External Quality Assessment (EQA) of Laboratory Tuberculosis Diagnosis in Lagos State, Nigeria: A Three-Year Review
Abstract:
The low detection of tuberculosis cases
is a big problem in Nigeria. The rate of accurate diagnosis while ensuring the quality
of TB treatment monitoring tool – AFB, with a 90% Pass grade system among the testing
laboratories requires to be monitored. Therefore, this study evaluated the external
quality assessment (EQA) of TB diagnosis to satisfy laboratory quality requirements
in Lagos, Nigeria. This study was conducted using data from 132 laboratories in
Lagos, examining 3years retrospective EQA reports from 2019 to 2021. A structured
data abstraction chart was employed to extract EQA data from the STBLCP database,
while a trained supervisor checked for completeness, clarity, and consistency of
data. IBM-SPSS
version 28.0 was used for data analysis. The external assessment report showed
an improved TB Laboratory diagnostic performance in the 2nd quarter of
2019 and 2020, but a decline was noticed in the 3rd and the 4th
quarters. There was an increase in the overall laboratory performance from 94.4%
in 2019 to 96.1% in 2020. A significant proportion (79.2%) of the slides assessed
in 2019 passed external assessment tests (had a concordant score of 90 and above).
However, the performance was significantly better in 2020 (84.2%) and 2021 (88.2%).
Laboratories should be upgraded to a world-standard level, and staff should be well-trained,
with periodic competency assessments to make reliable diagnoses, while ensuring
all testing laboratories are enrolled in EQA program for the measure of quality
laboratory services and consistency in service delivery.
Keywords: Assessment, Diagnosis, External, Laboratory, Tuberculosis, Quality.
References:
[1] WHO, 2020d, Global Tuberculosis Report
2020. Geneva, Switzerland, https://www.who.int/.
[2] WHO. (2020g). Tuberculosis and Covid-19:
Considerations for tuberculosis care. World Health Organisation, 1-11, https://www.who.int/docs/defaultsource/documents/tuberculosis/infonote-tb-covid-19.pdf.
[3] WHO. Global tuberculosis report 2018. dIn
Global Tuberculosis, http://www.who.int/iris/handle/10665/274453.
[4] MacNeil A, Glaziou P, Sismanidis C, Date A,
Maloney S, Floyd K., 2020, Global Epidemiology of Tuberculosis and Progress
Toward Meeting Global Targets — Worldwide, 69(11):281–5, MMWR Morb Mortal Wkly
Rep.
[5] Thumamo BP, Asuquo AE, Abia-Bassey LN,
Lawson L, Hill V, Zozio T, et al., 2012, Molecular epidemiology and genetic
diversity of Mycobacterium tuberculosis complex in the Cross River State,
Nigeria, 12(4):671–7, Infect Genet Evol.
[6] Holmes KK, Bertozzi S, Bloom BR, Jha P,
Gelband H, DeMaria LM, et al. 2017, Major Infectious Diseases: Key Messages
from Disease Control Priorities, Third Edition.
[7] Aliyu G, El-Kamary SS, Abimiku A, Ezati N,
Mosunmola I, Hungerford L, et al. 2013, Mycobacterial Etiology of Pulmonary
Tuberculosis and Association with HIV Infection and Multidrug Resistance in
Northern Nigeria. Tuberc Res Treat; 2013:1–9.
[8] World Health Organization. Global
Tuberculosis Report. Blood [Internet] 2015;(September):1–98. http://www.who.int/tb/publications/global_report/en/index.html.
[9] Pubmed. Tuberculosis [Internet]. 2017
[cited 2021 Jun 25];1–5, https://pubmed.ncbi.nlm.nih.gov/30212088/.
[10] Rocha C, Montoya R, Zevallos K, Curatola A,
Ynga W, Franco J, et al. 2011, The Innovative Socio-economic Interventions
Against Tuberculosis (ISIAT) project: An operational assessment. 2011;15(SUPPL.
