Towards Malaria Elimination: Strengthening the Quality of Malaria Diagnostic Services in Sao Tome and Principe


Malaria is a preventable, treatable, and curable disease. However, without prompt diagnosis and effective treatment, malaria can progress to a severe form of the disease and death. The WHO African Region carries a disproportionately high share of the global burden of the disease, with 2021 hosting 95% of malaria cases and 96% of deaths. Nevertheless, the following African countries have made good progress and are part of the malaria elimination initiative (E2025): South Africa, Botswana, Namibia, ESwatini, Comoros, Cape Verde and Sao Tome and Principe. WHO recommends that countries in the malaria elimination process must have a core group of WHO-certified expert microscopists to guarantee the quality of malaria diagnosis.

Early diagnosis and rapid treatment are one of the critical interventions to reduce mortality and morbidity from malaria. To ensure accurate diagnosis, the competence of every microscopist should be regularly assessed and their competence levels certified. The competence assessment should be based on malaria parasite detection, malaria parasite species identification and malaria parasite quantification.

Sao Tome and Principe has succeeded in reducing malaria incidence in the country in the last two decades. The annual incidence is currently around 18/1000 inhabitants. The country was intending to eliminate malaria by 2025. However, the country has recorded the following increasing cases in the past three years:1944, 2730 and 3999 respectively for 2020, 2021 and 2022.Then this 2025 target seems to be compromised possibly due to the COVID-19 impact and climate change effects that Sao Tome and Principe has experienced in the last three years.

WHO in partnership with the Global Fund to Fight AIDS, Tuberculosis and malaria supported the Ministry of Health in Sao Tome and Principe to conduct an External Competency Assessment for Microscopists from 09 – 20 January 2023 to ensure there is a pool of WHO certified expert malaria microscopists in the country that contribute to the national malaria elimination agenda. This was the first time that Sao Tome and Principe held such a workshop.

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The two-weeks ECAMM training of 12 national microscopists included one week of refresher training and one week of assessment. The training and evaluation were conducted by two experts from University Cheikh Anta Diop of Dakar (UCAD), a WHO collaborative center for malaria for francophone and lusophones-speaking countries, Dr. Mamadou Alpha Diallo and Professor Ndiaye Daouda. This ECAMM resulted in three microscopists certified for level 1 or 2 and nine microscopists certified for level 3 or 4. Sao Tome and Principe, therefore, now has three WHO-certified microscopists, which is a good score for a small island country of about 220,000 habitants, compared to other countries in the region.  Professor Daouda Ndiaye, the director of ECAMM courses reiterated the commitment of the University of Cheik Anta Diop of Dakar, Senegal to continue to support Sao Tome and Principe for malaria microscopy.

WHO Country Representative Dr. Françoise Bigirimana stated in her speech during the closing ceremony that WHO will continue to provide technical support to build capacity and maintain the competency level of microscopists and other human resources for health in the country. She highlighted that it is essential to have effective skill-based trainings, periodic assessment and monitoring of performance in the area of diagnosis for malaria and other priority diseases in the country. WHO is committed to support the country to fight and eliminate diseases and progress towards Universal Health Coverage in the context of the Sustainable Development Goals by 2030. 

Closing the workshop, the Minister of Health, Célsio Junqueira, emphasized that the final stage of elimination is more challenging and demanding. He highlighted the crucial role of human resources for health and called for increased engagement of microscopists and other health workers towards elimination of malaria in the country. Finally, he acknowledged the south-to-south cooperation between African countries like Senegal and Sao Tome and Principe for this ECAMM.

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Distributed by APO Group on behalf of World Health Organization (WHO) – Sao Tome and Principe.

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