Performance of Tuberculosis Smear Microscopistson Fluorescent stained microscopy among Health facilities of Eastern Region of Oromia, Ethiopia
Creators: name: Nebi, Aman
Publisher: name: National Academic Digital Repository of Ethiopia
Year: 2019

description: Background:Tuberculosis (TB) is an infectious disease caused mainly by the bacillus Mycobacterium tuberculosis and it remains a major public health problem. Globally 10.0 people were ill and 1.3 million died of tuberculosis in 2017/18.In resource limited settings, tuberculosis diagnosis relies on sputum smear microscopy with many variables affecting the sensitivity and specificity.Tuberculosis is considered as a "global emergency" by the World Health Organization (WHO). Fluorescence microscopy (FM) can improve performance of microscopy and with the new light emitting diode (LED), technologies could be appropriate for peripheral settings. The WHO defines External Quality Assessment (EQA) as a system for objectively checking a laboratory's performance using an external agency or facility. EQA participation is associated with improved laboratory performance over time and is a requirement for accreditation. However, many professionals in Sub-Saharan countries including Ethiopia are unable to effectively implement quality improvement programs and many laboratories in Ethiopia remain without an accredited clinical laboratory. Objective: To assess the Performance of TB Smear Microscopistson fluorescent stained microscopy among Health facilities of Eastern Region of Oromia, Ethiopia, 2018. Methods: Afacility based cross sectional study design was conducted on 57 government Health facilitiesin Eastern Oromia Regional State from September to December 2018. The study was included 57 governmental health facilities (42 health centers and 15 hospitals). Panel slides were prepared and validatedat Adama Public Health Referral and Research Laboratory Centrecustomized checklist were used to conduct on site supervision and slides were collected for Random Blinded Re-checking by Lot Quality Assurance Sampling Data were collected using the three external quality assessment methods.DataTechniques. Datawaswereentered into EPI Info version 7 and transported to SPSS version 21.0 for analysis. The percentof agreements, differences and different types of errors were calculated. The Sensitivity, Specificity, PPV, NPV of smear reading by TB smear Mmicroscopist was calculated. The strength of an agreement among between participant readers and the reference readers were assessed using kappa statistics. Results: In this study, the overall achievements during onsite evaluation were 62.7% and the overall agreement in reading among smear between mMicroscopists and Reference readers were92.21%92.21 %( kappa=0.755),which was good agreement.Overallagreement. Overall Sensitivity and Specificity of detecting TB-FM bacilli were 90.54% and 94.03% respectively. The overall errors for panel test were 185(9.3%) which indicates25(1.26%) major errors, 160(8.04%) minor errors. The overall Sensitivity, Specificity, PPV and NPV for blinded rechecking were 93.755.1%, 99.608%, 96.151.67% and 99.3547% respectively. Conclusionsand Recommendation: The overall performance of panel testing and random blinded re-checking were satisfactory for this study but the overall facilities assessment results for on-site evaluation were (62.53%)this need more effort to improve the performance. ErrorsBesides, the total errors committed were 9.3% and majority of them were minor errors and the presence of this errorscommitted areare alarming for TB control program and due attention should be given for FM EQA method since the method is applied recently and not familiarized as that of ZN method. This study recommended that, much effort should be made by laboratory professionals need to up-grade their educational level to maximize the level ofagreement.method. Adama Public Health Referral and Research Laboratory Center and rechecking laboratories should give corrective actions such as, consistent refreshment training and regular supportive supervisions as per the EQA guidelines and further researches should also be conducted.