JCM Accepts, published online ahead of print on 3 January 2008

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J. Clin. Microbiol. doi:10.1128/JCM.01553-07
Copyright (c) 2008, American Society for Microbiology and/or the Listed Authors/Institutions. All Rights Reserved.

Sputum smear microscopy: evaluation of the impact of training, microscope distribution, and the use of External Quality Assessment Guidelines for resource poor settings

A. Van Rie^*, D. Fitzgerald, G. Kabuya, A. Van Deun, M. Tabala, N. Jarret, F. Behets, and E. Bahati

Department of Epidemiology, the University of North Carolina at Chapel Hill; Division of Infectious Diseases, the University of North Carolina at Chapel Hill; National Reference Laboratory, Tuberculosis Control Program, Kinshasa, Democratic Republic of Congo (DRC); Mycobacteriology Unit, Institute of Tropical Medicine, Antwerp, Belgium; Ecole de Sante Publique, University of Kinshasa, DRC; National Tuberculosis Program, Kinshasa, DRC

^* To whom correspondence should be addressed. Email: vanrie{at}email.unc.edu.

Sputum smear microscopy is the main and often only laboratory technique used for diagnosis of tuberculosis in resource poor countries, making quality assurance (QA) of smear microscopy an important activity. We evaluated the effect of a five-day refresher training for laboratory technicians and distribution of new microscopes on the quality of smear microscopy in thirteen primary health care laboratories in Kinshasa, Democratic Republic of Congo. The 2002 External Quality Assessment for AFB Smear Microscopy guidelines were implemented and blinded rechecking of slides was performed before and nine months after training 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 using the Lot Quality Assurance Sampling 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 QC guidelines are feasible for implementation in resource poor settings, that efficiency of EQA can be increased by selecting sample size parameters and interpretation criteria that take into account local working conditions, and that greater attention should be paid to timely feedback and correction of the causes of poorly performing laboratories.

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