scholarly journals Cost-Effectiveness and Validity Assessment of Cyscope Microscope, Quantitative Buffy Coat Microscope, and Rapid Diagnostic Kit for Malaria Diagnosis among Clinic Attendees in Ibadan, Nigeria

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Abiodun Ogunniyi ◽  
Magbagbeola David Dairo ◽  
Hannah Dada-Adegbola ◽  
Ikeoluwapo O. Ajayi ◽  
Adebola Olayinka ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Predictive Value ◽  
Malaria Diagnosis ◽  
Cost Effective ◽  
Turnaround Time ◽  
Cross Sectional Study ◽  
Buffy Coat ◽  
Cross Sectional ◽  
Validity Assessment ◽  
Diagnostic Instruments

Background. Unavailability of accurate, rapid, reliable, and cost-effective malaria diagnostic instruments constitutes major a challenge to malaria elimination. We validated alternative malaria diagnostic instruments and assessed their comparative cost-effectiveness. Method. Using a cross-sectional study design, 502 patients with malaria symptoms at selected health facilities in Ibadan between January and April 2014 were recruited consecutively. We examined malaria parasites using Cyscope®, QBC, and CareStart™ and results were compared to light microscopy (LM). Validity was determined by assessing sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Costs per hour of use for instruments and turnaround time were determined. Result. Sensitivity of the instruments was 76.0% (CareStart), 95.0% (Cyscope), and 98.1% (QBC). Specificity was 96.0% (CareStart), 87.3% (Cyscope), and 85.5% (QBC). PPV were 65.2%, 67.5%, and 84.7%, while NPV were 93.6%, 98.6%, and 99.4% for CareStart, Cyscope, and QBC with Kappa values of 0.75 (CI = 0.68–0.82) for CareStart, 0.72 (CI = 0.65–0.78) for Cyscope, and 0.71 (CI = 0.64–0.77) for QBC. Average cost per hour of use was the lowest ($2.04) with the Cyscope. Turnaround time was the fastest with Cyscope (5 minutes). Conclusion. Cyscope fluorescent microscope had the shortest turnaround time and is the most cost-effective of all the malaria diagnostic instruments evaluated.

Blinded Rechecking of AFB smear Microscopy performance in Selected private health facilities in Tigray, Northern Ethiopia

2020 ◽  
Author(s):  
Letebrhan Weldemhret
Keyword(s):  
Predictive Value ◽  
Cost Effective ◽  
Cross Sectional Study ◽  
Health Facilities ◽  
Sputum Smear ◽  
Smear Microscopy ◽  
Northern Ethiopia ◽  
Major Error ◽  
Cross Sectional ◽  
Tigray Region

Abstract Background: Sputum smear microscopy remains the most cost-effective tool for tuberculosis diagnosis and treatment monitoring in resource constrained settings. Random blinded rechecking is a reliable tool to measure and improve smear microscopy. So, this study was intended to assess random blinded rechecking of AFB smear microscopy performance in selected private health facilities in Tigray region, Northern Ethiopia.Methods: A cross sectional study was conducted from April 1st 2017 to May 30, 2017. The data was collected using standard data collection form. Statistical analysis was done using SPSS version 25 and the reading agreement was done using kappa statistics.Results: Of the total 269 blinded rechecked smears, 4.8% was found discrepant findings. The major and minor errors were reported by 2.6% (7/269) and 2.2% (6/269) respectively. Likewise, the major error was reported by 50% (5/10) of health facilities with microscopic center. Overall, the sensitivity, specificity, positive predictive value, and negative predictive value of the blinded rechecking smears were 87.5%, 98%, 89.7% and 97.8%, respectively with substantial reading agreement, kappa value= 0.80.Conclusions: The overall performance of blinded rechecking was satisfactory with good smear reading agreement. But, the major error reported indicated unacceptable performance. To minimize the discrepancy, private health facilities with tuberculosis smear microscopic center should adhere to national tuberculosis guidelines.

