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Abstract:Background: Phlebotomy is the system of drawing a blood sample for the use of laboratory testing and for blood transfusion. Professionals who are performing phlebotomy services called phlebotomists. It is a critical part of the pre analytical phase of laboratory testing and is the most neglected procedures in health care. About 70% of the quality of the test are affected during phlebotomy and other pre analytical services. However, little is known about the practice of phlebotomy services in developing countries like Ethiopia. Objectives: To assess the practice of phlebotomists and to identify the major sources of errors during venous blood collection in public hospitals in Addis Ababa. Methodology: Hospital based, cross sectional observational and follow-up study was conducted from March to May 30, 2014. The study followed 40 phlebotomists while each of them was collecting 5 different venous blood collections (giving a total of 200 phlebotomies). Well structured questionnaires and checklists were used to collect data. Data was entered on EPI-Data version 3.1 and statistical analysis was performed with SPSS version 20. Descriptive statistics were employed and the Chi square test was used for comparing major errors observed. Result: Almost all laboratory phlebotomy sites had no Standard Oprating Procedures (SOPs) available in collection sites and most of collection sites were not well ventilated. The major errors identified were use of single glove for more than one client 139 of 200 (69.5%), inappropriate cleaning practice of vein puncture sites 180 of 200 (90%), collecting blood before the disinfectant alcohol dried 139 of 200 (69.5%), incorrect tube collection sequences 107 of 200 (53.5%), unnecessarily applying of tourniquets after blood started flowing in to the collection tubes and syringes 170 of 200 (85.0%) and applying tourniquets before locating and selecting appropriate site for venous blood collection 175 of 200 (87.5%). Conclusion and Recommendation: -Many errors were identified in the phlebotomy practice during the observational study. As the quality of blood specimen influences patient result: emphasis should be given on phlebotomy training to improve the practices for phlebotomists and ensure safety as well as quality during blood collections for laboratory analysis.

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BackgroundUnreliable laboratory results lead to unnecessary tests, procedures or treatments which may harm the patient. Continuous quality improvement (CQI) is a useful objective tool to improve processes and services. The use of quality indicators that meet requirements for effectiveness is an important quality improvement tool. However, the quality of critical aspects of pre-examination, examination, and post-examination processes have not been evaluated in Ethiopia including our setting. Hence, this study aimed to assess the performance of continuous quality improvement of TB and HIV laboratory tests in the Amhara Public Health Institute (APHI). MethodsA cross-sectional study was conducted to evaluate the quality indicators of advanced TB and HIV related laboratory tests in APHI from 01 January to 30 September 2019. HIV viral load, exposed infant diagnosis (EID), GeneXpert and TB culture quality indicators data were used as a quality improvement tool and evaluated in comparison to established targets. Data were extracted from excel database and record review of patient information, and entered and analyzed using SPSS V20 software. ResultsA total of 26,487 samples were received from 01 January to 30 September 2019. The overall specimen rejection rate was 0.43% (115/26,487). Specifically, viral load and TB culture had 0.43% and 1.14% rejection rates, respectively. The highest monthly rejection was documented for TB culture (5.3%) and viral load (2.4%) in September 2019. Centrifugation problems (46.1% [53/115]) and the use of the wrong container (40.9% [47/115]) were the main reasons for the rejections. Moreover, EID test was interrupted for a total of 54 days and 22 days due to reagent stock out and equipment down time, respectively. Similarly, about 82% PLOS ONEPLOS ONE | https://doi.org/10. ConclusionsThere were high rates of TB culture and viral load specimen rejection, and EID test interruptions. The TAT of viral load and EID tests were longer than the targeted goal (10 days) average TAT. Hence, training of sample collectors, functional equipment maintenance systems and supply chain management are recommended for continuous quality improvement. PLOS ONEQuality improvement of tuberculosis and HIV diagnostic services in APHI PLOS ONE | https://doi.org/10.

Background: Worldwide Tuberculosis (TB) is the ninth leading cause of death from a single infectious agent, positioning on top of Human Immuno Deficiency Virus (HIV) and it is still an eminently serious public health problem. In developing countries, Ziehl-Neelsen (ZN)-stained sputum smear microscopy is the most widely used diagnostic method in diagnosing Pulmonary Tuberculosis (PTB). This study was aimed to compare the diagnostic performances of ZN-method with Xpert MTB/RIF assay for the diagnosis of PTB in Addis Ababa, Ethiopia. Methods: Facility-based cross-sectional study design was conducted from September 2016 to June 2017 on a total of 244 sputum samples collected from presumptive TB patients. The L-J sputum culture was used as a gold standard to compare the diagnostic performances of Xpert MTB/RIF assay and ZN-methods. Kappa values were analyzed by using statistical package for Social Science (SPSS) version 20 software at 95% Confidence Interval (CI). The Sensitivity, Specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of ZN-stained sputum smear microscopy and Xpert MTB/RIF assay were calculated against the gold standard. Results: The Sensitivity, Specificity, PPV and NPV of ZN-stained sputum smear microscopy were 68.38%, 95.28%, 93.02% and 76.58% respectively, while for Xpert MTB/ RIF assay were 88.89%, 81.89%, 81.89% and 88.89% respectively. The results of the two diagnostic approaches were concordant with the gold standard with a kappa value of ZN 0.650 and 0.743 for Xpert MTB/RIF assay. Conclusion: This study concludes that the sensitivity of Xpert MTB/RIF assay was better than ZN-stained direct sputum smear microscopy for the diagnosis of pulmonary tuberculosis.

Ethiopia is the second most populous country in Africa and the sixth most affected by COVID-19 on the continent. Despite having experienced five infection waves, >499 000 cases, and ~7 500 COVID-19-related deaths as of January 2023, there is still no detailed genomic epidemiological report on the introduction and spread of SARS-CoV-2 in Ethiopia. In this study, we reconstructed and elucidated the COVID-19 epidemic dynamics. Specifically, we investigated the introduction, local transmission, ongoing evolution, and spread of SARS-CoV-2 during the first four infection waves using 353 high-quality near-whole genomes sampled in Ethiopia. Our results show that whereas viral introductions seeded the first wave, subsequent waves were seeded by local transmission. The B.1.480 lineage emerged in the first wave and notably remained in circulation even after the emergence of the Alpha variant. The B.1.480 was out-competed by the Delta variant. Notably, Ethiopia lack of local sequencing capacity was further limited by sporadic, uneven, and insufficient sampling that limited the incorporation of genomic epidemiology in the epidemic public health response in Ethiopia. These results highlight Ethiopia role in SARS-CoV-2 dissemination and the urgent need for balanced, near-real-time genomic sequencing.