The Togo national proficiency test pilot programme for basic clinical chemistry tests

Background: A national proficiency test (PT) programme is not currently implemented in most low-income countries. However, participation in such PT programmes assists improves test performance and result accuracy.Objective: This study assessed how well 11 government hospital laboratories performed 18 basic clinical chemistry tests and identified areas needing improvement.Methods: A cross-sectional study was carried out by the Division of Laboratories of the Ministry of Health of Togo from 01 July 2016 to 31 December 2016. The test performance was evaluated using panels provided by One World Accuracy, Canada (Vancouver). The Clinical Laboratory Improvement Amendments criteria were used in evaluating the laboratories, and their success rates were compared with the World Health Organization Regional Office for Africa's target of 80%.Results: The overall rate of acceptable results at the laboratories was over 80% for glucose, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyltransferase, alkaline phosphatase and triglycerides tests. The laboratories using fully automated spectrophotometers had an acceptable results rate of 89% (p = 0.001). The overall performance of the laboratories by cycles varied from 71% to 82%.Conclusion: This national PT programme identified the tests, which laboratories must improve their performance (urea, creatinine, uric acid, bilirubin, cholesterol, total protein, calcium, magnesium, phosphorus). It demonstrated the need for the use of routine appropriate internal quality control in all laboratories. The proficiency test programme should be extended to all clinical laboratories and target all biology disciplines

The application of sigma metrics in the laboratory to assess quality control processes in South Africa

Objective: This study aimed to determine the sigma metrics of analytes when using different total allowable error guidelines.Methods: A retrospective analysis was performed on 19 general chemistry analytes at Charlotte Maxeke Johannesburg Academic Hospital in South Africa between January 2017 and December 2017. Sigma metrics were calculated on two identical analysers, using internal quality control data and total allowable error guidelines from the Ricos biological variation database and three alternative sources (the Royal College of Pathologists of Australasia, the Clinical Laboratory Improvements Amendment, and the European Federation of Clinical Chemistry and Laboratory Medicine). Results: The sigma performance was similar on both analysers but varied based on the guideline used, with the Clinical Laboratory Improvements Amendment guidelines resulting in the best sigma metrics (53% of analytes on one analyser and 46% on the other had acceptable sigma metrics) and the Royal College of Pathologists of Australia guidelines being the most stringent (21% and 23%). Sodium and chloride performed poorly across all guidelines (sigma < 3). There were also month-to-month variations that may result in acceptable sigma despite poor performance during certain months.Conclusion: The sigma varies greatly depending on the total allowable error, but could be a valuable tool to save time and decrease costs in high-volume laboratories. Sigma metrics calculations need to be standardised

Evaluation of the antimicrobial susceptibility testing process in clinical microbiology laboratories at Niamey, Niger

Background: Risk assessment is the means of identifying and evaluating potential errors or problems that may occur in testing process. The aim of this study was to perform risk assessment of antimicrobial susceptibility testing (AST) process in clinical microbiology laboratories of Niamey, Niger Republic. Methodology: We conducted a descriptive cross-sectional study from October 1 to December 31, 2019, to evaluate AST performance in seven clinical microbiology laboratories at Niamey, the capital city of Niger republic. The evaluation focused on the determination of the criticality index (CI) of each critical point (frequency of occurrence of anomalies, severity of the process anomaly, and detectability of the anomaly during the process) in the AST process and the performance of the AST through an observation sheet using two reference strains; Escherichia coli ATCC 25922 and Staphylococcus aureus ATCC 29213. Results: The criticality index (CI) was greater than 6 for most of the critical points related to material, medium, equipment, method and labour for the AST process in all the laboratories. A range of 18-100% errors on the inhibition zone diameters of the reference strains were observed. Major and/or minor categorization (Sensitive S, Intermediate I and Resistance R) discrepancies were found at all the laboratories for either one or both reference strains. The antibiotics most affected by the S/I/R discrepancies were trimethoprim (100%), vancomycin (100%), amoxicillin (80%) and amoxicillin + clavulanic acid (70%). Conclusion: This study showed a deficiency in the control of critical control points that impacts the performance of the AST reported by the laboratories in Niger. Corrective actions are needed to improve the performance of AST in clinical microbiology laboratories in Niger

Étude comparée des gels hydroalcooliques importés et ceux produits au Bénin, vendus dans les supermarchés de la ville de Cotonou / NA

