microscopy

Lab diagnosis of malaria-Slide preparation

Post-test: Slide reading

Management of District based training.

15.30 – 16.45

Skills development in reagents preparation

Lab diagnosis of malaria-Smear staining

Post-test: Picture reading

Post test.

16.45 – 17.00

End of day’s evaluation



End of course evaluationClosure

17.00 Evening tea /coffee and Retire



CLIMATE SETTING AND COURSE OVERVIEWSession 1

Session title: CLIMATE SETTING AND COURSE OVERVIEW

Purpose of the session: To create a socially conducive environment for learning that gives the trainees

freedom of expression. To remove fear due to meeting unfamiliar people and environment among the

trainees that tends to affect their level of participation and involvement in the training

Objectives By the end of the session, the trainees should be able to:1. Acquaint themselves with each other and refer to each other by

name.2. Acquaint themselves with their facilitators and refer to them by

their names and vice versa.3. Follow the norms and leadership of the class4. Express their own course expectations5. Familiarize with the course aims and objectives6. Familiarize with the Course schedule Relevant training materials Administration and logistical information

Time 60 minutes Preparation 1. Organize training room and prepare flip charts to guide the

climate setting session: Introductions by self or peer

Name and preferred name Place of work Cadre in service Best dish Likes and dislike Fears about the training Expectation of the training

Group leadership, ground rules and expectations of the training2. Prepare trainees folders and writing materials3. Name tags for both trainees and the facilitators4. Course aims and objectives5. Relevant ice breaker

Methods1. Brain storming and group discussion2. At least one interactive game as the ice breaker

Resource Materials

1. Flip chart stand, flip charts, masking tape and the markers

2. Power point

Course aims and objectives

Course schedule

3. Introduction to the course

4. Pointer 5. Name tags



presentations on

Facilitation procedure

Step 1: Introductions, trainees’ expectations and the course objectives:

Step 2: Group leadership and ground rules:

Step 3: Administrative and logistical information:


Large group session:1. Welcome the trainees to the course and ensure that they have all registered and

received all the required training materials or resources.2. Explain the background to the training course3. Introduce yourself and the team of facilitators4. Ask the trainees to introduce themselves by peer or self following the guidelines

agreed upon.5. Ensure that each trainee has got his or her preferred name printed on the name tag6. Ask the trainees to write one course expectation and fear about the training. Post

these on the flip board for discussion7. Show a slide on the course aims and objectives. Discuss these in relation to the

trainees own expectations. Note any areas of overlap or discrepancies and further discuss these with the trainees to gain consensus.

8. If there is any official opening of the training then invite the guest to do so

Large group session:1. Brainstorm with the trainees on what type of leadership they wish to have and who

of them should take the responsibility:2. Write their nominations on the flip chart. Their ideas might include the following:

President Welfare officer Spiritual/religious leader Time keeper

3. Post the confirmed names on the class wall for reference by the class. Lead the class to congratulate the successful candidates.

4. Brainstorm with the trainees on how they wish to conduct themselves while in the training:

Respect for one another Punctuality Talking one at a time Active participation Mobile phones on silent mode or switched off Equal opportunity for asking and answering questions Appreciation for work done by facilitators and the trainees

5. Write the confirmed ground rules and post them on the class wall for reference.

Large group session:1. Ensure that each trainee has got a copy of the introduction to the course and the

course schedule.2. Lead an orientation discussion on the course schedule and relevant aspects of the

Administration and logistical management of the training. Make reference to relevant pages in the introduction to the course and encourage the trainees to read the text for themselves.


Step 4: Registration and end of day’s evaluation:


Large group session:1. Introduce the trainees to the registration forms and reassure them that this activity

was to be done each morning of the training period.2. Introduce the trainees on how to make an evaluation of the day’s proceedings

using the forms available. Reassure the trainees on the significance of evaluating the day.


PRE-COURSE ASSESSMENT:

Session 2:

Session title: PRE-COURSE ASSESSMENT

Purpose of the session: To assess trainee level of knowledge, skills and attitudes for purposes of ensuring

that the course is tailored to meet their individual needs. To identify trainees needing special support.

Objectives By the end of the session, the trainees should be able to:1. Assess their own level of knowledge, skills and attitudes in

fever case management and the integrated management of malaria.

Time 30 minutes Preparation 1. Prepare enough copies of the Pre-test

2. Prepare small papers with numbers according to the size of the class. It is on these papers that the trainees will indicate their names and the numbers become their Trainee Identification numbers (TIN).

Resource Materials

1. Flip chart stand, flip charts, masking tape and the markers2. Copies of the pre-test3. Timer or clock4. Marking scheme



Procedure for administering the Pre-test

Step 1: Administering the pre-test:


Large group session:1. Give each trainee an Identification number2. Keep a record of the trainee identification number against the trainee name3. Ask the trainee to indicate the Trainee identification number in the space provided

for on the Pre-test copy and to keep this number private to them selves.4. Take the trainee through the relevant instructions to the Pre-test and remind them

to indicate their TIN.5. Explain to the trainees the purpose of the Pre-test and emphasize it to them that it

is not an examination but a tool to establish the level at which they are that forms the basis for directing the training

6. Pick the test papers when the trainees are done with them7. Mark the scripts using a marking scheme and record the marks gained by each

trainee in percentage.8. Display the marks gained by the whole class on a graph drawn on a flip chart

indicating only the TIN and not their names.9. Make an effort to provide the results of the pre-test on the first day of the traininig.10.Share the performance of the trainees in the Pre-test with the rest of the facilitators

so they can focus their guidance accordingly.


LABORATORY USE IN MALARIA PATIENT MANAGEMENT

Session 1

Session title: GOOD LABORATORY PRACTICES.

Purpose of the session:1. To enable trainees perform laboratory procedures safely and document processes

in performing these laboratory tests to ensure quality laboratory results.2. To emphasizes the importance of resources, rules, quality assurance and

documentation of the results.3. To enable trainees develop action points that can enable them to initiate,

develop and use SOPs for the different procedures in the laboratory so as to observe ethical code of conduct for medical laboratory practice.

Objectives By the end of the session, trainees should be able to:1. Define Good Laboratory Practices (GLP)2. List the objectives of Good Laboratory Practices.3. Explain the elements of Good Laboratory Practices4. Outline the procedures for writing and making use of Standard

Operating Procedures in GLP.

Time 120 minutes

Preparation Make readily available the following:1. Session hand outs. 2. Power point presentations.3. Copies of SOPs.4. SOP templates.

Methods 1. Illustrated lecture.2. Small group discussion3. Brainstorming 4. Demonstrations

Resource Materials

1. Handout2. LCD3. News print /Flip charts4. Markers5. Copy of SOPs.

Reference Materials1. Hand out: Course 3; Session 1:Good Laboratory practice (GLP) 2. Power point presentation: Course3; Session 1: Good Laboratory Practice.




Step1:introduce the session

Large Group Session

1. Lead a brainstorming session on trainees understanding of GLP by asking questions such as: Define GLP in full Give an outline of where GLP is applied.

2. Record the trainees responses on a flip chart3. Summarize the introduction with emphasis on code of practice for GLP.4. Explain the purpose and objectives of the session.5. Encourage the trainees to understand that each of the objectives of the session need to

be achieved and an action point generated from learning the session at the end of the day during project time.

Refer to slide 2-3

Step 2: Present content area 1: What is GLP

1. Display relevant slides and do the following: Describe when GLP stared and how it evolved overtime Give the WHO definition of GLP.

2. Ask the trainees to raise any questions for clarificationRefer to slide 4

Step 3: Present content area 2: Objectives of Good Laboratory Practice

1. Lead a brain storming session on what the trainees consider to be the aims of Good Laboratory Practice

2. Note their responses and display a relevant slide on the aims of GLPRefer to slide 5

Step 4: Present content area 3: Elements of Good laboratory practice

1. Start by defining the term “Element”2. Display a slide outlining the elements of Good laboratory practice and explain them

accordingly3. Lead a brainstorming session on the elements of Good laboratory practice4. Display relevant slides and explain each of the following principles of Good laboratory

practice: Personnel



Quality assurance programme Validation Standard Operating Procedure Laboratory note book Reporting results

5. Invite the trainees to raise any areas of this section needing clarification,Refer to slides 6-16

Step 5: Present content area 4: Developing and making use of Standard Operating Procedures

1. Lead a brainstorming session on: Definition of the term SOP If trainees have SOPs in their various laboratories How their SOPs are developed.