2), Int J Tuberc Lung Dis.
[11] Zaman K. 2011, Tuberculosis: A global
health problem. J Heal Popul Nutr 2010;28(2):111–3.
[12] Kaliakbarova G, Pak S, Zhaksylykova N,
Raimova G, Temerbekova B, van den Hof S, 2013, Psychosocial support improves
treatment adherence among MDR-TB patients: Experience from East Kazakhstan. Open
Infect Dis J 2013;7(SPEC ISS1):60–4.
[13] Horter S, Stringer B, Reynolds L, Shoaib M,
Kasozi S, Casas EC, et al. 2014, “home is where the patient is”: A qualitative
analysis of a patient-centred model of care for multi-drug resistant
tuberculosis. BMC Health Serv Res 2014;14.
[14] Thomas TA 2019. Tuberculosis in Children.
29(1):109–21, Thorac Surg Clin.
[15] Graham SM, Sismanidis C, Menzies HJ, Marais
BJ, Detjen AK, Black RE, 2014, Importance of tuberculosis control to address
child survival. 383(9928):1605–7, Lancet.
[16] Ogbo FA, Ogeleka P, Okoro A, Olusanya BO,
Olusanya J, Ifegwu IK, et al. 2018, Tuberculosis disease burden Nigeria. 1–11,
Trop Med Health;
[17] Luminous Jannamike, 2018, 302,096
tuberculosis cases undetected in Nigeria – NTBLCP https://www.vanguardngr.com/03/302096-tuberculosis-cases-undetected-nigeria-ntblcp/.
[18] K. L, GB M, I. A, L. D, G. DV, R. D, et al.
2015, Towards tuberculosis elimination: An action framework for low-incidence
countries. 45(4):928–52, European Respiratory Journal, http://erj.ersjournals.com/content/45/4/928.full.pdf+html%5Cnhttp://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed13&NEWS=N&AN=2015898639.
[19] Niemann S, Supply P. 2014, Diversity, and
evolution of Mycobacterium tuberculosis: Moving to whole-genome- based
approaches. Cold Spring Harb Perspect Med;4(12).
[20] Drobniewski FA, Nikolayevskyy V, Balabanova
Y, Bang D, Papaventsis D. 2012, Diagnosis of tuberculosis and drug resistance:
What can new tools bring us? Int J Tuberc Lung Dis;16(7):860–70.
[21] Drobniewski F, Nikolayevskyy V, Maxeiner H,
Balabanova Y, Casali N, Kontsevaya I, et al. 2013, Rapid diagnostics of
tuberculosis and drug resistance in the industrialised world: Clinical and
public health benefits and barriers to implementation. BMC Med;11(1).
[22] ISO 15189:2012. Medical laboratories-
Requirements for quality and competence. Int Stand Organ; Third edition
2012-11-01, (3)15–31, https://www.iso.org/.
[23] Library of Congress – Federal Research
Divsion. Country Profile: Nigeria [Internet]. Ctry.
Profiles2008;(November):1–23. Available from: http://lcweb2.loc.gov/frd/cs/profiles/Nigeria.pdf.
[24] Ekundayo JMO. Out of Africa:
Fashola-Reinventing Servant Leadership to Engender Nigeria’s Transformation:
Foreword by Femi Falana, San. Author House p [Internet] 2013; Available from: https://books.google.com/books?hl=en&lr=&id=WjhKyg8OjBUC&oi=fnd&pg=PP1&dq=servant+leadership&ots=XzRKV-tk_c&sig=mfYGIY6dMCLyOo3TA642M7KGLMg.
[25] Federal Ministry of Health National
Tuberculosis and Leprosy Control Programme, 2012, Report of First National TB.
Prevalence Survey.2012;49–71, http://www.who.int/tb/publications/NigeriaReport.
