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27Background: In 2002, the World Health Organization (WHO) launched a regional microbiology external 28 quality assessment (EQA) programme for national public health laboratories in the African region, initially 29 targeting priority epidemic-prone bacterial diseases, and later including other common bacterial pathogens. 30Objectives: The aim of this study was to analyse the efficacy of an EQA programme as a laboratory quality 31 system evaluation tool. 32 Methods:We analysed the proficiency of laboratories' performance of bacterial identification and AST for the 33 period 2011-2016. Overall, 81 laboratories from 45 countries participated. 34The National Institute for Communicable Diseases of South Africa provided technical coordination following 35 an agreement with WHO, and supplied EQA samples of selected bacterial organisms for microscopy (Gram 36 stain), identification, and antimicrobial susceptibility testing (AST). National public health laboratories, as well 37 as laboratories involved in the Invasive Bacterial Diseases Surveillance Network, were enrolled by the WHO 38 Regional Office for Africa to participate in the EQA programme. 39 Results: We analysed participants' results of 41 surveys, which included the following organisms sent as 40 challenges: Streptococcus pneumonia, Haemophilus influenza, Neisseria meningitidis, Salmonella Typhi, 41 Salmonella Enteritidis, Shigella flexneri, Staphylococcus aureus, Streptococcus agalactiae, Streptococcus 42 anginosus, Enterococcus faecium, Serratia marcescens, Acinetobacter baumannii, and Enterobacter cloacae. 43Overall, 76% of participants obtained acceptable scores for identification, but a substantial proportion of AST 44 scores were not in the acceptable range. 45 Conclusion:In the African Region, implementation of diagnostic stewardship in clinical bacteriology is 46 generally suboptimal. This report illustrates that AST is poorly done compared to microscopy and identification. 47It is critically important to make the case for implementation of quality assurance in AST, as it is the 48 cornerstone for antimicrobial resistance surveillance reporting and implementation of the Global Antimicrobial 49 Resistance Surveillance System. 50 100 laboratories for continuous capacity assessment, for example to obtain information on their facilities, capacity, 101 and staff competence. Preparation of the samples included quality control and validation of survey material 102 before dispatch. The programme followed the ISO/IEC 17043 guidelines and all samples were packaged and 103 shipped according to International Air Transport Association Packing Instructions P650. 4 104Concurrently, five referee laboratories tested the isolates and their results determined whether the specimen 105 panels were suitable for distribution to participants. For this analysis, participating laboratories' bacterial 106 identification and AST results for the period 2011-2016 were identified from the programme database.

Background: In 2002, the World Health Organization (WHO) launched a regional microbiology external quality assessment (EQA) programme for national public health laboratories in the African region, initially targeting priority epidemic-prone bacterial diseases, and later including other common bacterial pathogens. Objectives: The aim of this study was to analyse the efficacy of an EQA programme as a laboratory quality system evaluation tool. Methods: We analysed the proficiency of laboratories' performance of bacterial identification and antimicrobial susceptibility testing (AST) for the period 2011-2016. The National Institute for Communicable Diseases of South Africa provided technical coordination following an agreement with WHO, and supplied EQA samples of selected bacterial organisms for microscopy (Gram stain), identification, and antimicrobial susceptibility testing (AST). National public health laboratories, as well as laboratories involved in the Invasive Bacterial Diseases Surveillance Network, were enrolled by the WHO Regional Office for Africa to participate in the EQA programme. We analysed participants' results of 41 surveys, which included the following organisms sent as challenges: Streptococcus pneumonia, Haemophilus influenzae, Neisseria meningitidis, Salmonella Typhi, Salmonella Enteritidis, Shigella flexneri, Staphylococcus aureus, Streptococcus agalactiae, Streptococcus anginosus, Enterococcus faecium, Serratia marcescens, Acinetobacter baumannii, and Enterobacter cloacae. Results: Eighty-one laboratories from 45 countries participated. Overall, 76% of participants obtained acceptable scores for identification, but a substantial proportion of AST scores were not in the acceptable range. Of 663 assessed AST responses, only 42% had acceptable scores. Conclusion: In the African Region, implementation of diagnostic stewardship in clinical bacteriology is generally suboptimal. This report illustrates that AST is poorly done compared to microscopy and identification. It is critically important to make the case for implementation of quality assurance in AST, as it is the cornerstone of antimicrobial resistance surveillance reporting and implementation of the Global Antimicrobial Resistance Surveillance System.

Evaluation on Internet portals is a key component of any online resource development. Understanding user information seeking behaviour and user perceived behaviour is essential to obtain the full picture of user needs, online activities and draw lessons to improve the design of Internet portals to better meet user expectations. This article discusses the evaluation of a WHO Internet portal: the Labresources website. The evaluation investigates user satisfaction with the resource, usability, demographic information about users and how well they could complete specific tasks using the website and compared this with the actual online behaviour revealing a number of discrepancies. An online questionnaire was advertised on the Labresources website during the period 25 November 2005 to 20 February 2006. As the site caters to English and French speakers, the questionnaire was made available in both languages. It consisted of two sections - the first section required the participant to complete three tasks using the website whereas the second section tested user satisfaction, information needs and appropriateness of the content. Weblogs data were compared with the questionnaire results to compare user perceived and actual online behaviour. Twenty one respondents completed the online questionnaire from a total of 18 countries. This was out of a potential 60 website users among whom the questionnaire was promoted. In general, respondents were satisfied with the website layout and navigation. 61.9% of respondents listed WHO among their top 5 and a third listed the Labresources website. The number of sessions where users browse (146) the information resources is almost three times more than the number of users who search (52) the resources. Weblogs revealed most interesting results with differences between what users reported doing when completing tasks and how easy they perceived the tasks and what they actually did. Twelve respondents completed at least one task. Of the remaining nine respondents, three did visit the Labresources website from the link in the questionnaire but did not go on to complete the tasks. Only one of the twelve who completed a task reported it being difficult. Three of the respondents who didn't complete a task reported the tasks to be difficult but only one of these actually followed the link to begin the tasks in the questionnaire. This article described an evaluation study investigating user perceived and actual behaviour at the WHO Labresources Internet portal. Although the questionnaire results demonstrated general satisfaction with the resource, a combination of a weblog evaluation with the questionnaire revealed a clearer picture of the user perception of and satisfaction with the website compared to their actual activity when completing the set tasks.