Performance Evaluation Of Tb Smear Microscopists At External Quality Assessment Rechecking Laboratories In Ethiopia

Background: Tuberculosis (TB) is an infectious disease caused by the bacillus Mycobacteriumrntuberculosis. It is the second l eading cau se o f d eath among infectious disease w orldwide.rnAccording to FMoH 2013/14 report, the TB case detection rate was 53.7% which is below therntarget s et f or t he ye ar ( 81.0%). Quality assu red sp utum sm ear microscopy is one of essentialrncomponents of DOTs to detect TB cases. The quality of AFB smear microscopy often dependentrnon the s trength of national TB pr ogram that s upport, t rain, a nd m onitor the p erformance ofrnindividuals working in the laboratories.rnObjective: To assess the p erformance o f T B microscopists at E QA r echecking l aboratories i nrnEthiopia.rnMethods: A cr oss sec tional st udy was conducted on 81 EQA rechecking laboratories i n a llrnregions of E thiopia from April–July, 2015 . Panel sl ides were prepared a nd va lidated a t thernNational TB Reference Laboratory (NRL), Ethiopian Public Health Institute (EPHI). Validatedrnpanel sl ides an d customized o nsite ev aluation ( OSE) ch ecklist were used t o evaluate t hernperformance o f m icroscopists at EQ A rechecking l aboratories and th e laboratories. Data w ererncaptured, cleaned and analyzed by SPSS version 20. Chi square test and kappa values were usedrnfor comparison purpose. P value < 0.05 was considerable to statistically significant.rnResults: A total of 389 laboratory professionals form 81 T B EQA rechecking laboratories werernparticipated in t he s tudy. Out o f 38 9 study participants; 263 ( 67.6%) were male, 268 ( 68.9%)rnwere f rom hospitals and 241(62%) had gr eater t han f ive ye ars’ w ork experience on T B s mearrnmicroscopy services. About 201 (51.7%) participants were BSc degree holders and 319 (82 %)rnparticipants were trained in TB s mear microscopy in-service training. The overall performancernof professionals scored ≥ 80% was 328(83.3%). The overall sensitivity and specificity inrndetecting T B ba cilli w ere 84.5% and 93.1 %, respectively. T he o verall p ercent agreement o frnparticipant r eaders w ith reference readers were 87.1 ( kappa= 0.72) w hich w as good a greement.rnEighty (20.6%) p articipants c orrectly re ad al l t en sl ides, 156 ( 40.1%) got 90 -95%, 88 ( 22.6%)rnparticipants sco red 80-85% a nd 65 ( 16.7%) pa rticipants s cored be low 80%. There were 806rn(20.7%) t otal e rrors w hich a ccount 143 ( 3.7 % ) major e rrors a nd 663 ( 17%) minor e rrors. O frn143 major errors; 89 ( 2.3%) were HFN and 54 ( 1.4 %) were HFP errors. O f 663 minor errors;rn334 (8.6 %) were LFN, 26 (0.7%) were LFP and 303 ( 7.8%) were QE. Overall achievements ofrn81 facilities during onsite evaluation were 85.6% with minimum score of 14.8 % and maximumrnperformance of 98.8%. Greater than 80% of rechecking labs had appropriate facility and safetyrnpractice for TB bacilli detection.rnConclusion: The overall performance of participants in reading showed good agreement with thernreference readers. Overall performance of facilities during onsite evaluation was 85.6%. Overallrnerrors were 20.7% and majority of them were minor errors and the presences of these errors arernalarming f or T B c ontrol pr ogram a nd e mphasis s hould be gi ven f or the E QA pr ogram. T Brnsuspected cases may be misdiagnosed and detection rate could be reduced falsely with high riskrnof t ransmission. Even t hough ga ps w ere not ed on r echecking f acilities, t here w as pr omisingrnperformance of those facilities selected for rechecking services during decentralization.rnKey words: AFB, Quality of AFB microscopy, Rechecking laboratories, EQA, and Level of agreement

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