Assessing malaria staining practices with Giemsa for malaria microscopy; a case of selected laboratory facilities in the Ashanti region of Ghana

Background: Microscopy remains the gold standard for malaria diagnosis globally, especially where quality Giemsa stain is used. However, several Giemsa stains products have flooded the Ghanaian market which may not meet the required standard. In this study we report on the efficacy of Giemsa stains used for malaria detection in selected medical laboratories in Ashanti region. Methodology: A questionnaire was administered to obtain data of staining practices among participants. Thick and thin blood smears with standard parasite density of 300,000 parasites/ul ± 25,000 was given to facilities for staining. The stained slides were examined for their staining characteristics of the white blood cells, malaria parasites and parasite density by certified malaria microscopists. Results: Less than 40% of the participant had parasite density within the expected range (225,000-375,000/ul). Forty percent (40%) also scored less than 7 out of 10 on the staining characteristics of the white blood cells. Additionally, 73.3% of participating laboratories used tap water for preparation of Giemsa working solution which affected parasite negatively. A statistically significant association was observed between immediate preparations of working solution and the morphological changes of neutrophils (p<0.0001). Conclusion: The study found that a less than half (40%) of Giemsa products used in Ghanaian medical laboratory facilities were adequately effective in detecting in malaria parasites optimally. This poses a great threat to malaria diagnosis in Ghana.