Abstract
BackgroundTuberculosis is an infectious disease caused by the bacillus Mycobacterium tuberculosis. According to the Ethiopian Federal Ministry of Health’s 2013–2014 report, the tuberculosis case detection rate was 53.7%, which was below the target of 81% set for that year.ObjectiveThis study assessed the performance of tuberculosis smear microscopists at external quality assessment rechecking laboratories in Ethiopia.MethodsA cross-sectional study was conducted at 81 laboratories from April to July 2015. Panel slides were prepared and validated at the National Tuberculosis Reference Laboratory. The validated panel slides were used to evaluate the performance of microscopists at these laboratories compared with readers from the reference laboratory.ResultsA total of 389 external quality assessment rechecking laboratory microscopists participated in the study, of which 268 (68.9%) worked at hospitals, 241 (62%) had more than five years of work experience, 201 (51.7%) held Bachelors degrees, and 319 (82%) reported tuberculosis smear microscopy training. Overall, 324 (83.3%) participants scored ≥ 80%. Sensitivity for detecting tuberculosis bacilli was 84.5% and specificity was 93.1%. The overall percent agreement between participants and reference readers was 87.1 (kappa=0.72). All 10 slides were correctly read (i.e., scored 100%) by 80 (20.6%) participants, 156 (40.1%) scored 90% – 95%, 88 (22.6%) scored 80% – 85% and 65 (16.7%) scored below 80%. There were 806 (20.7%) total errors, with 143 (3.7%) major and 663 (17%) minor errors.ConclusionThe overall performance of participants in reading the slides showed good agreement with the reference readers. Most errors were minor, and the ability to detect tuberculosis bacilli can be improved through building the capacity of professionals.
Highlights
Tuberculosis is an infectious disease caused by the bacillus Mycobacterium tuberculosis
According to the 2014 World Health Organization Global Tuberculosis Report, there were nine million new tuberculosis cases and 1.5 million tuberculosis deaths (1.1 million among HIVnegative people and 0.4 million among HIV-positive people) in 2013.1 One quarter of global cases and deaths occurred in the African Region,[1] and Ethiopia ranked 10th in tuberculosis incidence among 22 high-burden countries.[1,4]
A total of 389 microscopists (2 to 13 microscopists per rechecking laboratory) from 81 tuberculosis external quality assessment (EQA) rechecking laboratories participated in the study, of whom 263 (67.6%) were men and 126 (32.4%) were women (Table 2)
Summary
Tuberculosis is an infectious disease caused by the bacillus Mycobacterium tuberculosis It remains a major global health problem, responsible for ill health among millions of people each year.[1,2,3] It is the second leading cause of death among all infectious diseases worldwide after HIV.[1,3] According to the 2014 World Health Organization Global Tuberculosis Report, there were nine million new tuberculosis cases and 1.5 million tuberculosis deaths (1.1 million among HIVnegative people and 0.4 million among HIV-positive people) in 2013.1 One quarter of global cases and deaths occurred in the African Region,[1] and Ethiopia ranked 10th in tuberculosis incidence among 22 high-burden countries.[1,4]. According to the Ethiopian Federal Ministry of Health’s 2013–2014 report, the tuberculosis case detection rate was 53.7%, which was below the target of 81% set for that year
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