1. MIS 2010 Laboratory procedures

2. Introduction During the MIS patients are tested for Anemia using a hem cure 201+ Malaria parasites using RDTs (ICT Mal Pf) Thick blood films stained in Geimsa 3% Dried spots will be used to resolve on discordant results Serology testing for malaria transmission intensity Other molecular amplification methods like LAMP

3. Tests per client Hemoglobin estimation RDTs test for P.falciparum Thick blood film Blood spot on a filter paper

4. Requirements for the four tests General Un used gloves Alcohol swab, Lancet Sharp disposal box General disposal bucket with a bin liner Anemia Hemocue analyzer, Microcuvette Malaria Testing by RDTs Testing device, Sucking blood Malaria testing by blood film Microscope slide Slide box carrier Slide making template Serology and molecular analysis Filter paper Descant Medicine pack

5. Blood collection procedure Clean the ring finger appropriately with an alcohol swab Using a sterile lancet gently prick the finger Put two normal drops on the centre of slide From the same finger stick put a drop of blood on each circle/square on the provided filter paper From the microscope slide Fill the microcuvette for HB estimation Suck the blood using the provided sucking bulb for RDTs testing in the kit to the right first mark The remaining blood on the slide is spread evenly using the provided template to make an even thick film

6. How to make a finger stick Assemble all the requirements for the four tests Hb,malaria test (RDTs &BF), serology testing and molecular analysis (PCR & Lamp) Put on new un-used gloves Clean the ring finger with an alcohol swab let it air dry Open a new un-opened sterile lancet from the RDT kit and use it to make a finger stick Without putting it on the floor or table discard it directly in the sharp box.

7. Blood collection Label the microscope slide, RDT testing device, medicine pack and filter paper with the client ID. Put two drops of blood on the centre of the microscope slide. Put additional drops of blood on each of the circles/squares on the filter paper.

8. Hemoglobin testing Turn on the Hemocue Open the sample rack Fill first the microcuvette from the two drops on the microscope slide Clean the microcuvette and put it in the Hemocue Read and report the results when displayed.

9. Malaria testing-RDTs Suck blood from the centre of the microscope slide to the first mark of the sucking bulb in the RDT kit Dispense the sucked blood on the sample well by touching-blotting Add five drops of buffer on the buffer well Wait for 15 minutes Read, and report the results Keep the used RDT cassette for QC

10. Malaria testing-BF From the remaining blood after anemia and RDTs testing, Spread it over the area as indicated by the slide making template Keep it on a flat surface to air dry Store air dried blood films in the slide carrier box. Blood films should be stored properly following the patient name, IDs,dates and enumeration areas

11. Blood spots Let each drop of blood on each circle completely air dry for a day protected from the dust and insects in the slide carrier box Puck them in a well labeled with client IDs medicine pack with a descant Enter or tick the specimens successfully collected on the specimen sheet provided. Ensure that this is verified by all team members

12. How to do lab procedures Follow Hemocue manufacture instructions Follow RDTs instructions sheets

13. Specimen dispatching All the specimens will received by one of the four laboratory supervisors only. No one should just leave the specimens with anyone without verification and signing in the specimen receiving register for each laboratory supervisors. All the four specimens (slide, RDT, filter paper, anemia test result) will be checked for labeling,presence or absence and collect collection. Each enumeration area will have its own slide carrier and all the specimens bundled together with the daily specimen collection sheets in one place.

14. Specimen Storage Slides will be stained at NMCC Examined and results report at NMCC Filter papers will be stored at 4 degree Celsius before molecular and serology analysis at a selected institution.