Smear Microscopy Examination for Malaria and Tuberculosis at Primary Health Care Unit Level of Guragae Zone, Southern Ethiopia

Abstract

Background: Accurate early diagnosis and prompt treatment is one of the core strategies employed to address malaria and tuberculosis related problems. Laboratory confirmation improves disease management most efficiently within well-managed health laboratory systems. External quality assurance participation is associated with improved laboratory performance over time as it is a system for objectively checking a laboratory’s performance. However, many professionals in Sub Saharan Africa countries are unable to effectively implement a quality assurance program. This study aimed to assess the quality of smear microscopy in Guragae zone primary health care unit, Southern Ethiopia. Methods: Health institution-based cross-sectional study was conducted to recruit twenty-one primary health care units between May and August 2019. Blind rechecking was used to collect data. The sensitivity, specificity, positive predictive values, and negative predictive values were calculated by considering the final re-reading result as the gold standard. The level of agreement was measured using Kappa value. SPSS version 21 was used for data management and analysis. Result: A total of 860 and 318 stained slides for tuberculosis and malaria were collected, respectively. From total collected slides for tuberculosis, about 13.1 % of them were reported positive and from total malaria slides collected, half were positive for Plasmodium species at the peripheral laboratory while about 36.1% and 13% were confirmed positive for Plasmodium species and tuberculosis, respectively during re-reading at Wolkite University laboratory. Referring to the final result, the surveyed health facilities achieved “moderate agreement”(K=0.6) on malaria slide detection and “almost perfect agreement” (K=0.9) on slides for acid-fast bacilli. Only 4.4% of the surveyed health facilities incorporate malaria parasite count estimation in their report as per the current guideline. Conclusion: Now is the time to build sustainable laboratory capacity in resource-poor settings like Ethiopia that can be used to manage existing infectious diseases including malaria and tuberculosis. Malaria related technical problems were identified in this study. Thus, the authors believe that a continuous and strong malaria quality assurance schemes should be implemented at each laboratory to ensure reliable results.