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Impact Of External Quality Assurance In Diagnosis Of Tuberculosis Patients In Mid-Western, Uganda

  • Byaruhanga Gerald, Masindi General Hospital Laboratory
  • Maryanne Aketch, A Global HealthCare Public Foundation
  • Grace Apecho, Masindi General Hospital Laboratory
  • Moses Matovu, A Global HealthCare Public Foundation
  • Kunihira Bridget, Masindi General Hospital Laboratory

BACKGROUND

Tuberculosis (TB) remains an important public health problem globally and within sub-Saharan Africa despite significant progress made in the past decade. External quality assurance (EQA) systems are essential to ensure accurate diagnosis of TB and drug-resistant TB. The implementation of EQA through organizing regular EQA rounds is one of the key activities of the National Tuberculosis and Reference Laboratory network (NTRL). The aim of this study was to assess the impact of External Quality Assurance (EQA) in diagnosis of TB patients Hoima region.

METHOD

We retrospectively reviewed EQA results for 2018 for performance for the seven districts in Hoima Region. Reports received from participating laboratories were analyzed against reference results as determined by the EQA provider, National Tuberculosis Reference Laboratory (NTRL) and the percentage of correct results for each district was calculated by dividing the number of correct results at each lab by the total number of labs in each district. Laboratories scoring 80-99% were ranked as “good” and 100% as “excellent”. Scores under 80% were considered to indicate poor performance.

RESULTS

The average performance of laboratories within the region was 70% (range 38%-100%). The EQA performance from the seven districts was as follows: Excellent; Kakumiro & Kibaale 100%, Good; Hoima & Masindi 93%, Buliisa 83%, Poor; Kiryandongo 66%, Kagadi 38%.
Consistency of positives ranged from 38% to 100%, indicating under-reading at some sites. Considering overall agreement, four of the districts showed an agreement of over 90%. Kakumiro and Kibale had no false-positive result. For the remaining districts, the false positivity rate varied from 2% to 7% and a small variation was observed in the proportion of false-negatives (3%–9%).

CONCLUSION

Overall, laboratories demonstrated good proficiency with scores exceeding the 80% threshold in the vast majority of the laboratories. We recommend targeted refresher trainings and onsite mentorship about TB microscopy for facilities with poor performance.