Lot Quality Assurance Sampling Method Research Articles

Predictors of Health Seeking Behaviours for Common Childhood Illnesses in Poor Resource Settings in Zambia, A Community Cross Sectional Study.

Background: Developing countries, including Zambia, account for larger share of child morbidities and mortalities due to common childhood illnesses. Studies on wider determinants of behaviour pertaining to treatment seeking for childhood febrile illnesses in poor resource settings are limited. This study investigated health seeking behaviours of mothers in poor resource settings of Zambia and identified associated factors.Methods: Secondary data from a community cross sectional study design from the Health for the Poorest Population (HPP) Project was analysed between March and May 2019. Data was collected between May and August, 2013. It was collected by means of administering a structured questionnaire from the mothers of under-five children. The survey took place in Samfya and Chiengi of Luapula province while in Northern Province, Luwingu and Mungwi were settled for. A total of 1 653 mothers of under 5 years who had an episode of diarrhoea, malaria, pneumonia or a combination of any of them not more than 14 days before the interview were included in the study. A sample size was arrived at using A Lot Quality Assurance Sampling (LQAS) method. In order to determine the associations between respondent's demographic characteristics and health seeking behaviour, chi square test of independence was carried out. Multivariable logistic regression was also done to identify predictors of health seeking behaviours for common childhood illnesses in children aged <5 years old in poor resource settings.Results: Among the mothers interviewed, 64.6% were married while 35.4% were unmarried. Their mean age was 32 years. Mothers who took their sick children to the health facilities for the purpose of seeking health care for their child for either of the illnesses accounted for 75.2%, [95% CI: 0.62–0.96], while 24.8% did not seek health care for their sick child. Factors typically associated with health seeking behaviours were mothers' marital status [aOR = 0.74; 95% CI: 0.58–0.94], and mothers ‘education level [aOR = 1.47; 95% CI: 1.13–1.92].Conclusion: It was established in this study that health care seeking behaviours for these common childhood illnesses in poor resource settings was relatively high and could be predicted by mother's education level and mothers' marital status. Integrating interventions targeted at increasing utilisation of maternal and child health services with basic education to women and moral support counselling to families may potentially maximise health seeking behaviours in marginalised communities.

Food Fortification: The Level of Awareness among Kenyan Consumers.

More than half of the morbidity and mortality cases among children in Kenya are as a result of micronutrient deficiencies (MNDs). Food fortification is considered by the Government of Kenya as a feasible strategy for addressing MNDs. Worldwide, fortification has been proven to be effective since it does not require any change in dietary habits. Success of large-scale food fortification however may depend on consumer awareness of the fortification benefits. A cross-sectional study was conducted in 13 counties to collect information on fortification awareness using structured questionnaires. 1435 respondents were selected using the Lot Quality Assurance Sampling method. Data were analyzed using Stata version 14.0 and statistical significance p < 0.05. The study participants were described using descriptive statistics. The association of sociodemographic characteristics and awareness of fortification was performed using binary logistic regression analysis. The median age of the study participants was 35 years. Only 28% of the respondents were aware of the term “fortification.” Of the respondents, about 27% heard of food fortification through radio. Vernacular radio emerged as the most preferred channel for communicating fortification information among 24.9% of the respondents. Although awareness of vitamins (32%) and minerals (1.5%) was limited, most (76%) respondents reported of existence of health risks for lacking micronutrients. Awareness of food fortification was significantly associated with respondents' occupation (p < 0.001), household size (p=0.012), education levels (p < 0.001), and age (p=0.025). There is need for a wider use of broadcast media sources to modify information and education materials to promote fortification awareness among Kenyan consumers.

Review of Lot Quality Assurance Sampling, Methodology and its Application in Public Health.

Rapid collection of data is of utmost importance in monitoring and evaluation of activities of public health importance. Among others techniques, 30 by 7 cluster sampling and Lot quality assurance sampling(LQAS) methods have been described in literature for this purpose. However, LQAS is often sparingly used in most settings, undermining its importance as a effective epidemiological tool in public health practice. To some extent LQAS is inadequately understood and even less emphasized method, especially in the postgraduate teaching and training. In this paper we aim to explain the use, method and application of LQAS in public health settings as well as discuss common pitfalls to avoid while planning and drawing inferences based on data collected through LQAS.

Short-Term Safety and Tolerability of an Antimalarial Herbal Medicine, CoBaT-Y017 in Healthy Volunteers.