scholarly journals Advantage of ultrasonography in the diagnosis of acute appendicitis at Al-Karama Teaching Hospital

2019 ◽  
Vol 6 (3) ◽  
pp. 702
Author(s):  
Mohammed Hillu Surriah ◽  
Amine Mohammed Bakkour ◽  
Nidaa Ali Abdul Hussain
Keyword(s):  
Acute Appendicitis ◽  
Teaching Hospital ◽  
Predictive Value ◽  
Diagnostic Technique ◽  
Cost Effective ◽  
Cross Sectional Study ◽  
Negative Appendectomy ◽  
Cross Sectional ◽  
Suspected Appendicitis ◽  
Presenting Symptoms

Background: The clinical diagnosis of acute appendicitis remains a challenge to surgeons. Different aids were introduced to improve the diagnostic accuracy. Among these modalities, ultrasonography is simple, easily available, non-invasive, convenient and cost effective. The aim of the study was to determine the validity of ultrasound in diagnosis of the acute appendicitis in those with clinically diagnosed patients.Methods: A cross sectional study was carried out in Al-Karama teaching hospital for thirty months from the period of 1st June 2016 to 1st December 2018. All patients with suspected appendicitis underwent clinical evaluation then sent for US. Results of surgeries, where relevant, were compared against US results. Positive and negative appendices on histopathology were regarded in accordance to the criteria which was negative appendectomy was defined as normal looking appendix and absence of acute inflammation on histopathology while positive cases included appendices showing acute inflammatory changes. Sensitivity, specificity and overall accuracy was calculated.Results: A total of 435 patients with suspected appendicitis, males 224 (51.49%) and females 211 (48.50%) were included in present study. There were no significant differences between patients with positive and negative histopathology findings regarding presenting symptoms. There was a significant association between (cough sign, localized tenderness sign and pointing sign) and patients with positive histopathology findings. Regarding to the validity results of ultrasound in comparison to histopathology findings were  accuracy 87.6%, sensitivity 87.8%, specificity 85.3%, positive predictive value 98.6% and negative predictive value 62.8%.Conclusions: The ultrasonography had a good accuracy, sensitivity and specificity in diagnosing acute appendicitis cases. Negative with ultrasonography results should be re-examined with different diagnostic technique like CT-scan.

scholarly journals Cost-effectiveness Analysis of Per-abdominal and Laparoscopic Cholecystectomy

2019 ◽  
Author(s):  
Shahariar Islam
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Cost Effectiveness ◽  
Treatment Cost ◽  
Cost Effective ◽  
Cross Sectional Study ◽  
Total Treatment Cost ◽  
Laboratory Cost ◽  
Cross Sectional ◽  
Average Hospital ◽  
The Cost

Cholelithiasis is one of the major problems which need cholecystectomy. Laparoscopic cholecystectomy is a newer technique. But there is a need to evaluate the cost-effectiveness of per-abdominal and laparoscopic method from patients perspective. The study was performed to assess the cost-effectiveness of per-abdominal and laparoscopic cholecystectomy.
Materials and Methods:
This cross sectional study in two sample situations was conducted among 90 purposively selected cholecystectomy patients of which 60 patients underwent laparoscopic cholecystectomy (LC) and 30 patients underwent per-abdominal cholecystectomy (PAC) from three tertiary level government hospitals of Dhaka, Bangladesh at the time of their discharge through face to face interview using a semi-structured questionnaire and checklist. The study found average age 45.33(13.63) and 41.75(13.39) years in PAC and LC respectively. Average monthly income was less in the PAC group Tk.23200.00(12374.61) than LC Tk.24925.00(12166.86). Average duration of suffering from cholelithiasis was 9.50(8.68) months in PAC group and 12.43(17.49) months in LC group. Average hospital stay was 13.97(6.88) days in PAC group while it was 12.02(6.66) days in LC group. Average treatment cost was little higher Tk.21927.407795.89 in LC group than Tk.21466.306261.42 in the PAC group. Both direct cost and indirect cost were also higher in LC group (Tk.18668.305965.67 and Tk.3661.324229.85) than in PAC group (Tk.18228.004624.75 and Tk.3350.004124.58). But these differences were not statistically significant. In both groups treatment cost significantly increased with duration of hospitalization (correlation, p<0.01). Cure rate was significantly high in LC group (94.4%) than in PAC group (86.7%) (χ2, p<0.05).
This study revealed LC method is cost-effective than PAC method. Total treatment cost in LC can be reduced by minimizing hospital cost, laboratory cost and securing the income of the patients which enhance the economic load.

