A study of Revised National Tuberculosis Control Programme quality assurance of sputum microscopy at tuberculosis unit
DOI:
https://doi.org/10.18203/2349-3933.ijam20193270Keywords:
Assurance, Microscopy, Quality, Sputum, StudyAbstract
Background: Since, Revised National Tuberculosis Control Programme (RNTCP) relies on sputum microscopy for diagnosis, categorization of patients and assessment of treatment, the credibility, success and sustainability of the programme depends on the lab networks. The objectives of this study were to Quality assurance of Sputum Microscopy under RNTCP in Tuberculosis Unit.
Methods: A cross-sectional analytic study was conducted at DMC ML Chest hospital, DMC LLRM Hospital and DMC ESI Hospital. On-site evaluation was conducted once a month by Senior Tuberculosis Lab. Supervisor (STLS) of the DMCs (First Controller). This visit included a comprehensive assessment of laboratory safety procedure, conditions of equipment as well as technical components of AFB smear microscopy which includes prepare, staining and reading of smears. This also included examination of five positive and five negative smears in unblinded manner, to observe the quality of smear and staining as well as condition of microscope at each DMCs. A check list prepared for collection and analysis of standard data to point out remedial action.
Results: The overall slide positivity rate (SPR) was 20.17% and 23.99% for ZN-stained slides and fluorescence stained slides respectively. On-site evaluation of all DMCs revealed a good result except of DMC- LLR in maintenance of microscope and well organized and clean working areas. The overall concordance for RBRC slides result of ZN-stained slides was 98.64% and overall discordance was 1.35%. The overall agreement in the re-reading of fluorescent stained slides was 100%. The overall sensitivity, specificity, positive predictive value and negative predictive value of blinded re-checked fluorescence stained slides were 100% each respectively.
Conclusions: The overall performance of all DMCs is acceptable.
References
Addo KK, Dan-Dzide M, Yeboah-Manu D, Owusu-Darko K, Caulley P, Minamikawa M, et al. Improving the laboratory diagnosis of TB in Ghana: the impact of a quality assurance system. Int J Tuberc Lung Dis. 2006;10(7):812-7.
Aziz M, Bretzel G. Use of a standardized checklist to assess peripheral sputum smear microscopy laboratories for tuberculosis diagnosis in Uganda. Int J Tuberc Lung Dis. 2002;6(4):340-9.
Basra D, Matee MI. Quality assessment of sputum smears microscopy for detection of acid fast bacilli in peripheral health care facilities in Dar es Salaam, Tanzania. East Afr Med J. 2006;83(6):306-10
Mulat M. Quality performance evaluation of laboratories on AFB smears microscopy in Eastern Amhara region, Ethiopia, 2011. Available at: http://hdl.handle.net/123456789/2607 Accessed July 2012.
Ajaykumar T, Shyni S, Shiju S, Balasangameshwara VH, Kumar P. Qualitative and quantitative assessment of ten Intermediate Reference Laboratories for quality of sputum smear microscopy based on RNTCP on-site evaluation. NTI Bulletin. 2006;42(3,4):74-94.
Farnia P, Ghazi SK, Zia ZA, Masjedi M, Mohammadi F, Bahadori HM, et al. The Results of Three Years Surveillance on Sputum Smear Microscopy in 285 District and Regional Tuberculosis Laboratories of Iran. Tanaffos. 2003;2(5):29-36.
Sarin R, Singla N, Mukerjee S, Sharma PP. RNTCP: Quality control of sputum microscopy at sub-district level. Indian J Tub. 2002;49(3):143-5.
Paramasivan CN, Venkataraman P, Vasanthan JS, Rahman F, Narayanan PR. Quality assurance studies in eight State tuberculosis laboratories in India. Int J Tuberc Lung Dis. 2003;7(6):522-7.
Shargie BE. Quality control of sputum microscopic examinations for acid fast bacilli in southern Ethiopia. Ethiop J Health Dev. 2005;19(2):104-8.
Nguyen TN, Wells CD, Binkin NJ, Pham DL, Nguyen VC. The importance of quality control of sputum smear microscopy: the effect of reading errors on treatment decisions and outcomes. Int J Tuberc Lung Dis 1999;3(6):483-7.