Background Malaria is the most prevalent parasitic disease in Benin and the main cause of morbidity and mortality. To fight this disease, a large proportion of the population resorts to herbal drugs. However, for most of these herbal preparations, no scientific evidence of their safety or efficacy has yet been established. The aim of this study was to evaluate the short-term safety and tolerability of CoBaT-Y017 and collect some data on its antimalarial efficacy. Material and Methods CoBaT-Y017 was formulated into syrup accommodated in 70 mL bottles. The trial involved a sample of 10 male volunteers, selected using the Lot Quality Assurance Sampling (LQAS) method and declared apparently healthy by a physician through clinical examination. During the baseline analysis, two cases of parasitaemia were detected. The volunteers were hospitalized for 5 days and orally given 35 mL of CoBaT-Y017 diluted in 1.5 L of mineral water, for four consecutive days. Safety and tolerability were monitored clinically, haematologically, biochemically, and parasitologically on days 0 to 5, 7, and 14. Adverse events were recorded by self-reporting or by a physician through clinical examinations and biological investigations. Results 60% of the volunteers experienced no adverse events; appetite increase (40%) and drowsiness (20%) were adverse events noted. There were no changes in physical characteristics or vital signs and haematological and biochemical parameters. The two initial positive cases of parasitaemia became negative 24 hours after administration. Conclusion CoBaT-Y017 presented a significant safety and tolerability in healthy volunteers to allow its further development by starting a phase II clinical study.

Factors which contributed for low quality sputum smears for the detection of acid fast bacilli (AFB) at selected health centers in Ethiopia: A quality control perspective.

ObjectivesQuality of tuberculosis (TB) microscopy diagnosis is not a guarantee despite implementation of External Quality Assurance (EQA) service in all laboratories of health facilities. Hence, we aimed at evaluating the technical quality and the findings of sputum smear microscopy for acid fast bacilli (AFB) at health centers in Hararge Zone, Oromia Region, Ethiopia.MethodsA cross-sectional study was carried out between July 8, 2014 and July 7, 2015.A pre-tested structured questionnaire was used to collect data. Lot Quality Assurance Sampling (LQAS) method was put into practice for collecting all necessary sample slides. Data were analyzed by using SPSS (Statistical Package for Social Sciences) version 20 software. P-value < 0.05 was considered as statistically significant.ResultsOf the total55 health center laboratories which had been assessed during the study period, 20 (36.4%) had major technical errors; 13 (23.6%) had 15 false negative results and 17 (30.9%) had 22 false positive results. Moreover, poor specimen quality, smear size, smear thickness, staining and evenness were indicated in 40 (72.7%), 39 (70.9%), 37 (67.3%), 27(49.1%) and 37 (67.3%) of the collected samples, respectively. False negative AFB findings were significantly associated with lack of Internal Quality Control (IQC) measures (AOR (Adjusted Odds Ratio): 2.90 (95% CI (Confidence Interval): 1.25,6.75) and poor staining procedures (AOR: 2.16(95% CI: 1.01, 5.11).ConclusionsThe qualities of AFB smear microscopy reading and smearing were low in most of the laboratories of the health centers. Therefore, it is essential to strength EQA program through building the capacity of laboratory professionals.

Predictors of Antenatal Care, Skilled Birth Attendance, and Postnatal Care Utilization among the Remote and Poorest Rural Communities of Zambia: A Multilevel Analysis.

Optimal utilization of maternal health-care services is associated with reduction of mortality and morbidity for both mothers and their neonates. However, deficiencies and disparity in the use of key maternal health services within most developing countries still persist. We examined patterns and predictors associated with the utilization of specific indicators for maternal health services among mothers living in the poorest and remote district populations of Zambia. A cross-sectional baseline household survey was conducted in May 2012. A total of 551 mothers with children between the ages 0 and 5 months were sampled from 29 catchment areas in four rural and remote districts of Zambia using the lot quality assurance sampling method. Using multilevel modeling, we accounted for individual- and community-level factors associated with utilization of maternal health-care services, with a focus on antenatal care (ANC), skilled birth attendance (SBA), and postnatal care (PNC). Utilization rates of focused ANC, SBA, and PNC within 48 h were 30, 37, and 28%, respectively. The mother's ability to take an HIV test and receiving test results and uptake of intermittent preventive treatment for malaria were positive predictors of focused ANC. Receiving ANC at least once from skilled personnel was a significant predictor of SBA and PNC within 48 h after delivery. Women who live in centralized rural areas were more likely to use SBA than those living in remote rural areas. Utilization of maternal health services by mothers living among the remote and poor marginalized populations of Zambia is much lower than the national averages. Finding that women that receive ANC once from a skilled attendant among the remote and poorest populations are more likely to have a SBA and PNC, suggests the importance of contact with a skilled health worker even if it is just once, in influencing use of services. Therefore, it appears that in order for women in these marginalized communities to benefit from SBA and PNC, it is important for them to have at least one ANC provided by a skilled personnel, rather than non-skilled health-care providers.