2. Summarize their responses in a flip chart.3. Describe the format of an SOP4. Display relevant slides to describe how SOPs are developed.5. Show samples of SOPs.6. Display relevant slides describe the step by step process in developing an SOP.7. Display relevant slides describe the initiation of an SOPRefer to slides 17-21

Step 6: Assess trainees’ knowledge gain from the session

1. Invite the trainees to raise any questions on the areas of the session they will not have understood

2. Give relevant clarification on the questions raised3. Assess trainees’ knowledge gain from the session by asking thought provoking

questions. Here are sample questions for your reference What is GLP? Why was the major aim of GLP? What are the elements of GLP?4. Give the trainees home work on developing sample SOPs:

Home work:1. Divide the trainees into two groups and ask them to draft a sample SOP2. Mark the sample SOP and give feed back in the course of the training3. Ask each trainee to develop SOPs for the various tests they perform in their facilities

which shall be followed up during supportive supervision.

Step 7: Summarize the session



1. Summarize the session by revisiting the following key points: Definition of GLP Objectives of GLP Elements of GLP Writing , initiation ,and use of SOP2. Highlight the following information: GLP –Stands for Good Laboratory Practices The concept of Good Laboratory Practices first evolved from USA in 1970’s because of

the concerns about the validity of the preclinical safety data submitted to Food and Drug Administration (FDA) in the context of new drugs.

GLP continues to be applied wherever analytical testing is carried out.3. Thank the trainees for their active participation in the session and ask the to prepare for

the next sessionRefer to slide 22

Session 2

Session title: MICROSCOPY



Purpose of the session:1. To teach trainees about the different types of microscopes with emphasis on the

commonly available microscope types, its essential parts and how to take good care of the microscope.

2. To give the trainees knowledge on how to identify and remedy problems with their microscopes and encourage them to correct them using the trouble shooting guide provided.

3. To enable trainees appreciate that using the microscope can be enjoyable if you know the different parts of the microscope and other equipment used in diagnosis of malaria which is the commonest test performed in our laboratories.

Objectives By the end of the session, you should be able to:1. Name the different types of microscopes2. Describe the essential parts of a microscope.3. Describe how to install and operate a microscope.4. Describe the care and maintenance of a microscope.5. Describe other major laboratory equipment used in the diagnosis of malaria.

Time 90 minutes

Preparation 1. Make readily available the following: Hand outs of the session materials Copies of SOPs for caring for the microscope.

Methods1. Illustrated lecture.2. Small group discussion3. Brainstorming 4. Demonstrations.

Resource Materials

1. Handout2. LCD3. Flip charts4. Markers5. Copy of SOPs.6. Microscope

Reference Materials:1. Handout: Course 3; Session 2: Microscopy.2. Power point presentation: ;Session 2:Microscopy

Facilitation Procedure

Step 1:Introduce the session



Large Group Session1. Lead a brainstorming session on trainees understanding of importance of

microscopy in ensuring correct diagnosis of malaria.2. Record the participant’s responses on a flip chart.3. Explain the purpose and objectives of the session and with reference to the

trainees’ responses help them appreciate the role of a microscope in malaria patient management.

Refer to slides 1-3

Step.2:Present content area 1: Different types of microscopes

1. Start by brainstorming on the following issues; What are the different types of microscope? What types of microscopes are available in your various facilities?

2. Display the power point on the different types of microscopes.3. Describe the different types of microscopes with emphasis on the commonest; the

light microscope.4. Give each participant an opportunity to talk about the type of microscope they use in their

various facilities.

Step 3. Present content area 2: The essential parts of a microscope.1. Display a microscope in front of the trainees.2. Ask each trainee to show one essential part of a microscope.3. Display the power point on the essential parts of a microscope. and review the

trainees responses 4. Describe the different parts of a microscope by name and functionRefer to slide 4

Step 4. Present content area 3: Installation and operation of a microscope

1. Ask the trainees to define the terms “installation” and “operation”2. Note their responses and provide feedback3. Brain storm on how they think a microscope can be installed and operated for use.4. Display a slide on the operation of a microscope.5. Clarify important aspects of installation and operation of a microscope.

Refer to slide 5-6

Step 5 Present content area 4: Care and maintenance of a microscope1. Ask the trainees to list the worst enemies of a microscope and how they overcome

them.



2. Summarize their responses on a flip chart and provide feedback.3. Display slides to list the enemies of microscopes and how these enemies are

overcome.4. Brainstorm on how the trainees maintain the different parts of a microscope.5. Record the trainees’ responses in a flip chart.6. Display the power point on maintenance of different parts of a microscope7. Encourage the trainees to refer to the trouble shooting guide in the handout; (Table

2/1: Trouble shooting guide for microscopes on page 9) to solve common problems they may encounter in the course of using the microscope.

Refer to slides7-16

Step 6: Present content area 5: Other major equipment used in diagnosis of malaria

1. Ask the trainees to list other equipment used in diagnosis of malaria other than a microscope.

2. Record the trainees’ responses in a flip chart. 3. Display relevant slide on other equipment used in diagnosis of malaria4. Review the trainees responses and provide clarification as need arisesRefer to slide 17

Step 7:.Assess knowledge gain from the session1. Ask the trainees to raise questions on any areas not clear in the presentation2. Respond to the trainees’ questions as appropriate3. Assess the trainee knowledge gained by asking thought provoking questions to

ascertain their understanding: What are the types of microscopes? What are essential parts of a microscope? How are essential parts of a microscope maintained? List other equipment used in diagnosis of malaria?4. Make the assessment of the session interactive by making most of the trainees

contribute to the answers.5. Reinforce and correct the responses as appropriate

Step 8: Summarise the session

1. Display a slide on the summary of the session and highlight the following: There are two major types of microscopes namely light and electron microscopes.

The different types of light microscopes include: Bright field, Dark field, Phase contrast, and fluorescence microscopes.

The essential parts of a light microscope are; eyepieces, body tube, nosepiece, objectives, mechanical stage, condenser, coarse and fine adjustment knobs, plus the light source. You should install your microscope on a steady level table in a place free from vibrations, water, and chemicals.

Microscopes can develop faults. You should always identify these faults as soon



as possible and have them fixed accordingly. The trouble-shooting guide provided in the learner’s manual will help you to solve common problems of the microscope. Encourage the trainees to make reference to it when ever you have a problem with your microscope

2. Thank the trainees for the active participation and them to prepare for the practical session that follows:

Refer to slide 18

Step 9: Conduct a practical session on: Developing an SOP for Microscopy – operation, care and maintenance

Small group discussion1. Divide the trainees into two groups and ask them to draft a simple SOP for operation,

care and maintaining the microscope. Let them spend ten minutes in writing the simple SOP.

2. Inform trainees that the exercise will help them put into practice what has been learnt in the two session above..

3. Ask each group to identify the following: A group leader who will coordinate the groups contributions A Scribe who will record the contributions on flip charts and present on behalf of the

whole group.4. Move round the groups make sure the trainees are on the right track in their

discussions.5. Provide guidance and clarification where needed.6. Remind the trainees to observe and stick to the required time.

Step 10 Lead the plenary session

Large group session1. Invite one group at a time to make their presentation to the general class.2. Take note of the key observations in each of the presentations.3. Ask members from other groups to give their comments to the presentation4. Wrap up the session by encouraging the trainees to generate an action point at the

end of the day during project time for proper care and maintenance of microscopes

Session 3

Session title: PREPARATION AND STORAGE OF REAGENTS FOR MALARIA DIAGNOSIS.



Purpose of the session:1. To equip trainees with knowledge and skills to prepare, label and store laboratory

reagents for malaria diagnosis accurately and document processes in preparing these reagents.

2. To provide the trainees with an understanding of the constituent elements of each of the reagents and their material requirements.

3. To impart skills and attitudes to trainees to develop and use SOPs for the preparation ,labelling and storage of Field stain, Leishman stain and Giemsa commonly referred to as Romanovsky stains.

ObjectivesBy the end of the session, trainees should be able to:

1. Explain the quality of constituents required to prepare laboratory reagents for Malaria microscopy.

2. List the materials required to prepare specified reagents for malaria microscopy.

3. Describe the procedure for preparing the specified reagents for Malaria microscopy.

4. List the information required on the label of a newly prepared reagent for Malaria microscopy.

5. Describe the storage of the specified reagents for Malaria microscopy.

Time 120 Minutes

Preparation1. Make readily available the following: Hand outs of the session materials Copies of SOPs. Materials required.

Methods1. Illustrated lecture.2. Small group discussion3. Brainstorming 4. Demonstrations

Resource Materials

1. Handout2. LCD /

Computer3. News print

/Flip charts4. Markers5. Copy of

SOPs

6. Measuring cylinders7. Graduated flasks8. pH meter / pH strips9. Hot water bath10. Thermometer11. Weighing balance12. Gloves 13. Filter paper14. Reagent bottles 15. Sodium azide

16. Reagents (Field stain A and B powder, Leishman, Giemsa, wrights)

17. Methanol(analytical grade)

18. Funnel19. Stirring rod20. Distilled water21. Labels22. Glycerol

Reference Materials1. Hand out: Course 3; Session 3: Preparation and storage of different reagents for Malaria diagnosis2. Power point presentation: Course 3; Session 3: Preparation and storage of different reagents for

Malaria diagnosis.




