External quality assessment for acid fast bacilli smear microscopy in eastern part of Ethiopia.

BACKGROUND: External quality assessment (EQA) of sputum smear microscopy is essential and indispensable component of any tuberculosis program. This study assessed the EQA of acid fast bacilli (AFB) smear microscopy through onsite evaluation, blinded rechecking and panel test. A one year study was conducted on eight health institution laboratories from December 2011 to December 2012. Onsite evaluation, blinded rechecking and panel tests were used to collect data. Data were analyzed using SPSS version 16. Sensitivity, specificity, predictive values, and proportions of false readings were calculated. The level of agreement was measured using Kappa (κ) value. RESULTS: Problems observed during onsite evaluation include shortages of materials, disinfectant, and poor storage and working condition. A total of 578 slides were collected for blinded rechecking, of which 102 (17.6%) were reported as positive by peripheral laboratories. The panel test revealed an overall error of 17 (25.25%) of which 14 (17.5%) were minor errors [low false negative 6 (7.5%) and low false positive 8 (10%)], and 3 (3.75%) were major errors (high false positive). The sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) of the peripheral laboratories were 83.5, 97.8, 91.7, and 95.7, respectively. The false readings at the peripheral laboratories were 32 (5.5%). Agreement on reading the slides was observed on 546 (94.5%) slides (K = 0.84, SE = 0.054). CONCLUSIONS: Lack of reagents, supplies, favorable working environment and AFB related technical problems were identified in the peripheral laboratories. High false negative error was found to be the predominant major error. A continuous and strong EQA scheme should be implemented to avoid reporting errors and produce quality sputum results.

Strengthening evidence-based planning of integrated health service delivery through local measures of health intervention delivery times.

BACKGROUND: Immunization services in developing countries are increasingly used as platforms for delivery of other health interventions. A challenge for scaling up interventions on existing platforms is insufficient resources allocated to the integrated platform with the risk of overburdening a health worker. Determining the length of time to deliver priority interventions can be useful information in planning integrated services and mitigating this risk. We designed and tested a methodology for collecting the time needed to deliver selected interventions. METHODOLOGY: At 18 health facilities in Mali, Ethiopia, and Cameroon, we observed delivery of 11 maternal and child health interventions to determine delivery times. We interviewed health workers to estimate self-reported delivery times. RESULTS: Based on observations, vitamin A supplementation (median, 2:00 minutes per child) and vaccinations (median, 2:22 minutes) took the least amount of time to deliver, whereas human immunodeficiency virus counseling and testing and sick infant treatment interventions were among the longest to deliver. Health worker-reported times to deliver interventions were consistently higher than observed times. CONCLUSIONS: Using locally-obtained data can be useful to step for planners to determine how best to use existing platforms for delivering new interventions, particularly since these interventions may require substantially more time to deliver compared to immunizations.

Community and health worker perceptions and preferences regarding integration of other health services with routine vaccinations: four case studies.

BACKGROUND: Integration of routine vaccination and other maternal and child health services is becoming more common and the services being integrated more diverse. Yet knowledge gaps remain regarding community members and health workers acceptance, priorities, and concerns related to integration. METHODS: Qualitative health worker interviews and community focus groups were conducted in 4 African countries (Kenya, Mali, Ethiopia, and Cameroon). RESULTS: Integration was generally well accepted by both community members and health workers. Most integrated services were perceived positively by the communities, although perceptions around socially sensitive services (eg, family planning and human immunodeficiency virus) differed by country. Integration benefits reported by both community members and health workers across countries included opportunity to receive multiple services at one visit, time and transportation cost savings, increased service utilization, maximized health worker efficiency, and reduced reporting requirements. Concerns related to integration included being labor intensive, inadequate staff to implement, inadequately trained staff, in addition to a number of more broad health system issues (eg, stockouts, wait times). CONCLUSIONS: Communities generally supported integration, and integrated services may have the potential to increase service utilization and possibly even reduce the stigma of certain services. Some concerns expressed related to health system issues rather than integration, per se, and should be addressed as part of a wider approach to improve health services. Improved planning and patient flow and increasing the number and training of health staff may help to mitigate logistical challenges of integrating services.