Browsing by Author "Asrat Habtamu"

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    Performance Evaluation of TB Smear Microscopists at External Quality Assessment Rechecking Laboratories in Ethiopia
    (Addis Ababa University, 2015-09) Asrat Habtamu; Desta Kassu
    Background: Tuberculosis (TB) is an infectious disease caused by the bacillusMycobacteriumtuberculosis. It is the second l eading cau se o f d eath among infectious disease w orldwide.According to FMoH 2013/14 report, the TB case detection rate was 53.7% which is below thetarget s et f or t he ye ar (81.0%). Quality assu red sp utum sm ear microscopy is one of essentialcomponents of DOTs to detect TB cases. The quality of AFB smear microscopy often dependenton the s trength of national TB pr ogram that s upport, t rain, a nd m onitor the p erformance of individuals working in the laboratories. Objective: To assess the p erformance o f T B microscopists at E QA rechecking l aboratories i nEthiopia. Methods: A cr oss sec tional st udy was conducted on 81 EQA rechecking laboratories i n a llregions of E thiopia from April–July, 2015 . Panel sl ides were prepared a nd va lidated a t theNational TB Reference Laboratory (NRL), Ethiopian Public Health Institute (EPHI). Validatedpanel sl ides an d customized o nsite ev aluation ( OSE) ch ecklist were used t o evaluate t heperformance o f m icroscopists at EQ A rechecking l aboratories and th e laboratories. Data w erecaptured, cleaned and analyzed by SPSS version 20. Chi square test and kappa values were usedfor comparison purpose. P value < 0.05 was considerable to statistically significant. Results: A total of 389 laboratory professionals form 81 T B EQA rechecking laboratories wereparticipated in t he s tudy. Out o f 38 9 study participants; 263 ( 67.6%) were male, 268 ( 68.9%)were f rom hospitals and 241(62%) had gr eater t han f ive ye ars’ w ork experience on T B s mearmicroscopy services. About 201 (51.7%) participants were BSc degree holders and 319 (82 %)participants were trained in TB s mear microscopy in-service training. The overall performanceof professionals scored ≥ 80% was 328(83.3%). The overall sensitivity and specificity indetecting T B ba cilli w ere 84.5% and 93.1 %, respectively. T he o verall p ercent agreement o fparticipant r eaders w ith reference readers were 87.1 ( kappa= 0.72) w hich w as good a greement.Eighty (20.6%) p articipants c orrectly re ad al l t en sl ides, 156 ( 40.1%) got 90 -95%, 88 ( 22.6%)participants sco red 80-85% a nd 65 ( 16.7%) pa rticipants s cored be low 80%. There were 806(20.7%) t otal e rrors w hich a ccount 143 ( 3.7 % ) major e rrors a nd 663 ( 17%) minor e rrors. Of143 major errors; 89 ( 2.3%) were HFN and 54 ( 1.4 %) were HFP errors. O f 663 minor errors;334 (8.6 %) were LFN, 26 (0.7%) were LFP and 303 ( 7.8%) were QE. Overall achievements of81 facilities during onsite evaluation were 85.6% with minimum score of 14.8 % and maximumperformance of 98.8%. Greater than 80% of rechecking labs had appropriate facility and safetypractice for TB bacilli detection. Conclusion: The overall performance of participants in reading showed good agreement with thereference readers. Overall performance of facilities during onsite evaluation was 85.6%. Overallerrors were 20.7% and majority of them were minor errors and the presences of these errors arealarming f or T B c ontrol pr ogram a nd e mphasis s hould be gi ven f or the E QA pr ogram. T Bsuspected cases may be misdiagnosed and detection rate could be reduced falsely with high riskof t ransmission. Even t hough ga ps w ere not ed on r echecking f acilities, t here w as pr omising performance of those facilities selected for rechecking services during decentralization. Key words: AFB, Quality of AFB microscopy, Rechecking laboratories, EQA, and Level of agreement