Step 1 :Introduce the session

Large Group Session1. Lead a brainstorming session on trainees understanding of the following;

What reagents do you use for malaria diagnosis in your facility? Who prepares these reagents How are they prepared? Why do we use reagents?

2. Record the trainees responses on a flip chart3. Summarize the introduction with emphasis on Romanovsky stains4. Explain the purpose and objectives of the session.5. Encourage the trainees to understand that each of the objectives of the session need to

be achieved at the end of the session and an action point generated from learning6. Describe when the use of reagents started and how it evolved overtime with emphasis

on the ones used for malaria diagnosis.Refer to slides 2-3

Step 2 Present content area 1:Quality of constituents of Romanovsky stains

1. Brain storm on the constituents of Romanovsky stains.2. Put trainee’s responses on a flip chart.3. Display the slides on constituents of laboratory reagents for Malaria microscopy.4. Review trainees/ responses and summarize by emphasizing on the major constituentsRefer to slides 5-8

Step 3 Present content area 2.Materials required to prepare reagents for malaria diagnosis

1. Ask the trainees to list the materials required to prepare Leishman, Fields stain and Giemsa .

2. Put trainee’s responses on a flip chart.

3. Display the power point on materials required for preparing each of the common reagents and compare with the response of the trainees.

4. Provide feedback on the type of materials required to get quality reagents.5. Describe the importance of each of the materials.6. Inform the trainees that each of these materials shall be required during the practical

session that follows the lectures.Refer to slides 9-12



Step 4. Present content area 3 Procedure for preparing reagents for malaria diagnosis

1. Brainstorm by asking the trainees to list the quantities of the constituents of Leishman, Fields stain and Giemsa.

2. Put the participant’s responses on a flip chart.3. Ask the trainees to describe how these reagents are prepared.4. Display the power point on the procedure for preparing each of the reagents and review

trainee responses.5. Summarise by emphasizing the importance of having analytical grade materials and

constituents.Refer to slides 13-14

Step 5.Present content area 4: Labelling of a newly prepared reagent for Malaria diagnosis

1. Lead a brainstorming session on the following: Definition of the term label. How the trainees label in their various laboratories How labels are filled or prepared.2. Summarize their responses in a flip chart.3. Describe the format of a label and how a reagent should be labelled.4. Display slides to describe the format of a label.5. Show samples of labels.6. Encourage the trainees to always label newly prepared reagents and reagents already in

use.Refer to slides 15-16

Step 6 Present content area 5: Storage of reagents1. Ask the trainees to describe how they store reagents for malaria diagnosis2. Summarise their responses on a flip chart3. Display the power point on storage of reagents 4. Emphasize the consequences of poor storage of reagents. Refer to slides 17-20

Step 7.Assess trainees’ knowledge gain from the session

1. Display the power point that contains the learning objectives2. Ask the trainees if the learning objectives have been achieved.3. Ask the trainees to give the key points /important points in each objective.4. Assess the trainees understanding of the session by asking the following questions

What is a reagent? Why do we use reagents in malaria diagnosis?



What are the major reagents used in malaria diagnosis? What are the major constituents of Romanovsky reagents? What materials are required to prepare 1 litre of each reagent?


1. Summarize the session by highlighting the following:: A reagent is a standard mixture of chemicals that is used in analysis of samples in

laboratories. The reagents commonly used in malaria diagnosis are called Romanovsky stains and

these include Leishman, Giemsa, and Fields stain. Reagents should be labelled to designate the person who prepared it, the date of

preparation, the name of the reagent, the expiry date, concentration if any, and storage requirements.

Storage of reagents occurs at room temperature but under different environmental conditions and bottle requirements.

2. Thank the trainees for the active participation and encourage them to study the handout in preparation for the practical session on laboratory Diagnosis of malaria.

Refer to slide 21

Session 4

Session title: LABORATORY DIAGNOSIS OF MALARIA

Purpose of the session:

1. To provide trainees with the knowledge and skills to effectively use the most convenient and common methods of diagnosing Malaria.



2. To enable the trainees perform phlebotomy, prepare thick and thin blood films, identify different species of Malaria parasites, rule out other infections in a blood film, correctly record and report laboratory blood film results

Objectives By the end of this session, trainees should be able to:1. Describe the composition of blood2. Describe the two common laboratory methods for the diagnosis of

Malaria.3. Describe the procedures taken in the collection of samples for Malaria

microscopy.4. Describe the procedure for preparation of thin and thick blood smears

for microscopy.5. Describe the common faults in making blood films.6. Discuss the steps taken in staining blood films for Malaria microscopy.7. Discuss the methods used in examination of blood films8. Discuss the methods used in reporting blood film results.9. Describe the characteristic features of the different Plasmodium

species.10. Describe the characteristic features of other haematological findings in

a blood film.

Time 210 minutes

Preparation1. Make readily available the following: Hand outs of the session materials Copies of coloured charts

Methods1. Illustrated lecture.2. Small group discussion3. Brainstorming 4. Demonstrations.

Resource Materials1. Handout2. LCD3. News print /Flip

charts4. Markers5. Copy of SOPs.6. Microscope

7. News print8. Markers9. Slides10. Cover slips11. Immersion oil12. RDT kits13. Tourniquet

14. Differential counter15. Slide boxes16. Lancets/Needles17. Coupling jar18. Disinfectant19. Timer 20. Gloves

21. Buffer tablets 22. Distilled water23. DPX24. slide drier(blow

drier)25. IEC materials26. Slide template

Reference Materials1. Hand out: Course 3; Session 4: Laboratory diagnosis of Malaria 2. Power point presentation: Course 3;Session 4: Laboratory diagnosis of Malaria


Step 1: Introduce the session:



Large Group Session1. Reaffirm to the trainees that laboratory diagnosis by microscopy remains the gold

standard not only for malaria diagnosis but also fungi, bacteria and host cells especially in resource limited areas

2. Invite the trainees to share their experiences on the use of a microscope for laboratory diagnosis of malaria:

Do you trust your performance in making a microscopic diagnosis of malaria? Explain why yes or no Do your colleagues trust your results? Explain why yes or no3. Note the trainees’ responses4. Explain the purpose and objectives of the session.5. Link the trainee’s responses with the displayed session learning objectives and wrap up

the introduction session.Refer to slides 2-4

Step 2: Present content area1: Composition of blood.

1. Ask the trainees to list the composition of blood2. Give each participant an opportunity to talk about the type of blood cells they see in a

blood film.3. Record their responses and provide feedback4. Display the slide on the composition of blood5. Describe the composition of blood with emphasis on the relevance in malaria diagnosisRefer to slide 5-6

Step 3: Present content area 2: Common methods used in diagnosis of Malaria

1. Brainstorm on what methods the trainees use to diagnose malaria.2. Display the power point on the common methods and highlight the importance of using

microscopy as opposed to other methods.3. Display an RDT in front of the trainees as one of the methods 4. Describe the mode of operation of the RDT using the relevant slide.

Refer to slides 7-13

Step 4: Present content areas: .3: Procedure for collecting samples for Malaria microscopy. 4:Procedures for preparation of thin and thick films

1. Before discussing the procedure for collecting samples for Malaria microscopy emphasize to the trainees about the precautions they must take in taking blood samples to avoid contamination.

2. Highlight the following to the trainees:



Chances of transmitting or contracting a disease in this way are very small provided that they observe the simple precautions outlined at the end of this session in the Handout.

The need to deal gently and sympathetically with patients at all times. The need to protect the slides from flies, dust, heat and intense sunlight.3. Explain the differences between a thick and thin blood film and what each is used for.

You can use slide templates to illustrate what you say.4. Display the relevant slide Refer to slide 14-16

Step 5 Present content area 5:.Faults in making blood films1. Display the power point on the faults in making blood films.2. Explain the different faults as outlined on the slideRefer to slide 17

Step 6.Present content area 6 Staining blood films1. Brain storm on how the trainees stain blood films.2. Summarize their responses in a flip chart.3. Describe to the trainees to: Stain blood films correctly they should start by preparing the buffered water that will be

required to mix the stain. Measure the pH with a pH meter or with a colour indicator. Become completely familiar with the weighing process and colour testing.4. Emphasize to the trainees that all activities from this point on wards will take place in the

laboratory and will require practical skill development using standard operating procedures.