Tuberculosis Laboratory Diagnosis Quality Assurance among Public Health Facilities in West Amhara Region, Ethiopia.

IntroductionReliable smear microscopy is an important component of Directly Observed Treatment Scheme (DOTS) strategy for TB control program in countries with limited resources. Despite external quality assessment is established in Ethiopia, there is lower TB detection rate (48%) in Amhara region compared to the World Health Organization (WHO) estimate (70%). This highlights the quality of smear microscopy needs to be evaluated. Therefore, the aim of this study was to assess the quality of sputum smear microscopy performance among health center laboratories in West Amhara region, Ethiopia.Materials and MethodsA cross sectional study was conducted from July 08, 2013 to July 07, 2014. Data were collected from 201 public health center laboratories using a structured questionnaire. Slides were collected based on Lot Quality Assurance Sampling (LQAS) method and rechecked blindly by trained laboratory technologists. The data were entered into EPI info V.7 and smear quality indicators and AFB results were analyzed by SPSS version 20.ResultsAmong 201 laboratories enrolled in this study, 47 (23.4%) laboratories had major errors. Forty one (20.4%) laboratories had a total of 67 false negative and 29 (14.4%) laboratories had a total of 68 false positive results. Specimen quality, smear thickness and evenness were found poor in 134 (66.7%), 133 (66.2%) and 126 (62.7%) laboratories, respectively. Unavailability of microscope lens cleaning solution (AOR: 2.90; 95% CI: 1.25–6.75; P: 0.013) and dirty smears (AOR: 2.65; 95% CI: 1.14–6.18; P: 0.024) were correlated with false negative results whereas no previous EQA participation (AOR: 3.43; 95% CI: 1. 39-8.45; P: 0.007) was associated with false positive results.ConclusionThe performance of health facilities for sputum smear microscopy was relatively poor in West Amhara region. Hence, strengthening the EQA program and technical support on sputum smear microscopy are recommended to ensure quality tuberculosis diagnostic service.

Improving the quality of nurse clinical documentation for chronic patients at primary care clinics: A multifaceted intervention.

BackgroundDeficiencies in record keeping practices have been reported at primary care level in the public health sector in South Africa. These deficiencies have the potential to negatively impact patient health outcomes as the break in information may hinder continuity of care. This disruption in information management has particular relevance for patients with chronic diseases.ObjectivesThe aim of this study was to establish if the implementation of a structured clinical record (SCR) as an adjunct tool to the algorithmic guidelines for chronic disease management improved the quality of clinical records at primary care level.MethodA quasi-experimental study (before and after study with a comparison group) was conducted across 30 primary health care clinics (PHCs) located in three districts in South Africa. Twenty PHCs that received the intervention were selected as intervention clinics and 10 facilities were selected as comparison facilities. The lot quality assurance sampling (LQAS) method was used to determine the number of records required to be reviewed per diagnostic condition per facility.ResultsThere was a a statistically significant increase in the percentage of clinical records achieving compliance to the minimum criteria from the baseline to six months post-intervention for both HIV patients on antiretroviral treatment and patients with non-communicable diseases (hypertension and diabetes).ConclusionsA multifaceted intervention using a SCR to supplement the educational outreach component (PC 101 training) has demonstrated the potential for improving the quality of clinical records for patients with chronic diseases at primary care clinics in South Africa.

LQAS in Health Monitoring – Insights from a Bayesian Perspective

Lot Quality Assurance Sampling (LQAS) is strongly advocated for use in monitoring the health status of populations, largely in the developing world. It is advocated both for the monitoring of small areas as well as for making global assessments of the health status of a larger region. This paper contrasts the interpretation offered by LQAS methods to that offered by Bayesian hierarchical models. It considers applications to previously reported local area data and presents a reanalysis of published data on vaccine coverage in Peru as well as HTLV-1 prevalence in Benin. The desirability of using Bayesian methods in the field may be challenged; nevertheless this work amplifies previously expressed concerns about the way the LQAS method can be used. It raises questions about the ability of the LQAS approach to make, sufficiently often, the correct decisions in order to be useful in monitoring health programmes at the local level.

Cluster lot quality assurance sampling: effect of increasing the number of clusters on classification precision and operational feasibility.

