Abstract
Ethiopia adopted Public-Private Mix Directly Observed Treatment Short Course Chemotherapy (PPM-DOTS) strategy for tuberculosis (TB) control program. Quality of sputum smear microscopy has paramount importance for tuberculosis control program in resource-poor countries like Ethiopia. A cross-sectional study was conducted to assess the quality of sputum smear microscopy in 37 Public-Private Mix laboratories in West Amhara, Ethiopia. The three external quality assessment methods (onsite evaluation, panel testing and blind rechecking) were employed. Onsite assessment revealed that 67.6% of PPM-DOTS laboratories were below the standard physical space (5 X 6) m2. The average monthly workload per laboratory technician was 19.5 (SD±2.9) slides with 12.8% positivity rate. The quality of Acid Fast Bacilli (AFB) staining reagents was sub-standard. The overall agreement for blind rechecking of 1,123 AFB slides was 99.4% (Kappa = 0.97). Reading of 370 AFB panel slides showed 3.5% false reading (Kappa = 0.92). Moreover, the consistency of reading scanty bacilli slides was lower (93%) compared to 1+, 2+ and 3+ bacilli. Based on blind rechecking and panel testing results, PPM-DOTS site laboratories showed good agreement with the reference laboratory. Physical space and qualities of AFB reagents would be areas of intervention to sustain the quality of sputum smear microscopy. Therefore, regular external quality assessment and provision of basic laboratory supplies for TB diagnosis would be the way forward to improve the quality of sputum smear microscopy services in PPM-DOTS laboratories.
Highlights
Tuberculosis (TB) is a chronic infectious disease caused by Mycobacterium tuberculosis [1]
Public-Private Laboratories Quality of Smear Sputum Microscopy health facility laboratories are integrated in the national TB control program [1, 2]
A total of 18,267 sputum smears were processed in 37 PPM- DOTS site laboratories in one year
Summary
Tuberculosis (TB) is a chronic infectious disease caused by Mycobacterium tuberculosis [1]. The main source of infection is untreated smear-positive pulmonary tuberculosis patients discharging M. tuberculosis. Public-Private Laboratories Quality of Smear Sputum Microscopy health facility laboratories are integrated in the national TB control program [1, 2]. Ethiopia adopted the ‘Stop TB’ strategy’ of World Health Organization (WHO), which is Public-Private Mix Directly Observed Treatment (PPM-DOTS) in 2006 [3], but DOTS was limited only to government sector health facilities. In Ethiopia, private health sectors have employed 55% of general practitioners, 65% of specialists and 79% of laboratory technicians [4]. Expanding TB care services to the private sector has increased access for clients who are reluctant to visit public health facilities due to fear of stigma and perception of unsatisfactory quality of health care services [5]
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