Tuberc Respir Dis.  2020 Jan;83(1):89-95. 10.4046/trd.2019.0029.

Quality of Same-Day Sputum Smears Microscopy and Presumptive Tuberculosis Patients Drop-out at Health Facilities of Addis Ababa, Ethiopia

• Taddese BD
• Misganaw A

• KMID: 2466624
• DOI: http://doi.org/10.4046/trd.2019.0029

Abstract

BACKGROUND
Same-day sputum microcopy is recommended in areas where sputum smear microscopy external quality assessment (EQA) is effectively implemented and sturdy. In Addis Ababa, the status of EQA and drop-out of same-day sputum smear microcopy has not yet been assessed. The objective of this study was to assess the quality of same-day sputum smear microscopy and diagnostic drop-out of presumptive tuberculosis (TB) patients in health facilities (HFs) across Addis Ababa, Ethiopia.
METHODS
Amulti-analysis was conducted from September 2016 to July 2017 to determine the status of external quality assessment and diagnostic drop-out of presumptive TB patients registered for same-day sputum smear microscopy. Data was coded and entered in Microsoft Excel, and subsequently transferred and analyzed using SPSS version 20.0.
RESULTS
The drop-out of same-day sputum smear microscopy was 209 (6.2%). More than 33% of the specimens collected for purposes of same-day sputum smears were of poor quality. Among the selected HFs for the study: 13 (46.4%) used filter reagents prior to sputum smear staining while 75% of the selected HFs for the study used smear microscopy services interruption in a year. The sensitivity and specificity of the HFs participating in regional quality assessment scheme for the diagnosis of TB was 97.4% and 99.6%, respectively.
CONCLUSION
The diagnostic drop-out of same-day sputum smear microscopy was high in Addis Ababa. Strengthening EQA, competency-based laboratory professionals training on sputum smear microscopy might reduce the reading errors in sputum smear. Awareness creation of the community on the benefits gained from completion of specimen provision for the same-day approach decreases diagnostic drop-out and enhances TB control program.

Keyword

Same-Day; Sputum Smear Microscopy; Drop-out; External Quality Assessment

MeSH Terms

Diagnosis
Ethiopia*
Health Facilities*
Humans
Indicators and Reagents
Microscopy*
Sensitivity and Specificity
Sputum*
Tuberculosis*
Indicators and Reagents

Reference

1. World Health Organization. Same-day diagnosis of tuberculosis by microscopy: WHO policy statement [Internet]. Geneva: World Health Organization;2011. cited 2018 Oct 10. Available from: http://www.who.int/about/licensing/copyright_form/en/index.html.

2. Parsons LM, Somoskovi A, Gutierrez C, Lee E, Paramasivan CN, Abimiku A, et al. Laboratory diagnosis of tuberculosis in resource-poor countries: challenges and opportunities. Clin Microbiol Rev. 2011; 24:314–350. PMID: 21482728.

3. International Union Against Tuberculosis and Lung Disease. Technical guide: sputum examination for tuberculosis by direct microscopy in low-income countries. 5th ed. Paris: International Union Against Tuberculosis and Lung Disease;2000.

4. Davis JL, Cattamanchi A, Cuevas LE, Hopewell PC, Steingart KR. Diagnostic accuracy of same-day microscopy versus standard microscopy for pulmonary tuberculosis: a systematic review and meta-analysis. Lancet Infect Dis. 2013; 13:147–154. PMID: 23099183.

5. Central Statistical Agency of Ethiopia. Summary and statistical report of the 2007 population and housing census. Addis Ababa: Central Statistical Agency of Ethiopia;2008.

6. Addis Ababa City Administration Health Bureau. TBL, TB/HIV and MDR-TB prevention and control program. In : The 12th TRAC and 20th World TB Day; 2017 Mar 21; Addis Ababa, Ethiopia.

7. Association of Public Health Laboratories. Centers for Disease Control and Prevention. International Union Against Tuberculosis and Lung Disease. Royal Netherlands Tuberculosis Association. Research Institute of Tuberculosis, Japan. World Health Organization. External quality assessment for AFB smear microscopy. Washington, DC: APHL;2002.

8. Ethiopian Health and Nutrition Research Institute. Guidelines for external quality assessment of tuberculosis smear microscopy in Ethiopia. Addis Ababa: Ethiopian Health and Nutrition Research Institute and Federal Ministry of Health;2013.

9. Khan MS, Khan S, Godfrey-Faussett P. Default during TB diagnosis: quantifying the problem. Trop Med Int Health. 2009; 14:1437–1441. PMID: 19843298.

10. Manalebh A, Demissie M, Mekonnen D, Abera B. The quality of sputum smear microscopy in public-private mix directly observed treatment laboratories in West Amhara region, Ethiopia. PLoS One. 2015; 10:e0123749. PMID: 25849516.

11. Kusznierz GF, Latini OA, Sequeira MD. Quality assessment of smear microscopy for acid-fast bacilli in the Argentine tuberculosis laboratory network, 1983-2001. Int J Tuberc Lung Dis. 2004; 8:1234–1241. PMID: 15527156.

12. Desalegn DM, Kitila KT, Balcha HM, Gebeyehu CS, Kidan YW, Amare K, et al. Misdiagnosis of pulmonary tuberculosis and associated factors in peripheral laboratories: a retrospective study, Addis Ababa, Ethiopia. BMC Res Notes. 2018; 11:291. PMID: 29751778.

13. Misganaw AS, Abebe MT, Lulie AD, Bika AT. External quality assessment (EQA) of randomly blinded rechecking slides on TB AFB microscopy laboratories: a retrospective study, Addis Ababa, Ethiopia. Am J Lab Med. 2016; 1:9–15.

14. Mfinanga GS, Ngadaya E, Mtandu R, Mutayoba B, Basra D, Kimaro G, et al. The quality of sputum smear microscopy diagnosis of pulmonary tuberculosis in Dar es Salaam, Tanzania. Tanzan Health Res Bull. 2007; 9:164–168. PMID: 18087893.

15. Ayana DA, Kidanemariam ZT, Tesfaye HM, Milashu FW. External quality assessment for acid fast bacilli smear microscopy in eastern part of Ethiopia. BMC Res Notes. 2015; 8:537. PMID: 26437958.

16. Singhal R, Myneedu VP. Microscopy as a diagnostic tool in pulmonary tuberculosis. Int J Mycobacteriol. 2015; 4:1–6. PMID: 26655191.

17. Asemahagn MA. Assessing the quality of tuberculosis laboratory services in selected public and private health facilities in Western Amhara, Ethiopia. J Med Diagn Methods. 2014; 3:158.

18. Weldu Y, Gebru H, Kahsay G, Teweldemedhn G, Hagos Y, Kahsay A. Standard operating procedure utilization for tuberculosis microscopy in Mekelle City, North Ethiopia. Am J Clin Pathol. 2017; 147:83–88. PMID: 28028117.

19. Cattamanchi A, Miller CR, Tapley A, Haguma P, Ochom E, Ackerman S, et al. Health worker perspectives on barriers to delivery of routine tuberculosis diagnostic evaluation services in Uganda: a qualitative study to guide clinic-based interventions. BMC Health Serv Res. 2015; 15:10. PMID: 25609495.

20. Mosissa L, Kebede A, Mindaye T, Getahun M, Tulu S, Desta K. External quality assessment of AFB smear microscopy performances and its associated factors in selected private health facilities in Addis Ababa, Ethiopia. Pan Afr Med J. 2016; 24:125. PMID: 27642463.