To assess the quality of supplementary immunization activities (SIAs), the Global Polio Eradication Initiative (GPEI) has used cluster lot quality assurance sampling (C-LQAS) methods since 2009. However, since the inception of C-LQAS, questions have been raised about the optimal balance between operational feasibility and precision of classification of lots to identify areas with low SIA quality that require corrective programmatic action. To determine if an increased precision in classification would result in differential programmatic decision making, we conducted a pilot evaluation in 4 local government areas (LGAs) in Nigeria with an expanded LQAS sample size of 16 clusters (instead of the standard 6 clusters) of 10 subjects each. The results showed greater heterogeneity between clusters than the assumed standard deviation of 10%, ranging from 12% to 23%. Comparing the distribution of 4-outcome classifications obtained from all possible combinations of 6-cluster subsamples to the observed classification of the 16-cluster sample, we obtained an exact match in classification in 56% to 85% of instances. We concluded that the 6-cluster C-LQAS provides acceptable classification precision for programmatic action. Considering the greater resources required to implement an expanded C-LQAS, the improvement in precision was deemed insufficient to warrant the effort.

Use of aggregated Lot Quality Assurance Sampling methods in Uganda to provide implementation-relevant evaluation data

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Assessing the quality of care in a new nation: South Sudan's first national health facility assessment.

We adapted a rapid quality of care monitoring method to a fragile state with two aims: to assess the delivery of child health services in South Sudan at the time of independence and to strengthen local capacity to perform regular rapid health facility assessments. Using a two-stage lot quality assurance sampling (LQAS) design, we conducted a national cross-sectional survey among 156 randomly selected health facilities in 10 states. In each of these facilities, we obtained information on a range of access, input, process and performance indicators during structured interviews and observations. Quality of care was poor with all states failing to achieve the 80% target for 14 of 19 indicators. For example, only 12% of facilities were classified as acceptable for their adequate utilisation by the population for sick-child consultations, 16% for staffing, 3% for having infection control supplies available and 0% for having all child care guidelines. Health worker performance was categorised as acceptable in only 6% of cases related to sick-child assessments, 38% related to medical treatment for the given diagnosis and 33% related to patient counselling on how to administer the prescribed drugs. Best performance was recorded for availability of in-service training and supervision, for seven and ten states, respectively. Despite ongoing instability, the Ministry of Health developed capacity to use LQAS for measuring quality of care nationally and state-by-state, which will support efficient and equitable resource allocation. Overall, our data revealed a desperate need for improving the quality of care in all states.

Factors associated with data quality in the routine health information system of Benin.

BackgroundRoutine health information systems (RHIS) are crucial to the acquisition of data for health sector planning. In developing countries, the insufficient quality of the data produced by these systems limits their usefulness in regards to decision-making. The aim of this study was to identify the factors associated with poor data quality in the RHIS in Benin.MethodsThis cross-sectional descriptive and analytical study included health workers who were responsible for data collection in public and private health centers. The technique and tools used were an interview with a self-administered questionnaire. The dependent variable was the quality of the data. The independent variables were socio-demographic and work-related characteristics, personal and work-related resources, and the perception of the technical factors. The quality of the data was assessed using the Lot Quality Assurance Sampling method. We used survival analysis with univariate proportional hazards (PH) Cox models to derive hazards ratios (HR) and their 95% confidence intervals (95% CI). Focus group data were evaluated with a content analysis.ResultsA significant link was found between data quality and level of responsibility (p = 0.011), sector of employment (p = 0.007), RHIS training (p = 0.026), level of work engagement (p < 0.001), and the level of perceived self-efficacy (p = 0.03). The focus groups confirmed a positive relationship with organizational factors such as the availability of resources, supervision, and the perceived complexity of the technical factors.ConclusionThis exploratory study identified several factors associated with the quality of the data in the RHIS in Benin. The results could provide strategic decision support in improving the system’s performance.

Data quality assessment in the routine health information system: an application of the Lot Quality Assurance Sampling in Benin.

Health information systems in developing countries are often faulted for the poor quality of the data generated and for the insufficient means implemented to improve system performance. This study examined data quality in the Routine Health Information System in Benin in 2012 and carried out a cross-sectional evaluation of the quality of the data using the Lot Quality Assurance Sampling method. The results confirm the insufficient quality of the data based on three criteria: completeness, reliability and accuracy. However, differences can be seen as the shortcomings are less significant for financial data and for immunization data. The method is simple, fast and can be proposed for current use at operational level as a data quality control tool during the production stage.