5. Refer to the trainees' handout for the protocol for staining highlighting the need for fresh reagents, filtering of the reagents, correct timing and concentration of stain.


Step 6:.Present content area 7: Methods used in examination of blood films

1. Display a power point about the methods used in examining blood films.2. Describe the steps of examining blood films in a systematic and standard way.3. Inform the trainees that: There may be abnormalities other than malaria parasites which adds to the versatility of

the microscopists and should be reported.. Routine examination is always of a thick film ,not thin films Consistency thick blood films should be examined in a standardized way as described in

the Trainees guide. Importance of parasite densities in the assessment of patients response of treatment. Importance of careful and systematic estimation of parasite densities.Refer to slides 21-22

Step 7.Present content area 8. Methods used in reporting blood film results.



1. Brainstorm on different methods trainees use for reporting malaria film results2. Record the learner’s responses in a flip chart.3. Display the slide on the different methods used in reporting blood films4. Discuss the various methods used in reporting blood film results5. Encourage each trainee to choose one method for reporting blood film results based on

the three methods Refer to slide 23

Step 8 Present content.9.Characteristic feature of the different malaria parasites in a blood film

1. Ask trainees to list key characteristics used to identify malaria species 2. Record the learner’s responses in a flip chart.3. Display the relevant power point and compare with trainee responses.4. Emphasize to the trainees that complete familiarity with the key characteristics on a

blood film is an essential foundation of malaria microscopy. It is important that the trainees make reference to the colored charts provided with the hand outs.


Step 9 Present content.10.Characteristic features of other haematological findings in a blood film

1. Ask trainees to list other haematological findings on a malaria blood film 2. Record the learner’s responses in a flip chart.3. Display the power point on the findings in a blood film and compare with trainee

responses.4. Emphasize to the trainees that complete familiarity with the components of normal blood

is an essential foundation of malaria microscopy. It is important that the trainees understand that the same blood component can look different in size and shape in different blood films.

5. It should also be stressed to the trainees that anything that they see in their routine work that appears to be abnormal should be reported.


Step 10.Assess knowledge gained from the session1. Display the power point that contains the learning objectives2. Ask the trainees if the learning objectives have been achieved.3. Invite the trainees to ask questions on any aspect of the session not understood4. Address the trainees questions appropriately5. Assess the trainees understanding of the session by asking the following questions:

What are major components of blood? What are the commonest methods for diagnosing malaria? What are essential parts of a microscope?



How is a blood film prepared? What are some of the common faults in preparing blood films Describe the method of staining blood films with the three common reagents for

malaria diagnosis. Describe any three methods for reporting blood films. What are the key characteristic features used to identify malaria parasites? What are the other haematological findings on a blood film?

6. Make the assessment interactive by making most of the trainees contribute to the answers.

Step 11 Summarise the session1. Display a slide on the summary of the session.2. Summarize the session by highlighting the following messages among others:

Always remember that laboratory diagnosis of Malaria in nutshell is a high quality systemic process that involves collection of blood samples, making the smears, staining the smears and, being able to identify Malaria parasites under the microscopy.

The common methods used in diagnosis of Malaria include the following: Microscopy Malaria Rapid Diagnostic Test (MRDT)

The four human species of Plasmodium include P. falciparum, P.ovale, P. malariae and P. vivax.

Each plasmodium species has a distinctive physical feature that is apparent under a microscope.

3. Key characteristics used to identify malaria Plasmodium speciesMalariae Pigment greenish brown and cover almost the cytoplasm Band formOvale Compact cytoplasm and red zoneFalciparum Crescent gametocyte and pigment rod -like Tiny ring and may have high density Clumped pigmentVivax Amoeboid cytoplasm

4. Malaria parasites may be reported in three different ways as:5. Thank the trainees for the active participation and encourage them to prepare for the

practical sessionRefer to slide 31

Session 5

Session title: QUALITY ASSURANCE AND QUALITY CONTROL



Purpose of the session:1. To enable trainees perform laboratory procedures safely and document processes

in performing these laboratory tests. to ensure reliable timely and correctly interpreted laboratory results

2. To improve on the processes through which health services are delivered .so as to detect errors at an early stage before they lead to incorrect test results.

3. To bring to the awareness of the trainees the following: The errors that can occur when collecting specimens. These are errors at the Pre-analytical stage.The errors that can occur at the testing of the specimens. These are errors at the Analytical stage.The errors that can occur at the reporting and interpreting of results. These are errors at the Post-analytical stage.

Objectives By the end of the session, trainees should be able to:1. Define quality assurance and quality control.2. Describe the elements of quality assurance in the

laboratory.3. Describe the quality control for reagents, diagnostics, and

equipment in malaria diagnosis.

Time 95 minutes

Preparation Make readily available the following:1. Hand outs of the session materials2. Copies of SOPs.3. SOP templates.

Methods1. Illustrated lecture.2. Small group discussion3. Brainstorming 4. Demonstrations

Resource Materials

1. Handout2. LCD3. News print /Flip charts4. Markers5. Copy of SOPs.6. Quality control log

Reference Materials1. Hand out: Course 3; Session 5.Quality assurance and Quality control 2. Power point presentation: Course 3;Session 5: Quality assurance and Quality

control


Step 1: Introduce the session:



Large Group Session

1. Lead a brainstorming session on trainees perception of the concept of QA/QC 2. Record the trainees responses on a flip chart3. Explain the purpose and objectives of the session.4. Link the trainee’s responses with the displayed session learning objectives and wrap up

the introduction sessionRefer to slides 2-3

Step 2: Present content area 1: Definition of Quality Assurance

1. Start by brainstorming on the following Definition of QA Aims of Quality assurance Definition of quality control

2. Put trainee’s responses on a flip chart.3. Display the relevant power point and compare with trainees responsesRefer to slides 4-6

Step 3: Present content area 2: Elements of Quality Assurance and Quality Control

1. Ask the trainees to list the elements of QA/QC2. Summarize their responses in a flip chart.3. Display relevant slides and explain the elements of QA/QC with reference to the trainees’

responses.Refer to slide 7

Step 4: Present content area 3: Quality control system for reagents, diagnostics and equipment in malaria diagnosis.

1. Lead a brainstorming session on what the trainees would consider to be Quality Control system for procedures, reagents, diagnostics and equipments in Malaria diagnosis.

2. Summarize their responses in a flip chart.3. Display relevant slides to describe how each of the systems is quality controlled.4. Review the trainees’ responses and clarify as need arisesRefer to slides 8-24

Step 5 Assess knowledge gained from the session

1. Display the power point that contains the learning objectives2. Ask the trainees if the learning objectives have been achieved.



3. Invite the trainees to ask questions on any area of the session they have not understood4. Provide relevant clarification to the trainees’ question.5. Assess the trainees understanding of the session by asking the following questions

What QA and QC? What quality control measures have the trainees put in place while diagnosing

malaria? What are the elements of QA?

6. Receive the trainees’ responses’ and clarify where necessary..


1. Summarize the session by highlighting the following messages: Quality Assurance involves analyses of operations step by step right from inputs,

process, output, outcome and impact. Quality Assurance aims at maximizing gains from available resources, looking at

opportunity to improve performance, and identifying the root cause of problems rather than symptoms.

Key elements of Quality Assurance include technical competence, effectiveness, efficiency, continuity, and safety among others.

Quality Control on the other hand aims at establishing performance standards for each test procedures, reporting results accurately and clearly, using control to check bias, and training laboratory workers to perform tests correctly.

Observe accuracy in specimen collection and processing, reagents preparation and use, reading techniques, reporting and recording results, use and maintenance of diagnostics, performance, and management to ensure quality laboratory results

2. Thank the trainees for the active participation and remind them to prepare for the practical sessions that follow.


Step 7 Administer the home work

1. Divide the trainees into two groups and ask them to draft a simple Quality control log on a flip chart.

2. Inform the groups that each should choose a reporter to take notes and report to the larger group at the end of the group work.

3. Encourage the trainees to draft a simple quality control system for slides to assess the performance of their laboratories.

4. Mark the sample quality control log and give feed back in the course of the training to fill in the missing links as required.

Session 6

Session title: PERFORMING AND READING AN RDT



Purpose of the session:1. To teach trainees about the different types of rapid diagnostic tests with emphasis on the commonly available RDT types, and how to read and record RDT results correctly. 2. To give the trainees knowledge on how to identify and remedy common mistakes in using RDTs and safe handling of sharps and blood.3. To enable trainees appreciate that using RDTs can be enjoyable if you know how to correctly dispose of the wastes generated during RDT use in our laboratories.