scholarly journals Evaluation of GeneXpert MTB/RIF for detecting Mycobacterium tuberculosis in a hospital in China

2017 ◽  
Vol 45 (2) ◽  
pp. 816-822 ◽  
Author(s):  
Tingyu Tang ◽  
Fang Liu ◽  
Xiaoling Lu ◽  
Qingdong Huang
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Predictive Value ◽  
Rate Sensitivity ◽  
Turnaround Time ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Significant Difference ◽  
Kappa Value ◽  
Positive Rate ◽  
Sensitivity Specificity

Objective To evaluate the performance of GeneXpert MTB/RIF in diagnosing pulmonary tuberculosis (TB) in China. Methods This cross-sectional study included sputum specimens of 240 suspected TB cases. Specimens were examined by light microscopy for the presence of acid-fast bacilli, which were cultured by the BACTEC MGIT 960 (M960) system and detected by the GeneXpert MTB/RIF assay. The positive rate, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and average turnaround time of methods were evaluated. Results The positive rate was 36.6% (87/238) for the GeneXpert MTB/RIF assay and 34.0% (81/238) by M960 culture, with no significant difference between methods (χ2 = 0.33, p > 0.05). According to culture results, sensitivity of the GeneXpert MTB/RIF assay was 84.0% (68/81), specificity was 87.8% (129/147), the PPV was 78.2% (68/87), and the NPV was 87.2% (129/148). The agreement for results between Gene Xpert MTB/RIF and the M960 system was 82.8% and the Kappa value was 0.73. Conclusion The GeneXpert MTB/RIF assay is a simple, rapid, and accurate test for detecting Mycobacterium tuberculosis in sputum specimens.

scholarly journals Evaluation of Truenat MTB/RIF Test in Comparison with Microscopy and Culture for Diagnosis of Extrapulmonary Tuberculosis in a Tertiary Care Centre

2021 ◽  
Author(s):  
Reena Anie Jose ◽  
Krishna Gopal ◽  
Abel K Samuel Johnson ◽  
Jennie Ann Johnson Samuel ◽  
Sherin Susan Abraham ◽  
...  
Keyword(s):  
Predictive Value ◽  
Point Of Care ◽  
Extrapulmonary Tuberculosis ◽  
Tertiary Care ◽  
Cost Effective ◽  
Cross Sectional Study ◽  
Smear Microscopy ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
Fitting In