The need for quality improvement in diagnosing pregnancy induced hypertension in Sri Lanka

Sri Lanka has shown relatively good maternal outcome indicators for a developing country. However, high maternal deaths from pregnancy induced hypertension and pre-eclamptic toxemia raise questions about the quality of detection and treatment at field antenatal clinics, which is the primary care setting for pregnant women. The objective of the study was to assess the quality of facilities and services provided at the field antenatal clinics to di-agnose pregnancy induced hypertension or pre-eclamptic toxemia. It was a cross-sectional study. This study was set in field antenatal clinics and was conducted in two stages based on the Lot Quality Assurance Sampling method. In the first stage 55 antenatal clinics were selected from 11 Medical officers of Health areas, and in the second stage 275 pregnant women were recruited from these 55 clinics. Quality of services and quality of facilities were assessed using observation checklists. The quality of facilities was better than the quality of services in the Colombo district. The quality of facilities was acceptable in all areas other than for the presence of the Medical Officer. The quality of services was unacceptable in all areas for history taking and examination. Investigation for urine albumin was also unacceptable in all the areas. The sensitivity for measuring the systolic blood pressure and the diastolic blood pressure were 57% (95% CI: 47.4%–66.8%) and 16.7% (95% CI: 9.4%–24%) respectively. Urgent steps should be taken to improve the quality of care in the substandard areas to reduce the leading cause of maternal mortality in Sri Lanka. DOI: http://dx.doi.org/10.3329/seajph.v2i2.15952 South East Asia J Public Health | Jul-Dec 2012 | Vol 2 Issue 2 | 55-60

Utility of Lot Quality Assurance Sampling (LQAS) as a Tool to Monitor the Immunization Services by Local Managers in Developing Countries

Purpose: To find out how Lot Quality Assurance Sampling (LQAS) method is useful to monitor immunization services by local managers at Primary Health Centre level. Objectives: 1. To identify the areas of low coverage of immunization under selected PHC's 2. To find various reasons for immunization failure in areas with low coverage Methods: Study design: Lot quality assurance sampling method. Study setting: Rural area. Sample size: 338 children 12-23 months of age. Results: LQAS is a useful method for routine monitoring of immunization services on a small area basis, especially as the overall coverage increases. In the present study, it helped us to identify the areas with low coverage seen in 4 Subcentres out of 13 studied. The overall immunization coverage was 86.01 % and the dropout rate was 8.66 %.The predominant reasons for immunization failure were mother out of village on scheduled day of vaccination and unaware to return for next dose. Conclusions: The lot quality assurance sampling method helps the medical officers of PHC to identify areas with low vaccination coverage. This helps us to direct interventions in these areas on priority basis when resources are limited as in developing countries.

SP4-39 Nutritional Vigilance System of Community: a lot quality assurance sampling for monitoring coverage of a nutritional knowledge and attitudes clues from mothers of children 0 to 23 months of age in Bolivia

BackgroundThis study reports on the results of a largescale targeted of nutritional promotional interventions in Bolivian municipalities with high Food Insecurity and Vulnerability classification.MethodsThe lot quality assurance sampling (LQAS) method...

Changes in the distribution of human schistosomiasis in Far North province, Cameroon, since 1986

Changes in the distribution of human schistosomiasis in Far North province, Cameroon, since 1986

Knowledge and coverage of Prevention of Mother to Child Transmission (PMTCT) in Eritrea

Objective: To explore the level of knowledge on prevention of mother to child transmission of HIV in both men 15-54 years and women 15-49 years of age. Methods: A community-based survey was conducted in October-November 2005 in 45 sub zones of Eritrea. Data were collected using the Lot Quality Assurance Sampling (LQAS) method. Results: Although 81.8% of men 15-54 and 75.5% of women 15-49 years of age know that HIV can be transmitted from mother to the child, only 33.7 % of men and 26% of women know that the risk of transmission can be reduced. The result varies across zones and various socio-demographic characteristics. Conclusion: Although there is high awareness on the risk of HIV transmission from the mother to the child, the knowledge that the risk can be reduced is very low and extensive education for both men and women is recommended

LQAS: User Beware

Researchers around the world are using Lot Quality Assurance Sampling (LQAS) techniques to assess public health parameters and evaluate program outcomes. In this paper, we report that there are actually two methods being called LQAS in the world today, and that one of them is badly flawed. This paper reviews fundamental LQAS design principles, and compares and contrasts the two LQAS methods. We raise four concerns with the simply-written, freely-downloadable training materials associated with the second method. The first method is founded on sound statistical principles and is carefully designed to protect the vulnerable populations that it studies. The language used in the training materials for the second method is simple, but not at all clear, so the second method sounds very much like the first. On close inspection, however, the second method is found to promote study designs that are biased in favor of finding programmatic or intervention success, and therefore biased against the interests of the population being studied. We outline several recommendations, and issue a call for a new high standard of clarity and face validity for those who design, conduct, and report LQAS studies.