Objectives By the end of the session, you should be able to:1. Describe an RDT and how it works2. Briefly describe the different types of RDTs3. Perform an RDT correctly and safely4. Read an RDT accurately and record the result as positive

or negative5. Describe common mistakes in using RDTs6. Describe the safe handling of blood and sharps in RDT

use.

Time 60 minutes

Preparation Make readily available the following: Hand outs of the session materials Copies of Job aides for performing the RDTs WHO picture guide.

Methods1. Illustrated lecture.2.Small group discussions3.Brainstorming 4. Demonstrations.

Resource Materials

1. Handout2. LCD3. Flip charts4. Markers5. Job aides.6. RDTs

Reference Materials:1. Handout: Course 6; Session 6: Performing and reading RDT.2. WHO picture guide on performing RDTs



Facilitation Procedure

Step 1:Introduce the session

Large Group Session1. Lead a brainstorming session on trainees understanding of rapid diagnostic tests.2. Record the participant’s responses on a flip chart.3. Explain the purpose and objectives of the session and with reference to the

trainees’ responses help them appreciate the role of malaria rapid diagnostic tests in malaria patient management.

Step.2:Present content area 1: Description of RDTs and how they work

1.Start by brainstorming on the following issues; What are RDTs? What RDTs detect? How do RDTs work?

2. Display the power point on the description of RDTs.

3. Describe how RDTs work with emphasis on antigen antibody reactions involved.4. Give each participant an opportunity to talk about their experiences with using RDTs

in their various facilities.

Step 3. Present content area 2: Types of RDTs.

1. Display RDT kit(s) in front of the trainees.2. Display the power point on different types of a microscope. and review the advantages of each type of RDT.

Refer to slide

Step 4. Present content area 3: Performing RDTs

1. Ask the trainees to refer to the WHO picture guide when following the steps in performing and reading RDT results.2. Ask for one volunteer and demonstrate how to perform RDTs as the rest of the trainees follow the various steps involved with reference to the WHO picture guide.7. Ask the trainees to pair up and perform RDTs on each other and read the results.8. Clarify important aspects of the picture guide and offer guidance as the trainees

perform RDTs on each other..



Refer to WHO picture guides

Step 5 Present content area 4: Common mistakes in using RDTs8. Ask the trainees to list common mistakes in using RDTs.9. Summarize their responses on a flip chart and provide feedback.10.Display slides to list the mistakes in RDT use and how these mistakes are overcome.11.Encourage the trainees to solve common problems they may encounter in the course

of using RDTs.Refer to slides

Step 6: Present content area 5: Safe handling of blood and sharps 1. Ask the trainees to list how they can dispose of sharps, blood and wastes generated during RDT use.2. Record the trainees’ responses in a flip chart. 3. Display relevant slide on safe handling of sharps and wastes during RDT use.4. Review the trainees responses and provide clarification as need arisesRefer to slide

Step 7:.Assess knowledge gain from the session1. Ask the trainees to raise questions on any areas not clear in the presentation2. Respond to the trainees’ questions as appropriate3. Assess the trainee knowledge gained by asking thought provoking questions to

ascertain their understanding: What are RDTs? What are the different types of RDTs? How do RDTs work? Describe how wastes generated during RDT use can be safely handled?4. Make the assessment of the session interactive by making most of the trainees

contribute to the answers.5. Reinforce and correct the responses as appropriate


1. Display a slide on the summary of the session and highlight the following: RDTs stands for rapid diagnostic tests. The different types of RDTs include: Histidine rich protein II (HRPII), parasite

Lactate Dehydrogenase (pLDH), Aldolase. RDTs detect malaria parasite antigens. Malaria parasite antigens can persist in blood for upto 2 weeks. You should

always compare your RDT results with microscopy which is a gold standard accordingly. The WHO picture guide provided in the learner’s manual will help you to correctly perform and read RDT results. Encourage the trainees to make



reference to it when ever you have a problem with your RDTs.2. Thank the trainees for the active participation and ask them to prepare for the

practical session that follows: Refer to slide

Session 7

Session title: FACILITATION AND MENTORING SKILLS FOR A PEER TRAINER OF

HEALTHCARE PROVIDERS.

Purpose of the session:1. To give the trainee an awareness of the basic facts about teaching and learning

processes in adults education and training.2. To offer the trainee an opportunity to develop relevant skills appropriate for

facilitating and mentoring peers on-site at workplace.3. To create an awareness among the trainees to value the need for continuous

quality improvement of performance in given tasks through on-site support by competent peer trainers.

Objectives By the end of this session, trainees should be able to:1. Define the terms:

Facilitating and facilitator Learning Feedback Assessment

2. Describe the roles and main tasks of a facilitator3. Describe the qualities of a good teacher4. Describe the factors that enhance learning5. List the commonly used teaching methods and situations in which

they are appropriate 6. Explain the various facilitation skills7. Describe how to mentor other healthcare workers

Time 120 minutes Preparation Make readily available the following:

5. Session hand outs. 6. Power point presentations.7. Copies of the small group discussion trigger questions.8. Instructions for a role play for the session.

Methods 5. Illustrated lecture.6. Small group discussion7. Brainstorming 8. Demonstrations9. Role play

Resource Materials

6. Handout7. LCD



8. News print /Flip charts9. Markers10. Copy of SOPs.

Reference Materials3. Hand out: Session 7: Facilitation and Mentoring skill for a peer trainer of healthcare

providers4. PowerPoint presentation: Session 7: Facilitation and Mentoring skills for a peer trainer of

healthcare providers.


Step1:introduce the session

Large Group Session

1. Lead a brainstorming session on trainees understanding of the following: Concept of teaching and learning generally and especially in adults. Need for healthcare workers to have skills in training peers. Need for healthcare workers to be sensitive about the quality of performance in carrying

out their responsibilities at their health facilities.2. Record the trainees responses on a flip chart3. Ask the trainees to share what they expect to learn in the session.4. Display slide 2 on Introduction to the session5. Summarize the introduction with emphasis on the need for peer trainers to apply the

right methods when facilitating and mentoring their fellow healthcare providers.6. Display slide 3 on the learning objectives for the session.7. Explain the purpose and objectives of the session in reference to the learning objectives

displayed and try to integrate the trainees’ responses for a clear understanding of the concepts to be discussed in the session.

8. Encourage the trainees to feel free to ask questions and share experiences throughout the training session.

Step 2: Present content area 1: Definition of relevant terms.



1. Display slide 4 on defining terms.2. Ask the trainees to define any of the terms that they are familiar with.3. Correct or clarify the trainees’ definition of the given terms and refer them to read their

handout on the pages where these terms are defined.

Step 3: Introduce the trainees to the class activity. This activity should be able to help the trainees interact in small groups and discuss the following concepts:

Roles and tasks of a facilitator Qualities of a good facilitator Factors that enhance adult learning Skills of a good facilitator Components of the coach modelDisplay slide 5 on the group activity. Depending on the time allocated for the whole

session, give the trainees at least 10 minutes to complete this activity.Once the trainees have completed their group discussion and preparations for the role play, invite the groups to present one a time.

Discuss and give feedback to the presentations respectively after the given concepts have been presented according to the way they are laid out in the content outline for the session.

Step 4: Present content area 2: Roles and tasks of a facilitator

1. Invite the respective discussion group to make their presentation.2. Invite the class to make comments and raise any points of interest to the presentation

made by the trainees in the group.3. Share the comments and ensure good time keeping.4. Display slides 6 and 7 on roles and tasks of a facilitator respectively.5. Give appropriate feedback to the presentation by integrating the trainees’ responses to

the activity and the points in the displayed slides to do with the roles and tasks of a facilitator.

6. Emphasise the need for a facilitator to provide for a good learning environment for the trainees and also to ensure adequate time allotted to the preparation of a session to be presented and how to present it.

Step 5: Present content area 3: Qualities of a good teacher

1. Invite the respective trainee group that will have taken up the responsibility to act the role play.



2. Ask the rest of the trainees to observe the role play and jot down some comments as might be required in their respective work sheet.

3. Host a discussion and highlight what the trainees see as qualities of a good teacher4. Display slide 8 on the qualities of a good teacher and summarize this section of the

session.5. Together with the entire class appreciate the role play group for the job well-done!

Step 6: Present content area 4: Factors that enhance learning

1. Display slide 9 on how adults learn.2. The named slide has the following reflection trigger questions: What environment do you prefer to learn? Why do you decide to engage in a learning event? Why do you choose the content that you learn? What methods do you prefer to apply in your learning and teaching situation? How do you prefer to be taught?3. Ask the trainees to buzz among themselves for 2 minute on the listed questions.4. Note some of the trainees’ responses on the flip chart and enrich them by further

discussing them to sure that the trainees understand. 5. Display Slide 10 on Factors that enhance adults to learn best.6. Make an effort to relate the trainees’ contributions to the content in the slide displayed

and appreciate them for their participation.7. Summarise the section on factors that enhance adults to learn best and prepare them for

the discussion on the next section of the session.