Introduction: Worldwide, Extrapulmonary Tuberculosis (EPTB) accounts for 15-20% of all cases of TB. The diagnosis of EPTB is a big challenge, as the number of Mycobacterium tuberculosis(MTB) bacilli in the tissues and other organs is often very low. Truenat MTB/RIF (rifampicin) is a novel method, which is battery operated, point-of-care and chip-based Real Time Polymerase Chain Reaction (RT-PCR) micro device. Aim: To evaluate Truenat as a screening test in the diagnosis of EPTB in comparison with microscopy and culture. Materials and Methods: A prospective cross-sectional study was carried out over a year in which samples from suspected cases of EPTB fitting in the inclusion criteria were subjected to Ziehl-Neelsen (ZN) staining for smear microscopy, culture on Lowenstein Jensen (LJ) medium and PCR for MTB by Truenat. Comparisons were made between the tests and the data was presented using summary statistics with 95% Confidence Interval (CI). Results: A total of 248 samples were received from suspected cases of EPTB. Out of the different samples tested, 9 (3.6%) were positive with Truenat MTB. The predominant type of EPTB observed in the study was lymph node Tuberculosis (TB) (66.6%) followed by intestinal, pleural and skeletal TB. Out of the 106 samples tested for culture, four were culture positive for MTB and out of 178 samples tested for microscopy, three were positive for acid fast bacilli. Sensitivity, specificity, Negative Predictive Value (NPV), Positive Predictive Value (PPV), observed agreement of Truenat with culture and microscopy were 100%, 95.1%, 100%, 44.4%, 95.3% and 100%, 96.6%, 100%, 33.3%, 96.6%, respectively. Conclusion: Truenat MTB test is a cost-effective rapid molecular test with good sensitivity and specificity for the diagnosis of EPTB in low resource settings.

scholarly journals A Cross-Sectional Study of Client Satisfaction towards Services Received at Boru Meda Hospital Pharmacy on Opd Basis and Community Pharmacy

2017 ◽  
pp. 26-31
Author(s):  
Abebaw Tegegn Damtie ◽  
Assen Muhe Getahun
Keyword(s):  
Cost Effectiveness ◽  
Malaria Diagnosis ◽  
Cost Effective ◽  
Staining Technique ◽  
Giemsa Staining ◽  
Cross Sectional ◽  
Effectiveness Analysis ◽  
Staining Techniques ◽  
The Cost ◽  
Acute Care Unit

Background: World Health Organization and Ministry of Health (Uganda) recommend use of microscopy for parasitological confirmation of malaria. Microscopy involves either Giemsa or Fields staining techniques. Ministry of Health prefers and recommends use of Giemsa staining technique but most health facilities still use Fields staining technique. The objective of this study was to compare the cost-effectiveness of Giemsa and Fields staining techniques in order to inform malaria diagnosis policy and practice in Uganda. Methods: This was a cross sectional cost effectiveness analysis from the providers perspective covering the period between April 25, 2014 and June 15, 2014. The study involved 243 children below five years of age presenting at Acute Care Unit laboratory for malaria test before admission. Giemsa and Fields staining techniques were compared with Polymerase Chain Reaction as the gold standard. Decision tree analytic model in TreeAge was used for the cost effectiveness analysis. Results: Fields and Giemsa staining techniques cost US $ 0.030 and US $ 0.769 respectively. Correctly diagnosed cases were 227 and 230 for Fields and Giemsa staining techniques respectively. The proportion of correctly diagnosed cases was 93.4% for Fields and 94.7% for Giemsa. Incremental cost effectiveness ratio was 0.35 US $ per additional correctly diagnosed case. Conclusion: Fields staining technique was more cost effective than Giemsa staining technique; provided a higher number of correctly diagnosed cases at a lower cost than Giemsa staining technique. Fields staining technique is recommended as staining technique for malaria diagnosis at the Acute Care Unit of Mulago National Referral Hospital. This implies that even with introduction of more superior staining techniques for laboratory diagnosis of malaria, Field staining technique is still a cost effective technique to be used in resource limited settings with high malaria burden like Uganda and Africa at large.

scholarly journals Mentorship on Malaria Microscopy Diagnostic Service in Ethiopia: Baseline Competency of Microscopists and Performance of Health Facilities

2020 ◽  
Author(s):  
Bokretsion Gidey ◽  
Desalegn Nega ◽  
Adugna Abera ◽  
Abnet Abebe ◽  
Sindew Mekasha ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Predictive Value ◽  
False Negative ◽  
Malaria Diagnosis ◽  
Cross Sectional Study ◽  
Health Facilities ◽  
Malaria Parasites ◽  
Cross Sectional ◽  
Predictive Values ◽  
Malaria Microscopy

