Ahmed Tahiru Issah, Charles B. Delahunt, Carine Mukamakuza
Malaria diagnosis in endemic regions depends on species-level identification of Plasmodium parasites in thick blood smears, but deep learning detectors classify detections without providing morphological evidence for their predictions, limiting the ability of microscopists to audit those predictions at the case level. We present SGMCE (Segment-Grounded Morphological Concept Explanation), a post-hoc explanation framework that requires no additional training, no morphological annotations, and no labelled explanation data, yet produces per-detection natural-language explanations anchored in thick-smear morphology. For each detection, SGMCE extracts mask-guided crop thumbnails, computes fourteen handcrafted computer-vision morphological features (shape, colour, chromatin, haemozoin pigment) using adaptive within-mask thresholds, and queries GPT-4o with both visual evidence and computed measurements, conditioned on a thick-smear-specific knowledge base compiled from the World Health Organization bench aids. The primary output is a structured explanation identifying which morphological features support the detected species and why the competing species are excluded. Explanations are validated by four automatic metrics: Knowledge-Base Consistency (KBC), CV-Claim Faithfulness (CCF), Discriminativeness Score (DS), and LLM-as-Judge (LLMj). A sentence-level semantic scoring rule with species-aware negation filtering resolves the vocabulary mismatch between clinical prose and knowledge-base terms. Across 737 detections from 139 thick-smear images spanning four Plasmodium species and white blood cells, parasite-class mean KBC is 0.91, mean DS is 0.99, and mean CCF is 0.97, while a per-rule CCF breakdown confirms that the CV-grounded claims made by the vision-language model are consistent with the measurements they cite.