Step 7: Present content area 5: Commonly used teaching methods and where you can most appropriately apply them.

1. Start by brain storming on what the trainees understand by the following: Teaching method Importance of teaching methods in a teaching and learning situation2. Record the trainees’ responses on a flip chart3. Display slide 11 on teaching methods and where these can be applied.4. With reference to the trainees’ contributions on the definitions and application of the

various teaching method and the contents of slide 11, put emphasis on the following: A method is a technique, way, approach or a means of doing something. Teaching methods are an essential part of teaching and learning process. The use of a variety of teaching method facilitates learning. It is very important that a facilitator identifies the most appropriate teaching method to

suite the kind of content that is to be delivered in a given session.5. Ask the trainees to open their “Trainee’s handout” on pages 69 to 71 and read the

contents of under the section of the session on “7.5: Commonly used teaching methods and the situations they are most appropriate” :

7.5.1: Lecture method 7.5.2: Questions and answers



7.5.3:Energiser and or breaks 7.5.4: Small group discussion 7.5.5: Role playing 7.5.10: Demonstration and practice6. Ask the trainees if there are areas of the section that they need further clarification and

guidance. Respond to these as might be appropriate for each of the questions asked.7. Summarise this section of the session before you proceed to the next.8. Thank the trainees for their active participation in the discussion so far.

Step 7: Present content area 6: Facilitation skills

1. Invite the small group that discussed the question on facilitation skills to make their presentation.

2. Ask the rest of the trainees to ask questions and or contribute to the presentation as might be relevant to them.

3. Invite the entire class to appreciate the work of the group that made the presentation.4. Display slide 12 on 7 basic facilitation skills.5. Highlight important aspects of each of the facilitation skills. Give a description of one or

so ways one could demonstrate each of the facilitation skills named: Set induction Variation Questioning Responding Explaining Reinforcement Set closure6. Following this, ask the trainees to refer to Section 7.6 on Basic facilitation skills on pages

71 and 72 of the trainee’s handout.

!Where time is available to you, ask the trainees to read the relevant aspects of the trainee’s handout under the section on facilitation skills. Just in case time for the session is limited, give the trainees to read the section as home work where possible.

7. Thank the trainees for their active participation in the session so far and ask them to prepare for the next discussion of the session.

Step 8: Present content area 7: Clinical coaching and mentoring healthcare workers

1. As part of the introduction of the section of the session on Clinical coaching and mentoring, you might be interested in asking the trainees the following questions to be sure they appreciate the concepts of coaching and mentoring:

Where have they seen or heard any of the two words use in ordinary interactions with different communities?

Ask the trainees to briefly share experiences of how in the past they were coached or



mentored, by whom and how coaching or mentoring was done for them. Now that they have shared their experiences on coaching or mentoring; how would they

define these terms? 2. Post the trainees’’ responses on a flip chart for reference during the on-going discussion.3. Display slides 13 and 14 that define the two terms respectively coaching and mentoring.4. Ask the trainees to establish the slight difference between clinical coaching and

mentoring.5. Emphasize the following about coaching and mentoring: Coaching is a short term capacity building strategy with the expected results clearly

defined. Mentoring is a long term capacity building strategy and that it doesn’t only focus on

technical or professional abilities but also puts into consideration other factors that might be compromising the healthcare worker’s standard of performance at work. These might include aspects of the healthcare worker’s social and public life, medical and or spiritual life. Mentoring of a healthcare worker also considers all other tasks that the interested healthcare worker has to accomplish be they defined on the job description or delegated.

6. Display slide 15 on the coach model and continue with the discussion.7. Explain the coach model that tries to define the major tasks that the one coaching a

healthcare worker should be able to do in order to ensure the healthcare worker is helped to improve the quality of healthcare services he or she offers to the community that is served by the respective health facility. The coach model provided the following steps in any direction that are defined by the letters that form the word coach:

Clear performance Openness to learning Assessment of performance Communication Help and follow – up8. Ask the trainees to refer to the text on page 74 of the trainee’s handout for a more

detailed explanation of the coach model in terms of the 5 tasks spelt out above.9. Ask the trainees to raise any comments and or areas of the coach model they might not

have understood while in the discussion.10.Respond to these as might be necessary.11. Introduce the trainees to the checklist for evaluating a facilitator on coaching healthcare

workers. Give the trainees time to read through and ask questions on the checklist.

No Coaching skills Yes Sometimes NoClear performance model1. I am careful to demonstrate the procedure according to the

approved standards2. I verbally explain each step in the procedure while I demonstrate

it 3. In my demonstration I use materials, equipment and a setting

similar to what the trainees have available in their work places4. While demonstrating the procedure, I ask trainees questions

such as “what should I do next?” or “What would happen if …?”, to keep their interest and test their understanding

Openness to learning1. I make it easy for the trainees to acknowledge that they lack



knowledge and skills 2. I show sensitivity to trainees’ natural feelings of fear and anxiety

when learning new skills3. I encourage trainees to be helpful and supportive to each other4. I don’t belittle or ridicule trainees if they make mistakesAssessment of performance1. I use a learning guide to give written feedback on trainee

performance2. My feedback to trainees is very systematic and is given as soon

as possible after I have observed them3. Following each practice session, I meet with the trainee to

discuss his/her strengths first and then review areas where improvement could be made

4. I encourage the trainees to take personal responsibility for problems- never to blame the clients or the others

5. When giving feedback I point out the things trainees are doing well and offer suggestions for improvement

Communication with the trainees1. I encourage a two-way communication with the trainees2. I request trainees’ opinions before expressing mine3. I emphasize solving problems rather than blame others4. I help the trainees to find their own solutions to problemsHelp and follow-up1. I make sure each trainee has a plan for continuing to practice

and apply the skills after the training2. I take steps to ensure that trainees have the necessary

equipment and supplies to apply the skills they have leant3. I get feedback from the trainees or their supervisors about how

well they are performing the skills4. I make sure the trainees’ supervisors understand and support

the procedures the trainees have learnt

12.Explain to the trainees that in both coaching and mentoring there are 4 things that must occur and include the following:

Observing a healthcare worker perform a given clinical task. Establishing the strengths of the healthcare worker in performing that task Establishing the shortcomings of the healthcare worker in performing that very task Giving feedback to the healthcare worker on how she or he performed the given task

13.Based on the above explanation on observing a healthcare worker perform a given task, indicate it to the trainees that giving feedback is very important and that the following are equally important:

When to give the feedback How one gives the feedback to the healthcare provider How the healthcare worker should be prepared to receive and own the feedback

14.Ask the trainees the following questions on how they would wish to deal with coaching and feedback in their own setting:

When would they give feedback to a healthcare worker on how she or he has performed a given task?

How would they want to give such feedback to the healthcare provider?



From their past experience, how would they wish to own their feedback?

15.Take note of the contributions from the trainees and complement them accordingly.16.Display slides 16, 17 and 18 on when to give feedback, how to give feedback and how to

receive feedback accordingly.17.Harmonise the contributions from the trainees and those in the displayed slides.18.Ask the trainees to raise any concerns to do with the concept of feedback and how to

make it more relevant and therefore more effective in ensuring excellent performance of the individual healthcare work.

19. In concluding the section on clinical coaching and mentoring, refer the trainees to their trainee’s handout on page 75 for a little more explanation on when to give feedback, how t give feedback and how to receive feedback.

20.Thank the trainees for their active participation during the discussion on the concepts of coaching and mentoring.

Step 9: Assess trainees’ knowledge gain from the session

1. Invite the trainees to raise any questions on the areas of the session they will not have understood

2. Give relevant clarification on the questions raised3. Assess trainees’ knowledge gain from the session by asking thought provoking

questions. 4. Display slide 19 on sample questions for assessing the trainees’ gain of knowledge from

the session.5. Ensure that all the trainees get actively involved in responding to the different questions

asked in this part of assessing learning attainment of the trainees. Clarify concepts where necessary.

Step 10: Summarize the session1. Summarize the session by revisiting the following key points: Need for healthcare workers involved in training peers to get skills on how to facilitate,

coach and mentor peers Definition of relevant terms in training adults Roles and tasks of a facilitator Qualities of a good teacher Factors that enhance adult learning Common teaching methods and where they can best be applied Facilitation skills Coaching and mentoring 2. Display slide 20 on summary of the session on facilitation and mentoring skills for peer

trainer of healthcare workers.

3. Emphasize to the trainees that these are the basic take home messages for them to refer to training their peers in their respective health facilities.

