Variations on External Quality Assessment Performance of Public Medical Laboratories: Experience from SLMTA Program in Morogoro and Iringa, Tanzania

Abstract

Background:The International Organization for Standardization has recommended monitoring and evaluation of quality laboratory services to ensure accuracy and reliability of diagnoses. The extent of accuracy and reliability of medical laboratory diagnoses in Tanzania has been scarcely documented. Objective:The evaluation aimed at determining the effect of SLMTA program on external Quality assessment participation and proficiency test performance of public laboratories in Iringa and Morogoro in Tanzania. Methodology: A comparative laboratory-based cross-sectional design involved four medical laboratories was conducted in Kilosa and Turiani districts in Morogoro region and Iringa Municipal and Mufindi district in Iringa region. Participation in, and the number of individual programs assessed by External Quality assurance programs was determined. Data were analyzed using Excel software to prepare contingency tables for test sensitivities, specificities, and predictive values. Statistics such as percentage distributions and cross-tabulations were used to analyse data.Findings: SLMTA and non-SLMTA labs are participating regularly in EQA for HIV Rapid tests (RTs), however, their participation is not regular for malaria and Hb tests. Proficiency test performance for HIV RTs in SLMTA lab category was 64%, while in non-SLMTA was 85%. PT performance for malaria test in non SLMTA was 44%, while it was zero percent in SLMTA lab category. Proficiency tTest performance (percentage at which the particular laboratory is able to correctly get the true result as per the reference laboratory for a particular laboratory tests) for Hb was zero percent in SLMTA labs and no datum for Hb PTs available in non SLMTA labs. The true positive rate (sensitivity) and true negative rate (specificity) for HIV RTs was 100% in both laboratory categories (SLMTA and non-SLMTA).The current study, registered a sensitivity and specificity of 100% and 75% respectively for malaria tests in SLMTA labs, while in non-SLMTA labs sensitivity and specific were 94% and 100% respectively. Sensitivity for Hb level estimation in SLMTA labs was 87% and there was no Hb data in non-SLMTA. Hb level estimation tests were enrolled at baseline year in both lab categories but currently they are not performed in non-SLMTA labs. Despite that Hb is being done in SLMTA labs there is no feedback from the EQA agent.Both lab categories comply the required TAT for submission of the facility PT results. SLMTA labs observed to review the HIV RT and malaria PTs feedback, while non-SLMTA did not. No evidence of corrective actions were taken following HIV, malaria and Hb test results in both SLMTA and non-SLMTA labs. Conclusion:No variations on EQA participation for HIV RTs, Sensitivity and specificity of HIV RTs are acceptably high in both SLMTA and non-SLMTA labs. Proficiency test score performance for HIV RT and malaria test is higher in non-SLMTA labs than it is in SLMTA labs. There is a need to continuously assess LQIs and calls for an improved attempt on reviewing EQA. Much more ...