# Presentation: 079936

## AMREF EXTERNAL QUALITY ASSESSMENT SCHEME (EQAS) FOR PRIMARY HEALTH CARE LABORATORIES

- Jane Carter, Orgenes Lema
- Christine Adhiambo, Sadiki Materu
- AMREF Laboratory Programme
- African Medical and Research Foundation (AMREF), Nairobi, Kenya

## OBJECTIVES OF THE AMREF EQAS

- Measure laboratory performance
- Identify and rectify problem areas
- Provide continuing education
- Evaluate training activities
- Standardize techniques
- Improve communication between clinical, laboratory and public health staff

## Slide 3

## METHODS

- Selection of laboratory tests
- Production of laboratory materials
- Clinical problem setting
- Clinical, laboratory & public health questions
- Answer sheet
- Marking key

## TESTS ADDRESSED

- Thick blood film for blood parasites
- Thin blood film for blood cell morphology
- Haemoglobin estimation
- Stool for parasites
- Urine for parasites
- Ziehl Nielsen staining
- Gram staining

## MATERIALS PRODUCED:  1993-2000 (1)

- Thick blood films for malaria parasites
- Thin blood films for red cell morphology
- Thin blood films for differential white blood cell count
- Haemiglobincyanide solution
- Haemoglobin lysate

## MATERIALS PRODUCED:  1993-2000 (2)

- Stool for ova (*S mansoni*, hookworm, *A lumbricoides, Taenia* sp)
- Urine for ova (*S haematobium*)
- Stained stool smear for *Cryptosporidium*
- Sputum smear, fixed, stained/unstained for AFB
- CSF smear, fixed, unstained for bacteria

## ASSIGNING VALUES FOR HAEMIGLOBINCYANIDE & LYSATE

- 4 AMREF Laboratory Technologists in the AMREF central laboratory
- 5 Reference Laboratories in Nairobi
- Mean values from participating laboratories*
- * Being reviewed

## DISPATCHING AND RECEIVING

- AMREF Specialist Outreach flights
- Postal services
- Hand delivery:   Field stations
- 				NGOs

## MARKING

- 2 AMREF technologists independently
- Consensus score for each participating laboratory
- Scoring system:
- -		3 marks: fully correct
- -		2 marks: partially correct/acceptable
- -		1 mark: some correct interpretation
- -		0 mark: wrong/misleading/no answer

## FEEDBACK TO PARTICIPANTS

- Participant’s mark
- Highest and lowest scores
- Correct answers
- Possible reasons for error & suggestions for improvement
- Health learning materials
- On-site visits
- Discussion with hospital authorities

## DISTRIBUTIONS SENT AND RETURNED

## RESPONSE TIME

## NUMBER OF PARTICIPATING LABORATORIES

**	****	****	****1993****	****1994****	****1995****	****1996****	****1998****	****1999****	****2000**
**Tanzania:**
**	****hospitals****	****11****	****6****	****5****	****13****	****7****	****26****	****23**
**	****health centres****	****-****	****-****	****-****	****-****	****-****	****1****	****1**
**Kenya: **
**	****hospitals****	****-****	****-****	****-****	****10****	****3****	****12****	****6**
**	****health centres****	****10****	****6****	****2****	****9****	****10****	****14****	****12**
**S Sudan****	****	****-****	****-****	****-****	****1****	****1****	****6****	****6**
**Uganda****	****	****-****	****-****	****-****	****-****	****3****	****4****	****7**
**Somalia****	****	****-****	****1****	****1****	****-****	****1****	****-****	****-**
**	**
**TOTAL****	****	****21****	****13****	****8****	****33****	****25****	****63****	****55**

## AVERAGE SCORES

## FACILITY IMPROVEMENT ASSESSMENTMINIMUM 4 DISTRIBUTIONS

## HAEMOGLOBIN METHODS EVALUATION BY EQAS

## MEAN DIFFERENCE IN HAEMOGLOBIN RESULTS FROM TARGET VALUES

## CHALLENGES AT LABORATORY LEVEL

- Few trained laboratory personnel
- Shortage of equipment and supplies
- Equipment failure
- No reference books or materials
- Low morale

## CHALLENGES AT AMREF

- Poor postal services
- Low response rate
- Few laboratory personnel
- Inadequate space
- Funding

## FUTURE PLANS FOR A REGIONAL PROGRAMME (REQAS)

- Cooperation between Kenya, Tanzania & Uganda
- Establishment of qualitative standards
- Preparation of SOPs, quality manuals
- Large scale preparation of materials
- Coordinating centre
- Mechanism for remedial action
- Dedicated funding