The First Ever External Quality Assessment Program on Urinary Sediment in a Country of Sub-Saharan Africa Based on New Smartphone Technologies.

Abstract

External Quality Assessment (EQA) programs on urinary sediment (U-sed) examination are recommended by international guidelines to improve the quality of this diagnostic tool. However, no such programs have been carried out so far in developing countries of sub-Saharan Africa. This paper describes an EQA program on U-sed which was realized in 2017 and 2018 by means of innovative communication technologies in Benin Republic, a small country of West Africa. On Monday morning, weekly in 2017 and fortnightly in 2018, the image of one U-sed element was sent from Italy with a smartphone, via WhatsApp application, to a group of 13 professionals (11 bachelors of science, 2 medical doctors) working in different institutions of Benin Republic. The image showed one U-sed element, for which the participants were asked the identification and, in 2018, also a clinical association. The images of 33 elements were submitted over the two-year period. Particle identification. Altogether 283 answers were received (8.5 ± 2.3/single image), 200 of which were correct (70.7%), 53 incorrect (18.7%), 17 partially correct (6.0%), and 13 "I don't know" (4.6%). Correct identification of elements presented twice (2nd answer vs. 1st). No change: 9/18 (50.0%); improvement: 5/18 (27.8%); worsening: 4/18 (22.2%). Clinical association. Correct answers: 8/17 (47%); incorrect: 8/17 (47.0%); no answer: 1/17 (5.6%). This paper demonstrates: 1. The need and utility of an EQA program on U-sed in developing countries of sub-Saharan Africa; 2. The feasibility of such programs by means of easily available and inexpensive smartphone applications.