Abstract Background: In Ethiopia, malaria case is declining as a result of proven interventions and the country launched malaria elimination strategy in targeted settings since 2017. Accurate malaria diagnosis and prompt treatment are the key components of the strategy to prevent morbidity and stop continuation of the transmission. However, the quality of microscopic diagnosis in general is deteriorating as malaria burden declines. Therefore, this study was carried out toevaluate the competency of microscopists and the performance of health facilities on malaria microscopic diagnosis.Methods: A cross-sectional study was conducted from August 01 to September 30, 2019 in nine Regional States and one city administration. A standard checklist was used for on-site evaluation, archived patient slides were re-checked and proficiency of microscopists was tested using WHO certified slides from national slide bank in public health institute. Strength of agreement, sensitivity, specificity and positive and negative predictive values were calculated.Results: In this study, 102 health facilities (84 health centers and 18 hospitals) were included; from which, 202 laboratory professionals participated. In slide re-checking, moderate agreement (Agreement: 76.0%; Kappa: 0.41) was observed between experts and microscopists on malaria detection in all health facilities. The sensitivity and specificity of routine slide reading and the rechecking results were 78.1% and 80.7%, respectively. Likewise, positive predictive value of 65.1% and negative predictive value of 88.8% were scored in the routine diagnosis. By panel testing, a substantial overall agreement (A: 91.8%; K: 0.79) was observed between microscopists and experts in detecting malaria parasites. The sensitivity and specificity in detection of malaria parasites was 92.7% and 89.1%, respectively. Furthermore, in identifying species, slight agreement (A: 57%; K: 0.18) was observed between microscopists and experts. Conclusion: The study found significant false positive and false negative results in routine microscopy on slide re-checking of Plasmodium parasites. Moreover, reduced grade in parasite species identification was reported on the panel tests. Therefore, implementing comprehensive malaria microscopy mentorship, in-service training and supportive supervision are the key strategies to improve the overall performance of health facilities in malaria microscopy.

scholarly journals Role of FNAC in the Evaluation of Solitary Cold Thyroid Nodule

2012 ◽  
Vol 4 (1) ◽  
pp. 15-17
Author(s):  
MA Quddus ◽  
M Alimuzzaman ◽  
MKH Sardar
Keyword(s):  
Thyroid Nodule ◽  
Predictive Value ◽  
Diagnostic Method ◽  
Sampling Technique ◽  
Cost Effective ◽  
Needle Aspiration ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Definitive Surgery ◽  
Needle Aspiration Cytology

Background: Fine needle aspiration cytology (FNAC) provides diagnostic information as to the nature of a solitary cold thyroid nodule. Objective: This study was carried out to evaluate the effectiveness of FNAC as a diagnostic method of malignancy in solitary cold thyroid nodule. Methodology: This cross sectional study was carried out among 40 cases of solitary cold thyroid nodule who were admitted in the Department Surgery and ENT of DMCH during period of January 2006 to December 2007. This study was conducted using convient type of non-probability sampling technique Data were collected by face to face interview, clinical examination and finding of both cytological and histological examination. Result: The study revealed that the mean age of the patients was 35.8± 2.36 year with female to male ratio 2.6:1. For all the patients, FNAC were done preoperatively and after definitive surgery histopathology were done for confirmed diagnosis and results of FNAC were compared with histopathology reports. 30 cases were diagnosed as benign and 10 case diagnosed as malignant cold thyroid solitary nodules among 40 cases. In this study, the sensitivity of FNAC was 80% for the presence of malignancy and specificity 96.7% for the absence of malignancy in solitary cold thyroid nodules. The positive predictive value was 88.9% and negative predictive value was 92.5% and diagnostic accuracy was 92.5%. Conclusion: FNAC can be used as a diagnostic method for the evaluation of malignancy as well as in the management of solitary cold thyroid nodule which has reasonable sensitivity and specificity. Finally, it is a quick, cost effective procedure and has excellent patient compliance. DOI: http://dx.doi.org/10.3329/jssmc.v4i1.11997 J Shaheed Suhrawardy Med Coll, 2012;4(1):15-17

scholarly journals A self-report questionnaire to detect hand dermatitis in nurses