[26] NPC and ICF, 2014, Nigeria Demographic and
Health Survey 2013. Natl Popul Comm 2014;566. http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:Nigeria+Demographic+and+Health+Survey#0%5Cnhttp://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:Nigeria+demographic+and+health+survey+1999#0.
[27] Beyeler N, Liu J, Sieverding M. A, 2015,
Systematic review of the role of proprietary and patent medicine vendors in
healthcare provision in Nigeria. PLoS One 2015;10(1).
[28] Adejumo O, Daniel O, Otesanya A,
Salisu-Olatunj S, Abdur-Razzaq H, 2017, Evaluation of outcomes of tuberculosis
management in private for profit and private-not-for profit directly observed
treatment short course facilities in Lagos State, Nigeria. 58(1):44, Niger Med
J.
[29] Ibrahim LM, Oleribe OO, Nguku P, Tongwong
GC, Mato LG, Longkyer MI, et al. 2014, Evaluation of quality of TB. control
services by private health care providers in Plateau state, Nigeria. Pan Afr
Med J;17.
[30] Akanbi K, Ajayi I, Fayemiwo S, Gidado S,
Oladimeji A, Nsubuga P. 2019, Predictors of tuberculosis treatment success
among HIV-TB co-infected patients attending major tuberculosis treatment sites
in Abeokuta, Ogun State, Nigeria. 32:7, Pan Afr Med J.
[31] Duru CB, Uwakwe KA, Nnebue CC, Diwe KC,
Merenu IA, Emerole CO, et al. 2016, Tuberculosis Treatment Outcomes and
Determinants among Patients Treated in Hospitals in Imo State, Nigeria.
03(06):1–17. OALib
[32] Hogan AB, Jewell BL, Sherrard-Smith E,
Vesga JF, Watson OJ, Whittaker C, et al. 2020, Potential impact of the COVID-19
pandemic on HIV,
tuberculosis, and malaria in low-income and middle-income countries: a
modelling study. Lancet Glob Heal, 8(9): e1132–41. http://dx.doi.org/10.1016/S2214-109X(20)30288-6.
[33] Durant TJS, Peaper DR, Ferguson D, Schulz
WL, 2020, Impact of COVID-19 Pandemic on Laboratory Utilization. 5(6):1194–205,
J Appl Lab Med.
[34] Kunjok DM, Zingbondo IM, 2020, Effects of
covid-19 on the laboratory turn-around time of vaccine-preventable disease
surveillance: the case of measles in south sudan, 37(245):1–5, Pan Afr Med J.
[35] Nikolayevskyy V, Holicka Y, van Soolingen
D, van der Werf MJ, Ködmön C, Surkova E, et al. 2021, Impact of the COVID-19
pandemic on tuberculosis laboratory services in Europe. Eur Respir J
2021;57(1).
[36] WHO, 2004, World TB. day, 2(5):360, Nat Rev
Microbiol, https://www.ucl.ac.uk/tb/world-tb-day/world-tb-day-2020.
[37] Togun T, Kampmann B, Stoker NG, Lipman M,
2020, Anticipating the impact of the COVID-19 pandemic on TB. patients and TB
control programmes. 2020;19(1), Ann Clin Microbiol Antimicrob.
[38] Adejumo O, Daniel O, Adepoju V,
Femi-Adebayo T, Adebayo B, Airauhi A. 2020, Challenges of tuberculosis control
in Lagos state, Nigeria: A qualitative study of healthcare providers’
perspectives. 61(1):37, Niger Med J.
[39] Wynne A, Richter S, Banura L, Kipp W. 2014,
Challenges in tuberculosis care in Western Uganda: Health care worker and
patient perspectives. 1:6–10, Int J Africa Nurs Sci.
[40] Uzochukwu BSC, Ughasoro MD, Etiaba E,
Okwuosa C, Envuladu E, Onwujekwe OE. 2015, Health care financing in Nigeria:
Implications for achieving universal health coverage. 18(4):437–44, Niger J
Clin Pract.