Sarkinfada Faruk, Aliyu Yunusa, Chavasse Charles, Bates Imelda
Department of Medical Microbiology and Parasitology, Bayero University, Kano, Nigeria.
J Infect Dev Ctries. 2009 Feb 28;3(1):20-7. doi: 10.3855/jidc.101.
The World Health Organization (WHO) has recommended the integration of malaria microscopy quality assessment (QA) with that of other microscopically diagnosed diseases, but there is no evidence that it has been attempted. We assessed the feasibility of linking malaria microscopy into the existing tuberculosis (TB) microscopy QA system in Kano, Nigeria.
Five TB microscopy centres were selected for implementing the integrated TB and malaria microscopy QA scheme in the state. A model system was designed for selecting and blinded rechecking of TB and malaria slides from these laboratories. Supervision and evaluation was conducted at 3-month intervals for 24 months.
TB microscopy QA was strengthened in four laboratories. Full integration of the QA for TB and malaria microscopy was achieved in two laboratories, and partial integration in two other laboratories. The programme resulted in an increase in the specificity of both TB and malaria microscopy results. At the final assessment, 100% specificity was achieved for TB microscopy results in four laboratories. There was an increased concordance rate and decreased false positivity and false negativity rates of TB microscopy results in all five laboratories.
It is feasible to integrate the QA system and training for TB and malaria microscopy for assessing and improving quality of both services. However, the integrated system needs testing in different settings in order to be able to develop sound recommendations to guide the complex scaling-up process.
世界卫生组织（WHO）已建议将疟疾显微镜检查质量评估（QA）与其他显微镜诊断疾病的质量评估相结合，但尚无证据表明有人尝试过。我们评估了在尼日利亚卡诺将疟疾显微镜检查纳入现有结核病（TB）显微镜检查质量保证体系的可行性。
在该州选择了五个结核病显微镜检查中心，以实施结核病和疟疾显微镜检查综合质量保证计划。设计了一个模型系统，用于从这些实验室中选择并对结核病和疟疾玻片进行盲法复查。每隔3个月进行一次监督和评估，持续24个月。
四个实验室的结核病显微镜检查质量保证得到加强。两个实验室实现了结核病和疟疾显微镜检查质量保证的完全整合，另外两个实验室实现了部分整合。该计划提高了结核病和疟疾显微镜检查结果的特异性。在最终评估中，四个实验室的结核病显微镜检查结果特异性达到100%。所有五个实验室的结核病显微镜检查结果的一致性率提高，假阳性和假阴性率降低。
整合结核病和疟疾显微镜检查的质量保证系统及培训以评估和提高这两项服务的质量是可行的。然而，需要在不同环境中对综合系统进行测试，以便能够制定合理的建议来指导复杂的扩大规模过程。
