Performance Assessment of Laboratory Professionals on Malaria Smear Microscopy and Associated Factors in West Oromia Malaria External Quality Assessment Centers, Ethiopia 2025

Background Ensuring competency among laboratory personnel is crucial for accurate malaria microscopy. Accurate laboratory diagnosis is essential for effective treatment, reducing drug resistance, and guiding proper care. Yet, with diagnostic responsibilities now shifted to general laboratory technicians, concerns have emerged about their proficiency, especially in regions like West Oromia. Misdiagnosis and poor diagnostic quality of malaria microscopy in the area. Methods A cross-sectional study design was conducted among 131 laboratory professionals from 25 external quality assessment centers in West Oromia between January and March 2025. Demographic data were collected using a self-administered questionnaire. Each professional was assessed using 10 pre-validated malaria slide panels focusing on malaria parasite detection, species differentiation, and parasite quantification. Data were entered into EpiData and analyzed using SPSS version 20. Descriptive statistics summarized the findings, and diagnostic performance metrics were calculated. Bivariate analysis (p < 0.25) identified candidates for multivariate logistic regression, where p < 0.05 indicated statistical significance. Results The acceptable proficiency test result was 62.6%, with high sensitivity (95.7%) and specificity (96.2%), with strong overall agreement (95%) and a high kappa value (k = 0.91). Agreement in the identification of different malaria species was 69%, with a kappa value of 0.52, reflecting moderate concordance. Parasite quantification by laboratory professionals was very low, with only 3.4% counting parasites within the expected range. Multivariate analysis revealed that having a diploma/Level 4 education (AOR = 4.87; 95% CI: 1.5–15.6; p < 0.05) and professionals who had not received training within the past three years (AOR = 27.3; 95% CI: 8.1–91.6; p < 0.001) were significantly associated with the competency of laboratory professionals in diagnosing malaria smear microscopy. Conclusion There were high unacceptable proficiency test results among laboratory professionals; high parasite detection agreements, moderate species identification, and poor parasite counts were observed. The performance status of laboratory professionals in diagnosing malaria smear microscopy was associated with educational levels and recent malaria training. Training and promoting higher education among laboratory staff were important to enhance the diagnostic accuracy of malaria microscopy in West Oromia.