scholarly journals Implementation of quality management systems and progress towards accreditation of National Tuberculosis Reference Laboratories in Africa

2017 ◽  
Vol 6 (2) ◽  
Author(s):  
Heidi Albert ◽  
Jean De Dieu Iragena ◽  
Kekeletso Kao ◽  
Donatelle Erni ◽  
Teferi Mekonen ◽  
...  
Keyword(s):  
Quality Assurance ◽  
Quality Improvement ◽  
Quality Management ◽  
Susceptibility Testing ◽  
Drug Susceptibility ◽  
Drug Susceptibility Testing ◽  
External Quality Assurance ◽  
External Quality ◽  
National Tuberculosis ◽  
Line Drug

Background: Laboratory services are essential at all stages of the tuberculosis care cascade, from diagnosis and drug resistance testing to monitoring response to treatment. Enabling access to quality services is a challenge in low-resource settings. Implementation of a strong quality management system (QMS) and laboratory accreditation are key to improving patient care.Objectives: The study objective was to determine the status of QMS implementation and progress towards accreditation of National Tuberculosis Reference Laboratories (NTRLs) in the African Region.Method: An online questionnaire was administered to NTRL managers in 47 World Health Organization Regional Office for Africa member states in the region, between February and April 2015, regarding the knowledge of QMS tools and progress toward implementation to inform strategies for tuberculosis diagnostic services strengthening in the region.Results: A total of 21 laboratories (43.0%) had received SLMTA/TB-SLMTA training, of which 10 had also used the Global Laboratory Initiative accreditation tool. However, only 36.7% of NTRLs had received a laboratory audit, a first step in quality improvement. Most NTRLs participated in acid-fast bacilli microscopy external quality assurance (95.8%), although external quality assurance for other techniques was lower (60.4% for first-line drug susceptibility testing, 25.0% for second-line drug susceptibility testing, and 22.9% for molecular testing). Barriers to accreditation included lack of training and accreditation programmes. Only 28.6%of NTRLs had developed strategic plans and budgets which included accreditation.Conclusion: Good foundations are in place on the continent from which to scale up accreditation efforts. Laboratory audits should be conducted as a first step in developing quality improvement action plans. Political commitment and strong leadership are needed to drive accreditation efforts; advocacy will require clear evidence of patient impact and cost-benefit.

scholarly journals Comparison of Proportion and Resistance Ratio Methods for Drug Susceptibility Testing of Mycobacterium tuberculosis Isolated from Patients Attending National Tuberculosis Centre, Nepal

2010 ◽  
Vol 5 (1) ◽  
pp. 13-20
Author(s):  
S Acharya ◽  
P Ghimire ◽  
DK Khadka ◽  
S Nepali
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Fluorescence Microscopy ◽  
Susceptibility Testing ◽  
Drug Susceptibility ◽  
Drug Susceptibility Testing ◽  
Resistance Ratio ◽  
National Tuberculosis ◽  
Smear Negative ◽  
Culture Positive ◽  
Good Agreement

Background: Tuberculosis (TB) is among the most serious infectious cause of global morbidity and mortality. Emergence of Multi-drug resistant tuberculosis (MDR-TB) is posing an increased threat to TB control programs. Drug susceptibility testing (DST) of Mycobacterium tuberculosis (M. tuberculosis) isolates is important for tackling such problems. Setting: National Tuberculosis Centre (NTC), Thimi, Bhaktapur, Nepal. Objectives: Comparative evaluation of two in vitro DST methods in determining susceptibility of M. tuberculosis isolates from patients attending NTC, to front-line anti-TB drugs: (Isoniazid-INH, Rifampicin-RFP, Streptomycin-SM, and Ethambutol-EMB). Methodology: This study was conducted from Sep 2006-Jun 2007. A total of 862 sputum samples (diagnosis or follow up cases) collected from patients (type of patients or their categories was not differentiated in this study) attending NTC bacteriology lab for sputum direct smear microscopy were analyzed using fluorescence microscopy. All smear positive samples, smear negative samples requested for culture were cultured. All culture positive samples confirmed as M. tuberculosis by biochemical tests were processed for DST by both proportion (PR) and resistance ratio (RR) methods. Results: Out of 862 sputum samples analyzed, 226 (26.2%) samples were positive for Acid Fast Bacilli (AFB) by fluorescence microscopy. Among 323 samples 226 smear positive samples and 97 smear negative samples requested for culture), 221 (68.4%) were culture positive, 92 (28.5%) were culture negative and 10 (3.1%) were contaminated. Out of 221 isolates of M. tuberculosis, 57.5% were resistant to one or more drugs by the PR method and 56.6% by the RR method. Similarly, MDR isolates were 29.9% and 29% by PR and RR methods respectively. On correlation analysis using Mc Nemar Chi-square test, no significant difference between the two tests were observed (p>0.05). The results showed high agreement between both methods and agreement rates to INH, RFP, SM and EMB were 93.2%, 93.7%, 93.2% and 94.1% respectively. Similarly, the agreement rates between both methods using kappa analysis showed kappa (k) value of 0.86, 0.85, 0.86 and 0.84 for INH, RFP, SM and EMB respectively, which is believed to be good agreement between both methods (k=0.80 to 1.00: Very good agreement). Conclusion: In conclusion, this study showed that both the Proportion and Resistance ratio methods are equally good for determining drug susceptibility of M. tuberculosis. Keywords: Mycobacterium tuberculosis; Drug Susceptibility Testing; Proportion Method; Resistance Ratio Method. DOI: 10.3126/saarctb.v5i1.3078 SAARC J. Tuber. Lung Dis. HIV/AIDS 2008 Vol.5(1) 13-20

scholarly journals Impact of External Quality Assurance on the Quality of Xpert MTB/RIF Testing in Viet Nam

