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AMREF EXTERNAL QUALITY ASSESSMENT SCHEME (EQAS) FOR PRIMARY HEALTH CARE LABORATORIES

AMREF EXTERNAL QUALITY ASSESSMENT SCHEME (EQAS) FOR PRIMARY HEALTH CARE LABORATORIES. Jane Carter, Orgenes Lema Christine Adhiambo, Sadiki Materu AMREF Laboratory Programme African Medical and Research Foundation (AMREF), Nairobi, Kenya. OBJECTIVES OF THE AMREF EQAS.

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AMREF EXTERNAL QUALITY ASSESSMENT SCHEME (EQAS) FOR PRIMARY HEALTH CARE LABORATORIES

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  1. AMREF EXTERNAL QUALITY ASSESSMENT SCHEME (EQAS) FOR PRIMARY HEALTH CARE LABORATORIES Jane Carter, Orgenes Lema Christine Adhiambo, Sadiki Materu AMREF Laboratory Programme African Medical and Research Foundation (AMREF), Nairobi, Kenya

  2. OBJECTIVES OF THE AMREF EQAS • Measure laboratory performance • Identify and rectify problem areas • Provide continuing education • Evaluate training activities • Standardize techniques • Improve communication between clinical, laboratory and public health staff

  3. METHODS • Selection of laboratory tests • Production of laboratory materials • Clinical problem setting • Clinical, laboratory & public health questions • Answer sheet • Marking key

  4. TESTS ADDRESSED • Thick blood film for blood parasites • Thin blood film for blood cell morphology • Haemoglobin estimation • Stool for parasites • Urine for parasites • Ziehl Nielsen staining • Gram staining

  5. MATERIALS PRODUCED: 1993-2000 (1) • Thick blood films for malaria parasites • Thin blood films for red cell morphology • Thin blood films for differential white blood cell count • Haemiglobincyanide solution • Haemoglobin lysate

  6. MATERIALS PRODUCED: 1993-2000 (2) • Stool for ova (S mansoni, hookworm, A lumbricoides, Taenia sp) • Urine for ova (S haematobium) • Stained stool smear for Cryptosporidium • Sputum smear, fixed, stained/unstained for AFB • CSF smear, fixed, unstained for bacteria

  7. ASSIGNING VALUES FOR HAEMIGLOBINCYANIDE & LYSATE • 4 AMREF Laboratory Technologists in the AMREF central laboratory • 5 Reference Laboratories in Nairobi • Mean values from participating laboratories* * Being reviewed

  8. DISPATCHING AND RECEIVING • AMREF Specialist Outreach flights • Postal services • Hand delivery: Field stations NGOs

  9. MARKING • 2 AMREF technologists independently • Consensus score for each participating laboratory • Scoring system: - 3 marks: fully correct - 2 marks: partially correct/acceptable - 1 mark: some correct interpretation - 0 mark: wrong/misleading/no answer

  10. FEEDBACK TO PARTICIPANTS • Participant’s mark • Highest and lowest scores • Correct answers • Possible reasons for error & suggestions for improvement • Health learning materials • On-site visits • Discussion with hospital authorities

  11. DISTRIBUTIONS SENT AND RETURNED

  12. RESPONSE TIME

  13. NUMBER OF PARTICIPATING LABORATORIES 1993 1994 1995 1996 1998 1999 2000 Tanzania: hospitals 11 6 5 13 7 26 23 health centres - - - - - 1 1 Kenya: hospitals - - - 10 3 12 6 health centres 10 6 2 9 10 14 12 S Sudan - - - 1 1 6 6 Uganda - - - - 3 4 7 Somalia - 1 1 - 1 - - TOTAL 21 13 8 33 25 63 55

  14. AVERAGE SCORES

  15. FACILITY IMPROVEMENT ASSESSMENTMINIMUM 4 DISTRIBUTIONS

  16. HAEMOGLOBIN METHODS EVALUATION BY EQAS

  17. MEAN DIFFERENCE IN HAEMOGLOBIN RESULTS FROM TARGET VALUES

  18. CHALLENGES AT LABORATORY LEVEL • Few trained laboratory personnel • Shortage of equipment and supplies • Equipment failure • No reference books or materials • Low morale

  19. CHALLENGES AT AMREF • Poor postal services • Low response rate • Few laboratory personnel • Inadequate space • Funding

  20. FUTURE PLANS FOR A REGIONAL PROGRAMME (REQAS) • Cooperation between Kenya, Tanzania & Uganda • Establishment of qualitative standards • Preparation of SOPs, quality manuals • Large scale preparation of materials • Coordinating centre • Mechanism for remedial action • Dedicated funding

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