# Presentation: 888963

## TUBERCULOSIS LABORATORY NETWORK IN TANZANIA

- Presentation to the IUATLD AFB microscopy course
-  in Nairobi, Kenya
- 18th November 2003
- T.M. Chonde and B. Doulla
- Central TB Reference Laboratory
- P.O. Box 3436
- Dar es Salaam.

## Slide 2

## Base line information

- Population:		34.6 mil in 2002
- Administratively:  		22 regions and 119 districts
- Health facilities:		> 5000
- AFB dX centres 		>500
- NTLP launched 		1977
- Coverage of NTLP	Mainland and Zanzibar
- Established posts appointed RTLCs and DTLCs
- TB problem (2002)	63048 all forms
-                             **24136 (38.3%) New SM+**
**                         ****1703   (2.7%) Relapses**
**                         ****21959  (34.8% )PTB SM -ve **

## Training of laboratory staff in the diagnosis of TB. Tanzanian experience

- The correct performance of NTLP requires among other things well trained and motivated staff at all levels. Training  programmes for peripheral lab staff  include
- Relevance of sputum smear microscopy to TB diagnosis, follow up during treatment, and treatment evaluation
- Importance of carrying out all requested sputum smear examination
- Practical performance of  Ziehl Neelsen staining
- Reading and reporting of results in a timely manner

## Training of laboratory staff in the diagnosis of TB. Tanzanian experience (cont`d)

- Candidates                   – new and  previously trained( HC/ districts )
-                                          selection done by RLT and RTLC
-             - Lab tech. from Tb ref. Labs
-             - RLT attend NTLP biannual metings
- Duration:		          -   10 dys for new
- 					  3 dys for old
- Number of participants   	- 40 lab staff / 3 months( 20 per region)
- Number of facilitators:    	- 2 to  4
- Training resources 	      	 - per diem, stationery, travel expenses
-                                               	   refreshments all provided NTLP
- NTLP training target:		160 lab staff per year
- 					trained  120 lab staff ( 40 new , 60 old)
- Budget spent in 2002:		Tsh: 15,310,612

## Course contents

- Collection, storage, transport of specimen
- Smear preparation
- Use of microscope, preventive maintenance
- Reporting and recording of data in lab register
- Storage of slides for quality control
- Disinfection and sterilization of contaminated materials
- Safety measures for handling sputum specimen and performing microscopy
- Identification of problems occurring during AFB microscopy and recording of results
- Quality Control of AFB smear microscopy
- Management of reagents and lab supplies

## Supplies for Tb laboratory services 

- The NTLP has budget line for laboratory supplies, reagents and equipment for
-        a) for peripheral labs
- 	   b) for TB culture laboratories
- Aim : to ensure availability of lab materials and reagents at all levels
-  Calculation based upon proportion of cases found
-      among TB suspects
- In Tanzania we assume 1 case : 10 Tb  suspects

## Calculation of order of requirements for NTLP lab network (National Level)

| Item |  | Basic fuch. | Meth. blue | Imm. oil | Phenol | Methanol | Sputum cont.. | Slides |
| --- | --- | --- | --- | --- | --- | --- | --- | --- |
| SM+  |  r | 1.7
a | 1.7
a | 3.3
a | 8.3
a | 33
a | 33
a | 33
a |
| Running requirement
 |  | SM+ x a | SM+ x a | SM+ x a | SM+ x a | SM+ x a | SM+ x a | SM+ x a |
| Total needed | b | a x 2 | a x 2 | a x 2 | a x 2 | a x 2 | a x 2 | a x 2 |
| In stock | c | variable | variable | variable | variable | variable | variable | variable |
| Total order | d | b-c | b-c | b-c | b-c | b-c | b-c | b-c |
| Quantity
unit |  | gm | gm | ml | ml | ml | number | number |

## SUPERVISON OF AFB (M) NETWORK

- Aim: Monitor and evaluate diagnostic services of the national programme
- Levels of supervision:
- National level: TLCU/ CTRL and Local consultants visit regions once a year
- RLT together with RTLC visit regional, district, health centre labs and together they conduct QA of smear microscopy 2x year
- DTLCs visit microscopy centres monthly
- DLT through DHMT visit microscopy centres regularly
- -    A standard NTLP checklist for the collection of information available

## Quality assurance of smear microscopy

- Blinded rechecking method
- Labs requested to keep pos/ and negative slides in special manner following NTLP guidelines
- The person accompanying RLT/CRTL selects 20 slides (10 pos/10 neg )from slide boxes
- Lab supervisor reads slides without knowing the results ( blind rechecking) using the microscope available at the centre
- Results compared, a third reader rereads slides with discordance
- Corrective action taken and checklist kept by RLT and a copy  is sent to CTRL for analysis to examine trends and prepare annual plans and budget
- CTRL has a computer software for the QA programme
- In 2002, a total of 203 diagnostic centres submitted results to CTRL

## PROBLEMS

- Lack of laboratory staff
- Heavy workload in urban laboratories
- Inadequate laboratory space
- Lack of reliable maintenance facilities for defected microscopes
- Lab staff poorly motivated, low wages
- Poor infrastructure, water, electricity , and communication facilities
- New approach of Smear QA programme not well implemented