2020 ◽  
Vol 70 (9) ◽  
pp. 645-648 ◽  
Author(s):  
V Parsons ◽  
H C Williams ◽  
J English ◽  
J Llewellyn ◽  
G Ntani ◽  
...  
Keyword(s):  
Predictive Value ◽  
Service Providers ◽  
High Specificity ◽  
Cost Effective ◽  
Cross Sectional Study ◽  
Health Surveillance ◽  
Self Report ◽  
Cross Sectional ◽  
Hand Dermatitis ◽  
Screening Question

Abstract Background Hand dermatitis is highly prevalent among nurses due to their frequent exposure to wet work. Providing cost-effective dermatological health surveillance for this occupational group presents a challenge to health service providers. Aims To ascertain the predictive value of nurses’ self-assessment of whether they had current hand dermatitis using a screening questionnaire when compared with the assessment made by a dermatologist of the nurses’ hand photographs. Methods We conducted a cross-sectional study comparing the self-report decision made by student and intensive care nurses using a single hand dermatitis screening question with the clinical assessment of their hand photographs made by dermatologists using a standardized photographic guide. Results We analysed data collected at study baseline (n = 1599). The results showed that the screening question had a high negative predictive value (91%; 95% CI 89–93), but a low positive predictive value (39%; 95% CI 34–45). It demonstrated acceptable accuracy in distinguishing those with and without the disease (area under the receiver operator curve = 0.7) and had a high specificity (86%; 95% CI 84–88) but a sensitivity of only 52% (95% CI 46–59) in identifying hand dermatitis. Conclusions We found that nurses were able to accurately self-assess themselves as not having any signs of hand dermatitis. By contrast, they were less able to accurately self-assess positive cases suggesting under-recognition of early disease. We propose that a questionnaire containing a single hand dermatitis screening question should be considered as a tool for screening out clear cases as part of a workplace health surveillance programme for detecting hand dermatitis.

scholarly journals Cost-Effectiveness of Osteoporosis Screening in Women Over 40-Year-Old

2021 ◽  
Author(s):  
Fereshte Keshavarzi ◽  
Elham Aflaki ◽  
Mehrdad Askarian ◽  
Nahid Hatam
Keyword(s):  
Cost Effectiveness ◽  
Screening Method ◽  
Cost Effective ◽  
Cross Sectional Study ◽  
Mineral Density ◽  
Cross Sectional ◽  
Osteoporosis Screening ◽  
Density Reduction ◽  
Life Years ◽  
Progression Of Disease

Osteoporosis is a disease recognized by bone density reduction and is particularly common among older women, which imposes them to fractures. The evidence shows that if do no serious conflict with this issue, in the far little future, huge costs will be imposed on individuals, families, and the country. In this study, we studied the cost-effectiveness of osteoporosis screening in women over 40 years of age in Shiraz in 2016. This cross-sectional study was performed on 240 persons who were screened and 240 non-screened persons in the bone mineral density ward of Shiraz Namazi Hospital. The costs were identified and from the perspective of the insurer and the payer, which included only direct health care costs. To measure the effectiveness, the use of indicators as quality-adjusted life-years (QALY), the expected cost and effectiveness, and the Incremental cost-effectiveness ratio were calculated. The results showed that non-screening is the best strategy, given that the amount of ICER was obtained at $38484.56 and the threshold. As a result, the non-screening method compared to screening is cost-effective. The relevant authorities and proficients should prevent the progression of disease complications and consequently prevent the increase of the disease cost and improve the quality of life of the patients.

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