Depuis le début de la crise épidémique liée au virus Covid-19, pour de nombreux citoyens, se laver les mains est devenu un rituel nécessaire. Le gel hydroalcoolique constitue une solution alternative qui a été popularisée par les recommandations des autorités sanitaires dans le cas d'indisponibilité du lavage des mains. Que cela soit en pharmacie, en supermarché, ou sur internet, de nombreux sites de commerce proposent ces produits à la vente. Toutefois l'appellation ne garantit pas l'efficacité de chaque produit vendu. C'est ainsi que la présente étude s'est attelée à l'évaluation de la qualité des gels hydroalcooliques (GHA) utilisés pour la désinfection des mains au cours de la crise sanitaire liée au Coronavirus. Au total, 28 échantillons dont 23 importés et 5 locaux ont été collectés dans 16 supermarchés de la ville de Cotonou. Ils ont été soumis au test d'inspection visuelle, aux tests organoleptiques ainsi qu'aux analyses physico-chimiques et microbiologiques. Au terme de l'étude, 17,86% des GHA ont été déclarés non-conformes par rapport aux inspections visuelles, 39,28% par rapport aux tests organoleptiques, 21% par rapport au pH et à la densité et enfin 21% de non-conformité aux tests microbiologiques. Le taux de non-conformité est plus important dans le camp des gels importés ce qui atteste l'effort des producteurs locaux pour le respect des normes promulguées par les autorités sanitaires

Since the start of the epidemic crisis linked to the Covid-19 virus, for many citizens, washing their hands has become a necessary ritual. Hydroalcoholic gel constitutes an alternative solution which has been popularized by the recommendations of the health authorities in the case of hand washing unavailable. Whether in pharmacies, supermarkets, or on the internet, many shopping sites offered these products for sale. However, this name does not guarantee the effectiveness of each product sold. The present study has been set out to assess the quality of hydroalcoholic gels (GHA) used for hand disinfection during the health crisis linked to the Coronavirus. In total, 28 samples, of which 23 were imported and 5 locals, were collected in 16 supermarkets in the city of Cotonou. They were subjected to visual inspection test, organoleptic tests as well as physico-chemical and microbiological analyzes. At the end of the study, 17.86% of GHAs were declared non-compliant with respect to visual inspections, 39.28% with respect to organoleptic tests, 21% with respect to pH and density and finally 21% of noncompliance with microbiological testing. The rate of non-compliance is higher in the imported gel camp, which attests to the efforts of local producers to comply with the standards promulgated by the health authorities

Comparison of the duration and quality of epidural analgesia between plain bupivacaine alone and plain bupivacaine with tramadol in lower limb orthopaedic surgeries

Background: This study was aimed at comparing the duration and quality of epidural analgesia between plain bupivacaine alone with plain bupivacaine and tramadol in lower limb orthopaedic surgeries. Method: This was a prospective randomized double blinded control study involving 74 ASA I and II patients scheduled for elective lower limb orthopaedic surgeries. Group A (n=37) received 19mls of 0.5% epidural plain bupivacaine with 1 ml of water for injection, while group B received 19mls of 0.5% epidural plain bupivacaine with 1ml (50mg) of preservative freetramadol. The duration of analgesia was from the time of epidural block to the time of rescue analgesia. While, the quality of block was measured with Visual Analogue Scale (VAS) and Bromage scale. Results: Thestudy ages were between 16-60years,consisting of 22(60%) male and 15(40%) female in group A, while in group B 20 (54%) were male and 17(46%) female. It showed the mean duration of analgesia were 189.05±21.92min and 254.19±32.78min in group A and B respectively with p <0.01.The intra-operative VAS scores between the two groups did not show any significant difference between study groups (P> 0.05).The differences of grades of motor block and maximum sensory block height were not statistically significant (P=0.26) among the study groups. Conclusion: The addition of 50mg (1ml) of tramadol to plain bupivacaine epidurally prolonged the duration of analgesia and improved the quality of analgesia when compared to the use of bupivacaine alone

Organisational management of hospital blood transfusion services in Nairobi County, Kenya: Evidence of implementation

