Performance of Tuberculosis Smear Microscopistson Fluorescent stained microscopy among Health facilities of Eastern Region of Oromia, Ethiopia
No Thumbnail Available
Date
2019-06
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Addis Abeba University
Abstract
Background:Tuberculosis (TB) is an infectious disease caused mainly by the bacillus
Mycobacterium tuberculosis and it remains a major public health problem. Globally 10.0 people
were ill and 1.3 million died of tuberculosis in 2017/18.In resource limited settings, tuberculosis
diagnosis relies on sputum smear microscopy with many variables affecting the sensitivity and
specificity.Tuberculosis is considered as a “global emergency” by the World Health
Organization (WHO). Fluorescence microscopy (FM) can improve performance of microscopy
and with the new light emitting diode (LED), technologies could be appropriate for peripheral
settings. The WHO defines External Quality Assessment (EQA) as a system for objectively
checking a laboratory’s performance using an external agency or facility. EQA participation is
associated with improved laboratory performance over time and is a requirement for
accreditation.
However, many professionals in Sub-Saharan countries including Ethiopia are unable to
effectively implement quality improvement programs and many laboratories in Ethiopia remain
without an accredited clinical laboratory.
Objective: To assess the Performance of TB Smear Microscopistson fluorescent stained
microscopy among Health facilities of Eastern Region of Oromia, Ethiopia, 2018.
Methods: Afacility based cross sectional study design was conducted on 57 government Health
facilitiesin Eastern Oromia Regional State from September to December 2018. The study was
included 57 governmental health facilities (42 health centers and 15 hospitals). Panel slides were
prepared and validatedat Adama Public Health Referral and Research Laboratory
Centrecustomized checklist were used to conduct on site supervision and slides were collected
for Random Blinded Re-checking by Lot Quality Assurance Sampling Data were collected using
the three external quality assessment methods.DataTechniques. Datawaswereentered into EPI
Info version 7 and transported to SPSS version 21.0 for analysis. The percentof agreements,
differences and different types of errors were calculated. The Sensitivity, Specificity, PPV, NPV
of smear reading by TB smear Mmicroscopist was calculated. The strength of an agreement
among between participant readers and the reference readers were assessed using kappa
statistics.
Results: In this study, the overall achievements during onsite evaluation were 62.7% and the
overall agreement in reading among smear between mMicroscopists and Reference readers
were92.21%92.21 %( kappa=0.755),which was good agreement.Overallagreement. Overall
Sensitivity and Specificity of detecting TB-FM bacilli were 90.54% and 94.03% respectively.
The overall errors for panel test were 185(9.3%) which indicates25(1.26%) major errors,
160(8.04%) minor errors. The overall Sensitivity, Specificity, PPV and NPV for blinded
rechecking were 93.755.1%, 99.608%, 96.151.67% and 99.3547% respectively.
Conclusionsand Recommendation: The overall performance of panel testing and random
blinded re-checking were satisfactory for this study but the overall facilities assessment results
for on-site evaluation were (62.53%)this need more effort to improve the performance.
ErrorsBesides, the total errors committed were 9.3% and majority of them were minor errors and
the presence of this errorscommitted areare alarming for TB control program and due attention
should be given for FM EQA method since the method is applied recently and not familiarized
as that of ZN method. This study recommended that, much effort should be made by laboratory
professionals need to up-grade their educational level to maximize the level
ofagreement.method. Adama Public Health Referral and Research Laboratory Center and rechecking
laboratories
should
give
corrective
actions
such
as,
consistent
refreshment
training
and
regular
supportive
supervisions
as
per
the
EQA
guidelines
and further researches should also be
conducted.
Description
Keywords
ExternalQualityAssessment,TuberculosisAssessment, Tuberculosis and ,FluorescenceMicroscopy.