4. Thank the trainees for their active participation in the session and ask the to prepare for



the next session

PRACTICAL PLACEMENT

Practical placement 1

Session title: MICROSCOPIC AND PICTURE SLIDE READING

Purpose of the session: 1. To assess the knowledge of the trainees in malaria diagnosis.

Objectives By the end of this session, trainees should be able to:a. Identify a malaria blood film as positive or negativeb. Identify parasite stages. c. Identify parasite species.

Time 90 minutes

Preparation 1. Make readily available the following: Checklists for each trainee Slides Picture slides

Methods1. Small group discussions2. Demonstration

Resource Materials

1. Copy of microscopy report forms2. LCD3. Computer4. Prepared slides



5. Microscopes 6. Immersion oil7. Lens cleaning tissue

Reference Materials1. Handout: Course 3 Session 3: Preparation and storage of reagents for malaria

diagnosis 2. Handout: Course 3 Session 4: Laboratory diagnosis of Malaria.


Step 1: Introduce the practical placement

Large group session:1. Create rapport with the trainees2. Spell out the objective of the practical session.3. Give each participant a microscopy report form .Encourage them to fill their

details on the microscopy report form –name / personal identification number and date.

4. Display the power point containing the 50 picture slides one after another.5. Let the trainees fill the result form giving details of the following: slide number, slide result whether positive or negative species of the parasites stage of the parasites.6. Collect the microscopy report forms and subject the learners to reading slides to

assess their knowledge before the training in terms of slide reading.7. Arrange a set of 5 slides per microscope and encourage each learner to examine

them using the microscope provided. 8. Ask the trainees to exchange the slides amongst themselves so that all the slides

are read by each of them.9. Give each participant a microscopy report form.10. Let the trainees enter their result onto the microscopy report forms. See

microscopy report form below.11.Mark the slide results and provide feedback to the trainees.12.Display the slide results.



13. Inform the trainees that the picture slides and the slides will be discussed in a later session.

14.Remind the trainees to observe time for the practical sessions.

Microscopy Results Report SheetName: _________________________Site: _______________Date:_______

Slide No.

Results (+/-) Species Stage

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Lab Supervisor Name: _____________ Signature ____________ Date :___ Practical placement 2

Session title: VISIT TO A LABORATORY

Purpose of the session: 1. To provide an opportunity to the trainees to witness step by step procedures in

malaria diagnosis.2. To practice the skill described in the didactic sessions in a conditions as close as

possible to those that trainees will meet later in their jobs.

Objectives By the end of this session, trainees should be able to:1. Identify good and bad malaria diagnosis practices: Sample Collection Smear preparation Smear staining Smear result reporting Recording of smear results

Time 105 minutes

Preparation 1. Identify a health facility with an active laboratory2. Formally inform the staff and administration of the identified

health facility about the scheduled visit by the trainees.3. Identify a focal person from the health facility to work with

Methods1. Modified lecture 2. Small group discussions3. Demonstration



Resource Materials

1. Copies of SOPs2.

Reference Materials3. Handout: Course 3 Session 4: Laboratory diagnosis of Malaria4. Handout: Course 3 Session: Preparation and storage of reagents for malaria

diagnosis.



Large group session:1. Provide the trainees with the following information: Objectives of the practical placement Site of the practical placement2. Describe to the trainees how patients flow in the laboratory.3. Guide the trainees on a tour of how the different areas in the laboratory are

organised for malaria diagnosis.4. Demonstrate the best way of making blood films to the trainees then allow the

trainees to practice these techniques5. Demonstrate the best way of staining blood films to the trainees and then allow

them to stain their films6. Evaluate the skills each trainee has learnt and help each learner to assess his or

her own progress and identify areas for further improvement.7. Take pictures of the slides they would have prepared and stained before and after

the demonstrations.8. Remind the trainees to observe the time given for the practical placement.

Step 2: Supervise practical placement

Small group discussion1. Introduce the trainees to the focal person at the practical placement site2. Monitor to ensure progress of the practical placement.



Step 3: Lead the plenary session

Large group session1. Lead the plenary session when all the small groups have come back from the

practical placement site 2. Ask the trainees about their experience. in the practicum site3. Take note of the key observations in the presentations.4. Wrap up the session by giving highlights based on the presentations.


Session title: PREPARATION OF REAGENTS

Purpose of the session: 1. To provide opportunity to the trainees to witness step by step procedures in

preparing malaria diagnosis reagents

Objectives By the end of this session, trainees should be able to:1 .Prepare : Fields stain Leishman stain Giemsa stain Buffered water2. Test the quality of the prepared reagents3. Test the pH of the buffered water.4. Label prepared reagents correctly.

Time 120 minutes

Preparation 1. Make readily available the following: Preparation protocol Powders of the reagents Glassware and equipments required for the preparation


Resource Materials

1. Copy of SOPs2. Leishman stain, Giemsa stain and Fields stain3. Buffered water



4. Glassware and equipments required for the preparation

Reference Materials1. Handout: Course 3 Session 3: Preparation of reagents for malaria diagnosis.


Step 1: Introduce the practical session

Large group session:1. Provide the trainees with the following information: Objectives of the practical placement2. Arrange the materials required for the practical session as listed under resources 3. Divide the trainees into two groups and ask them to prepare Leishman

stain ,Fields stain, Giemsa stain and buffer4. Ask each trainee to accurately weigh the required quantities of the powders and

solvents to prepare the reagents5. Follow the steps in the trainee hand out accordingly.6. Ask the trainees to accurately label the newly prepared reagent and the buffer7. Test the quality of the newly prepared reagent in the next practical session8. Test the pH of the buffered water.


Small group discussion1. Monitor to ensure progress of the practical placement.


Large group session1. Lead the plenary session when all the small groups have performed the practical

session.



2. Ask one group at a time to give feedback about the general practical session3. Take note of the key observations in each of the presentations.4. Identify gaps in performing the skills and re-demonstrate it to the trainees.5. Ask the trainees to do return demonstration to master the skill.6. Thank the trainees for the active participation.


Session title: LABORATORY DIAGNOSIS OF MALARIA

Purpose of the session: 1. To provide opportunity to the trainees to practice steps involved in malaria

diagnosis.2. To practice the skill described in the didactic sessions on laboratory diagnosis of

malaria.

Objectives By the end of this session, trainees should be able to:2. Identify good and bad malaria diagnosis practices:1. Sample Collection2. Smear preparation3. Smear staining4. Smear result reporting5. Recording of smear results

Time 120 minutes

Preparation 1. Make readily available the following: Checklists for each trainee2. Identify a health facility with an active laboratory


Resource Materials

1. Copy of SOPs2.



Reference Materials1. Handout: Course 3 Session 4: Laboratory diagnosis of Malaria2. Handout: Course 3 Session: Preparation and storage of reagents for malaria

diagnosis.



Large group session:1. Provide the trainees with the following information: Objectives of the practical placement2. Remind the trainees to observe the time given for the practical placement3. Assemble all collection materials including record forms, slides, pencils, lancets,

stains, samples etc before the sampling begins4. Acquire a non infectious blood treated with an anticoagulant from a hospital

laboratory or ask a volunteer from among the trainees’5. Display 2 slides (thick and thin blood films) which have been prepared by you to

the trainees.6. Demonstrate to the trainees how thick and thin blood films are prepared.7. Ask each trainee to practice preparation of thin films first, making one per slide.

When they have reached the standard you require, allow them to make a thick film8. Judged a trainee competent when he /she has prepared three or four satisfactory

slides correctly labelled and accurately recorded.9. Move round to make sure each of the trainees is on the right track in their practical

sessions.10.Provide guidance, clarification and demonstration when there is need. 11.Ask the trainees to share their observations and impressions. 12.Keep the slides for staining during the staining practical session. 13.Ask the trainees to stain the films with the stains they had previously prepared14.Start by preparing the buffered water that will be required to mix the stain.15. Measure the pH with a pH meter or with a colour indicator.16.Get familiar with the weighing process and colour testing17.Refer to the learner’s handout for the protocol for staining.18.Discuss the best practices in relation to washing of the smears to avoid scum

covering the smears and the subsequent drying of the smears.



19.Discuss the stained smears with reference to the blood smear quality form below.

MALARIA BLOOOD FILM QUALITY CONTROL FORMITEM SLIDE QUALITY YES NO1. Is the MBF correctly labelled?

2. Does thick smear have adequate size to?3. Does the thick smear appear to be of

correct thickness (0.06 – 0.09mm and can allow a written mark be seen through)?

4. Is the thick film more than 90% intact?5. Are the WBC’s in thick film properly

stained?6. Are the RBC’s completely lysed?7. Does the thin film appear with feathered

edge?8. Do RBC’s appear well distributed in

single layer?9. Do RBC’s show correct stained intensity?10. Does the parasite manifest crescent blue

cytoplasm with pinkish red dot nuclear?11. Does the thick film contain anything to

suggest debris or artefacts’?12. Does the thin film contain anything to

suggest debris / artefacts?






