Objective To analyze the quality of malaria blood smears of febrile patients in Chenzhou city in order to provide a scientific basis for the standardization of blood test. Methods According to the technical solutions to eliminate malaria of 2011 edition, more than 3% Plasmodium negative blood smears and all Plasmodium positive blood smears were reviewed monthly from 2015 to 2017. The quality of blood smear preparation, staining, cleanliness and detection results were reviewed by malaria microscopic examination staff. The descriptive epidemiological method was used to analyze the data. The Chi square test was used to compare the rates, and P<0.05 was statistically significant. Results A total of 9 806 malaria blood tests among febrile patients were carried out in Chenzhou city in 3 years. Plasmodium negative blood smears were reviewed in the number of 518, accounting for 5.29% of all Plasmodium negative blood smears, with the production qualified rate of 77.80%, the staining pass rate of 89.58%, the cleanliness pass rate of 95.17%. No missed detection was found in Plasmodium negative blood smear review. Nine (9) Plasmodium positive blood smears were rechecked, accounting for 100% of all Plasmodium positive blood smears, and the qualified rate of production, staining and cleanliness all were 88.89%. One Plasmodium classification error was found in Plasmodium positive blood slides review. There were statistically significant differences among each county in the production qualified rates, the staining pass rates and cleanliness pass rates (χ²=87.286, 80.636, 81.023, all P<0.001). There were no statistically significant differences among each year in the production qualified rates and cleanliness pass rates (χ²=3.484, 1.941, both P>0.05). There were statistically significant differences among each year in the staining pass rates (χ²=6.521, P=0.038). Conclusion The production and staining of Plasmodium blood smears should be further standardized in Chenzhou in the future, the training and quality control of Plasmodium microscopy should be further strengthened to improve the quality and the accuracy of microscopic examination for malaria diagnosis.