Original Research

Performance evaluation of tuberculosis smear microscopists working at rechecking laboratories in Ethiopia

Habtamu Asrat, Abebaw Kebede, Abnet Abebe, Abyot Meaza, Getinet Hailu, Adinew Desale, Andargachew Gashu, Wondwossen Kassa, Tesfaye Mekonnen, Ebisea Abose, Feven Girmachew, Dereje Yenealem, Achamyeleh Mulugeta, Gonfa Ayana, Kassu Desta
African Journal of Laboratory Medicine | Vol 6, No 1 | a590 | DOI: https://doi.org/10.4102/ajlm.v6i1.590 | © 2017 Habtamu Asrat, Abebaw Kebede, Abnet Abebe, Abyot Meaza, Getinet Hailu, Adinew Desale, Andargachew Gashu, Wondwossen Kassa, Tesfaye Mekonnen, Ebisea Abose, Feven Girmachew, Dereje Yenealem, Achamyeleh Mulugeta, Gonfa Ayana, Kassu Desta | This work is licensed under CC Attribution 4.0
Submitted: 02 November 2016 | Published: 21 April 2017

About the author(s)

Habtamu Asrat, Ethiopian Public Health Institute, Addis Ababa and Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
Abebaw Kebede, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
Abnet Abebe, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
Abyot Meaza, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
Getinet Hailu, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
Adinew Desale, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
Andargachew Gashu, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
Wondwossen Kassa, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
Tesfaye Mekonnen, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
Ebisea Abose, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
Feven Girmachew, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
Dereje Yenealem, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
Achamyeleh Mulugeta, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
Gonfa Ayana, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
Kassu Desta, Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia


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Abstract

Background: Tuberculosis is an infectious disease caused by the bacillus Mycobacterium tuberculosis. According to the Ethiopian Federal Ministry of Health’s 2013–2014 report, the tuberculosis case detection rate was 53.7%, which was below the target of 81% set for that year.

Objective: This study assessed the performance of tuberculosis smear microscopists at external quality assessment rechecking laboratories in Ethiopia.

Methods: A cross-sectional study was conducted at 81 laboratories from April to July 2015. Panel slides were prepared and validated at the National Tuberculosis Reference Laboratory. The validated panel slides were used to evaluate the performance of microscopists at these laboratories compared with readers from the reference laboratory.

Results: A total of 389 external quality assessment rechecking laboratory microscopists participated in the study, of which 268 (68.9%) worked at hospitals, 241 (62%) had more than five years of work experience, 201 (51.7%) held Bachelors degrees, and 319 (82%) reported tuberculosis smear microscopy training. Overall, 324 (83.3%) participants scored ≥ 80%. Sensitivity for detecting tuberculosis bacilli was 84.5% and specificity was 93.1%. The overall percent agreement between participants and reference readers was 87.1 (kappa=0.72). All 10 slides were correctly read (i.e., scored 100%) by 80 (20.6%) participants, 156 (40.1%) scored 90% – 95%, 88 (22.6%) scored 80% – 85% and 65 (16.7%) scored below 80%. There were 806 (20.7%) total errors, with 143 (3.7%) major and 663 (17%) minor errors.

Conclusion: The overall performance of participants in reading the slides showed good agreement with the reference readers. Most errors were minor, and the ability to detect tuberculosis bacilli can be improved through building the capacity of professionals.


Keywords

Quality; acid-fast bacilli microscopy; external quality assessment; level of agreement

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