2018 ◽  
Vol 57 (3) ◽  
Author(s):  
Vidyanidhi Gumma ◽  
Kyle DeGruy ◽  
Davara Bennett ◽  
Thanh Nguyen Thi Kim ◽  
Heidi Albert ◽  
...  
Keyword(s):  
Quality Assurance ◽  
Positive Impact ◽  
Production Capacity ◽  
Control Program ◽  
External Quality Assurance ◽  
World Health ◽  
External Quality ◽  
National Tuberculosis ◽  
Control And Prevention ◽  
Health Organization

ABSTRACT Following the endorsement of the Xpert MTB/RIF assay (Cepheid, Sunnyvale, CA, USA) by the World Health Organization (WHO) in 2010, Viet Nam’s National Tuberculosis Control Program (NTP) began using GeneXpert instruments in NTP laboratories. In 2013, Viet Nam’s NTP implemented an Xpert MTB/RIF external quality assurance (EQA) program in collaboration with the U.S. Centers for Disease Control and Prevention (CDC) and the Foundation for Innovative New Diagnostics (FIND). Proficiency-testing (PT) panels comprising five dried tube specimens (DTS) were sent to participating sites approximately twice a year from October 2013 to July 2016. The number of enrolled laboratories increased from 22 to 39 during the study period. Testing accuracy was assessed by comparing reported and expected results; percentage scores were assigned; and feedback reports were provided to sites. On-site evaluation (OSE) was conducted for underperforming laboratories. The results from the first five rounds demonstrate the positive impact of PT and targeted OSE visits on testing quality. On average, for every additional round of feedback, the odds of achieving PT scores of ≥80% increased 2.04-fold (95% confidence interval, 1.39- to 3.00-fold). Future work will include scaling up PT to all sites and maintaining the performance of participating laboratories while developing local panel production capacity.

scholarly journals Quality Assurance in Higher Education: Comparative Analysis of Provisions and Practices in Ghana   and New Zealand

2021 ◽  
Author(s):  
◽  
Godwin Utuka
Keyword(s):  
Higher Education ◽  
Quality Assurance ◽  
Comparative Analysis ◽  
New Zealand ◽  
Quality Management ◽  
External Quality Assurance ◽  
External Quality ◽  
Education In Ghana ◽  
The Government

<p>This research involves a comparative analysis of Ghanaian and New Zealand contexts and provisions of quality assurance in tertiary education. The study examined policies and practices of quality assurance in higher education in Ghana and New Zealand in order to identify those practices in New Zealand which are potentially applicable to the Ghanaian Higher Education context or which, at least, may suggest a direction for the Ghanaian government to consider for development. This study argues that although the management and practices of quality assurance in higher education in New Zealand are not without flaws, Ghana stands a better chance of tapping from the formers’ experiences in shaping its future policy direction. The quality of higher education and its improvement have always been issues of high priority on the political and educational agendas of the government and higher institutions in Ghana. Like other developing nations, Ghana has adopted various methodologies to address the question of quality in higher education similar to those in Western countries. The government of Ghana established a national quality assurance agency, the National Accreditation Board (NAB) to be responsible for quality assurance in higher education. Higher educational institutions have also adopted various processes and practices for the assurance of quality of the education provided. However, despite the fact that the literature on quality assurance framework in higher education is growing, little is available in the literature on what Ghana is doing to regulate and improve higher education quality and what has been the impact of NAB since its inception in 1993. In addition, a formal study of the commonality or diversity of approaches between Ghana and any developed nation has been lacking. A qualitative methodology was used to gain the perceptions of key practitioners in quality management systems in the two countries. Interview and documentary analysis were the main research instruments employed for data collection. The study analysed the views of a range of respondents from Ghana and New Zealand and documents from selected tertiary institutions and external quality assurance agencies in the two countries. A comparative analysis of data revealed some gaps and challenges in the Ghanaian system. This study found that though NAB has made significant impacts on the quality regime of the higher education sector in Ghana since its inception, the processes of quality management demands remains a challenge to both the institutions and NAB and much remains to be done for improvement. Quality of provision at the institutional level (internal structures, documented policies, external involvement, conduct of self assessment), and at the national level (regular monitoring, change in compliance approach, adequate qualified staff etc) are key areas requiring urgent policy attention if Ghana is to achieve the objectives of its tertiary educational reforms. On the basis of empirical evidence and life experiences from the respondents, a contribution would be made to the design of higher education policy-making with regard to the improvement of the internal and external quality assurance practices in higher education in Ghana. This study has further contributed to quality assurance literature by critically examining and comparing life responses of respondents from two countries viv-a-vis the international trend before making its recommendations. This study has further deepened the understanding of quality management practices in higher education in the two countries involved in this study.</p>

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