Large group session

1. Lead the plenary session when all the trainees have completed their assigned tasks.

2. Discuss their slides with reference to the blood film quality assurance form3. Provide guidance and re-demonstration as need arises.4. Thank trainees for their active participation and ask them to prepare for the next

practical session.


Session title: REVIEW: MICROSCOPIC AND PICTURE SLIDE READING

Purpose of the session: 1. To assess the knowledge gained by the trainees in malaria diagnosis.2. To review the slides read during the pre test.

Objectives By the end of this session, trainees should be able to:a. Identify a malaria blood film as positive or negativeb. Identify parasite stages. c. Identify parasite species.d. Identify artefacts’e. Identify a well stained blood film.

Time 90 minutes

Preparation Make readily available the following: Checklists for each trainee Slides Picture slides


Resource Materials

1. Copy of microscopy report forms2. LCD3. Computer4. Prepared slides5. Microscopes 6. Immersion oil7. Lens cleaning tissue

Reference Materials



1. Handout: Course 3 Session 3: Preparation and storage of reagents for malaria diagnosis

2. Handout: Course 3 Session 4: Laboratory diagnosis of Malaria.



Large group session:1. Create rapport with the trainees2. Spell out the objective of the practical session.3. Display the power point containing the 50 picture slides one after another.4. Discuss the slides with reference to the quality of the stain ,whether it is positive or

negative and the stages of the parasites if any and give feed back immediately after each slide.

5. Refer to the results of the projected slides to guide you6. Place a selection of slides next to each learner’s microscope. These should be

slides positive for malaria and having the different species of malaria.7. Let each learner identify the parasite species and the stage and ask each trainee

to explain the feature that led to a particular diagnosis.8. Provide guidance where necessary.9. Clearly show the diagnostic features required for identification of each of the

species.10.Provide each learner with between 10 and 20 of these slides and allow them 20

minutes for the identification.






Large group session

1. Lead the plenary session when all the trainees have completed their assigned tasks.

2. Discuss their slides with reference to the blood film quality assurance form3. Provide guidance and re-demonstration as need arises.4. Thank trainees for their active participation and ask them to prepare for the next

common sessions and the post test.


Session title: POST TEST: MICROSCOPIC AND PICTURE SLIDE READING

Purpose of the session: 1. To assess the knowledge and skills gained by the trainees in malaria diagnosis.

Objectives By the end of this session, trainees should be able to:1. Identify a malaria blood film as positive or negative2. Identify parasite stages. 3. Identify parasite species.

Time 90 minutes

Preparation Make readily available the following: Checklists for each trainee Slides Picture slides


Resource Materials

1. Copy of microscopy report forms2. LCD3. Computer4. Prepared slides5. Microscopes 6. Immersion oil7. Lens cleaning tissue

Reference Materials1. Handout: Course 3 Session 3: Preparation and storage of reagents for malaria

diagnosis 2. Handout: Course 3 Session 4: Laboratory diagnosis of Malaria.




Step 1: Introduce the post test

Large group session:1. Create rapport with the trainees2. Spell out the objective of the practical session.3. Give each participant a microscopy report form .Encourage them to fill their details

on the microscopy report form –name / personal identification number and date.4. Display the power point containing the 50 picture slides one after another.5. Let the trainees fill the result form giving details of the following:

slide number, slide result whether positive or negative species of the parasites stages of the parasites.

6. Collect the microscopy report forms and subject the learners to reading slides to assess their knowledge after the training in terms of slide reading.

7. Arrange a set of 5 slides per microscope and encourage each learner to examine them using the microscope provided.

8. Ask the trainees to exchange the slides amongst themselves so that all the slides are read by each of them.

9. Give each participant microscopy report forms.10. Let the trainees enter their result onto the microscopy report forms.11.Mark the slide results and provide feedback to the trainees.12.Display the slide results.



POST – COURSE ASSESSMENT

Post - course Assessment

Session title: POST-COURSE ASSESSMENT

Purpose of the session: To assess trainee level of knowledge, skills and attitudes from the course To identify trainees needing special support after the course.

Objectives By the end of the session, the trainees should be able to:1. Assess their own level of knowledge, skills and attitudes in

fever case management and the integrated management of malaria.

Time 30 minutes Preparation 1. Prepare enough copies of the Post-test

2. Remind the trainees to indicate their Trainee Identification numbers (TIN) as they did in the Pre- test.

Resource Materials

1. Flip chart stand, flip charts, masking tape and the markers2. Copies of the post-test3. Timer or clock4. Marking scheme



Procedure for administering the Post-test

Step 1: Administering the post-test:

CONCLUDING THE COURSE


Large group session:1. Ask the trainee to indicate the Trainee identification number in the space provided

for on the Post-test copy and to keep this number private to them selves.2. Take the trainee through the relevant instructions to the Post-test and remind them

to indicate their TIN.3. Explain to the trainees the purpose of the Post-test and emphasize it to them that it

is not an examination but a tool to establish the level of knowledge from the course and identify trainees who need most help after the course.

4. Pick the test papers when the trainees are done with them5. Mark the scripts using a marking scheme and record the marks gained by each

trainee in percentage.6. Display the marks gained by the whole class on a graph drawn on a flip chart

indicating only the TIN and not their names. Display theses results in combination Pre and post test results.

7. Make an effort to provide the results of the post-test on the last day of the training – by the time of the closing ceremony.

8. Share the performance of the trainees in the Post-test with the rest of the facilitators so they can focus their guidance accordingly during the follow-up support visits to the trainees..


Closing ceremony

Session title: CLOSING CEREMONY

Purpose of the session: 1. To provide an opportunity for the trainees to receive messages to emphasize what

they will have learnt in the training2. To officially close the training.

Objectives1. By the end of this session, trainees should be able to: Outline the key messages emphasised during the closing

ceremony Award course certificates to the trainees

Time 60 minutes

Preparation 1. Make readily available the following: Certificates A Chief Guest to officiate the function Master of ceremony An appropriate venue

Methods1. speeches2. Award of certificates.

Resource Materials 1. HMIS forms in use at the health facility

Reference MaterialsNot applicable




Step 1: Give welcome and introduce

Large group session:1. The Master of ceremony welcomes every body and asks a trainee to lead an

opening prayer.

Step 2: Conduct the closing ceremony

1. The course director introduces trainees, the guests and gives an overview of the training.

2. Ask a representative of the trainees to make a speech on behalf of the group.The speech highlights the main lessons learnt and how they expect to use the knowledge gained for improved quality of care for malaria patients. He/she should also emphasise the resolution to go back to their facilities and work as a team.

3. Ask the representatives of JUMP to make speech if available.4. Ask the Guest of honour to make his speech and officially close the workshop.5. Chose one of the guests to invite the chief guest to close the training.6. Award of Certificates

Certificate award. The certificates are awarded to the trainees by the Chief Guest. The names are read by a Course director, who hands over the certificate to the Chief Guest who finally hands it over to the owner after a brief handshake.

7. At the end of the closing ceremony trainees assemble at one point to take group photographs.

8. After the group photograph the trainees are free to leave the training venue.



Compiling the activity report

Meeting title: COMPILING THE ACTIVITY REPORT

Purpose of the meeting: 1. To provide opportunity to the facilitators to share experience on the concluded

training and chart a way forward to more trainings and follow up of the trainees.2. To compile a report about important aspects of the training for information of

relevant stakeholders.

Objectives By the end of this meeting, facilitators should be able to:1. Review the implementation of the training in terms of the

strength and weaknesses of the following: Trainees invited Sessions conducted Practicum sites used Facilitators involved Venues used General administration of the training2. Compile a report with the following suggested outline: Acknowledgement Introduction: Background Aims and objectives of the training Course content Course trainees Course facilitators Course venue Course administration3. Methodology Laboratory staff course4. Course evaluation Daily session evaluation Pre-Post test assessment Laboratory skills assessment End of course evaluation5. Course constraints and challenges6. Lessons learnt7. Way forward for the implementation of the course in the district8. Conclusions9. Appendices



List of the trainees List of trainees’ expectations List of facilitators Course schedule Pre and Post test results Course project reports Trainees end of course evaluation

Time 60 minutes

Preparation

1. Facilitators to attend the meeting with relevant documentations or reference material about how they facilitated their respective sessions

2. Assessment results3. Agenda for the meeting

Methods1. Discussion

Resource Materials

1. Facilitators’ guide2. Documents compiled by the individual facilitators

Reference Materials1. Sample report form the JUMP office


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