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Journal of Clinical Microbiology, March 2008, p. 897-901, Vol. 46, No. 3
0095-1137/08/$08.00+0     doi:10.1128/JCM.01553-07
Copyright © 2008, American Society for Microbiology. All Rights Reserved.

Sputum Smear Microscopy: Evaluation of Impact of Training, Microscope Distribution, and Use of External Quality Assessment Guidelines for Resource-Poor Settings{triangledown}

A. Van Rie,1* D. Fitzgerald,2 G. Kabuya,3 A. Van Deun,4 M. Tabala,5 N. Jarret,1 F. Behets,1 and E. Bahati6

Department of Epidemiology, the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,1 Division of Infectious Diseases, the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,2 National Reference Laboratory, Tuberculosis Control Program, Kinshasa, Democratic Republic of Congo,3 Mycobacteriology Unit, Institute of Tropical Medicine, Antwerp, Belgium,4 Ecole de Sante Publique, University of Kinshasa, Kinshasa, Democratic Republic of Congo,5 National Tuberculosis Program, Kinshasa, Democratic Republic of Congo6

Received 3 August 2007/ Returned for modification 21 October 2007/ Accepted 23 December 2007

Sputum smear microscopy is the main and often only laboratory technique used for the diagnosis of tuberculosis in resource-poor countries, making quality assurance (QA) of smear microscopy an important activity. We evaluated the effects of a 5-day refresher training course for laboratory technicians and the distribution of new microscopes on the quality of smear microscopy in 13 primary health care laboratories in Kinshasa, Democratic Republic of Congo. The 2002 external QA guidelines for acid-fast bacillus smear microscopy were implemented, and blinded rechecking of the slides was performed before and 9 months after the training course and microscope distribution. We observed that the on-site checklist was highly time-consuming but could be tailored to capture frequent problems. Random blinded rechecking by the lot QA system method decreased the number of slides to be reviewed. Most laboratories needed further investigation for possible unacceptable performance, even according to the least-stringent interpretation. We conclude that the 2002 external QA guidelines are feasible for implementation in resource-poor settings, that the efficiency of external QA can be increased by selecting sample size parameters and interpretation criteria that take into account the local working conditions, and that greater attention should be paid to the provision of timely feedback and correction of the causes of substandard performance at poorly performing laboratories.

* Corresponding author. Mailing address: Department of Epidemiology, 2104 McGavran Hall, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7435. Phone: (919) 966-1420. Fax: (919) 966-2089. E-mail: vanrie{at}email.unc.edu

{triangledown} Published ahead of print on 3 January 2008.

Journal of Clinical Microbiology, March 2008, p. 897-901, Vol. 46, No. 3
0095-1137/08/$08.00+0     doi:10.1128/JCM.01553-07
Copyright © 2008, American Society for Microbiology. All Rights Reserved.



This article has been cited by other articles:

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