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Original Research
Implementation of a customised antimicrobial resistance laboratory scorecard in Cameroon, Ethiopia and Kenya
Submitted: 30 November 2020 | Published: 20 June 2022
About the author(s)
André Trollip, Foundation for Innovative New Diagnostics (FIND) South Africa, Cape Town, South AfricaRenuka Gadde, Becton, Dickinson & Company, Franklin Lakes, New Jersey, United States
Tjeerd Datema, DATOS, Leiden, the Netherlands
Kamau Gatwechi, Becton, Dickinson & Company, Nairobi, Kenya
Linda Oskam, DATOS, Leiden, the Netherlands
Zachary Katz, Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
Andrew Whitelaw, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa; and, National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
Peter Kinyanjui, National Public Health Laboratory, Kenyatta National Hospital, Nairobi, Kenya
Patrick Njukeng, Global Health Systems Solutions, Isokolo, Cameroon
Dawit A. Wendifraw, National Clinical Bacteriology and Mycology Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
Ibrahimm Mugerwa, Ministry of Health, National Health Laboratories and Diagnostic Services-AMR-National Coordination Centre, Kampala, Uganda
Grace Najjuka, National Health Laboratories and Diagnostic Services, Kampala, Uganda
Nicholas Dayie, Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
Japheth A. Opintan, Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
Heidi Albert, Foundation for Innovative New Diagnostics (FIND) South Africa, Cape Town, South Africa
Abstract
Background: In low-resource settings, antimicrobial resistance (AMR) is detected by traditional culture-based methods and ensuring the quality of such services is a challenge. The AMR Scorecard provides laboratories with a technical assessment tool for strengthening the quality of bacterial culture, identification, and antimicrobial testing procedures.
Objective: To evaluate the performance of the AMR Scorecard in 11 pilot laboratory evaluations in three countries also assessed with the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist.
Methods: Pilot laboratory evaluations were conducted in Cameroon, Ethiopia and Kenya between February 2019 and March 2019. Assessors with previous SLIPTA and microbiology experience were trained. Assessors performed the laboratory assessments using the SLIPTA and AMR Scorecard tools.
Results: Weaknesses in technical procedures and the quality management systems were identified in all areas and all laboratories. Safety had the highest mean performance score (SLIPTA: 68%; AMR Scorecard: 73%) while management review had the lowest (SLIPTA: 32%; AMR Scorecard: 8%) across all laboratories. The AMR Scorecard scores were generally consistent with SLIPTA scores. The AMR Scorecard identified technical weaknesses in AMR testing, and SLIPTA identified weaknesses in the quality management systems in the laboratories.
Conclusion: Since the AMR Scorecard identified important gaps in AMR testing not detected by SLIPTA, it is recommended that microbiology laboratories use SLIPTA and the AMR Scorecard in parallel when preparing for accreditation. Expanding the use of the AMR Scorecard is a priority to address the need for quality clinical microbiology laboratory services in support of optimal patient care and AMR surveillance.
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