Background: The World Health Organization in 2002 recommended implementation of a quality system for national blood programmes to ensure adequate and safe blood products to patients. Key elements of the quality system include organisational management, standards, documentation, training and assessment.Objectives: The aim of this study was to describe the extent to which organisational management, which is the first element of a quality system, has been implemented in hospitals in Nairobi County, Kenya.Methods: A descriptive, cross-sectional study design was used. Sixty health workers were selected as respondents from 15 hospitals that provide blood transfusion services in Nairobi County. The data collection period was from June to August 2015 and the data were analysed in 2016.Results: Faith-based hospitals had the lowest level of organisational management implementation (33.3%), private hospitals had 42.5%, whereas government hospitals had the highest implementation (60%). The extent of implementation was based on performance of the senior management team, overall rated by the respondents at 40.1%, establishment of hospital transfusion committees in nine (60%) of the hospitals and appointment of key staff ­ quality officers in three (20%) hospitals and blood transfusion specialists in six (40%) hospitals. These key staff were instrumental in steering the quality system and ensuring sound blood transfusion practices.Conclusion: The implementation of quality management systems in hospital blood transfusion services can be improved through commitment from senior management teams, who should provide the necessary resources for employment of key staff and establish and empower hospital transfusion committees to guide the blood transfusion services

Contrôle qualité et étude de comprimabilité des poudres de feuille de Moringa oleifera (lam) et de pulpe du fruit de Adansonia digitata

Moringa oleifera (LAM), arbre tropical à usages multiples, constitue de nos jours une nouvelle ressource alimentaire et économique pour les pays du Sud. Ces feuilles sont faciles d'accès et très riches en protéines, en vitamines et en minéraux. Elles sont de plus en plus utilisées dans des projets luttant contre la malnutrition. Cependant, le goût, la présentation et la qualité de ces produits demeurent une préoccupation majeure nécessitant des adaptations innovantes. L'objectif de cette étude était d'étudier la comprimabilité des poudres de feuilles de Moringa oleifera en améliorant le goût avec des matières premières locales et facilement accessibles comme la poudre de pulpe de Andansonia digitata. Les propriétés physico-chimiques et les tests pharmacotechniques ont permis de contrôler la qualité des poudres, des comprimés et orienter le choix du procédé de fabrication. Cinq (5) types de formulations (F1 à F5) ont été réalisés et les comprimés ont été fabriqués par compression après granulation par la voie sèche. Les comprimés des formulations F4 et F5 ont donné de meilleures propriétés pharmacotechniques selon les recommandations de la pharmacopée Européenne 6.0. L'association des deux poudres offre une alternative pour la fabrication de comprimés à croquer avec un goût acceptable

External quality assessment of national public health laboratories in Africa, 2002­2009

Objective: To describe findings from an external quality assessment programme involving laboratories in Africa that routinely investigate epidemic-prone diseases.Methode Beginning in 2002, the Regional Office for Africa of the World Health Organization (WHO) invited national public health laboratories and related facilities in Africa to participate in the programme. Three surveys comprising specimens and questionnaires associated with bacterial enteric diseases, bacterial meningitis, plague, tuberculosis and malaria were sent annually to test participants' diagnostic proficiency. Identical surveys were sent to referee laboratories for quality control. Materials were prepared, packaged and shipped in accordance with standard protocols. Findings and reports were due within 30 days. Key methodological decisions and test results were categorized as acceptable or unacceptable on the basis of consensus feedback from referees, using established grading schemes.Findings Between 2002 and 2009, participation increased from 30 to 48 Member States of the WHO and from 39 to 78 laboratories. Each survey was returned by 64­93% of participants. Mean turnaround time was 25.9 days. For bacterial enteric diseases and meningitis components, bacterial identification was acceptable in 65% and 69% of challenges, respectively, but serotyping and antibiotic susceptibility testing and reporting were frequently unacceptable. Microscopy was acceptable for 73% of plague challenges. Tuberculosis microscopy was satisfactorily performed, with 87% of responses receiving acceptable scores. In the malaria component, 82% of responses received acceptable scores for species identification but only 51% of parasite quantitation scores were acceptable.Conclusion The external quality assessment programme consistently identified certain functional deficiencies requiring strengthening that were present in African public health microbiology laboratories

Microbiological Water Quality Monitoring in a Resource-Limited Urban Area: a Study in Cameroon; Africa

In resource-limited developing nations; such as Cameroon; the expense of modern water-quality monitoring techniques is prohibitive to frequent water testing; as is done in the developed world. Inexpensive; shelf-stable 3MT PetrifilmT Escherichia coli/Coliform Count Plates potentially can provide significant opportunity for routine water-quality monitoring in the absence of infrastructure for state-of-the-art testing. We used shelf-stable E. coli/coliform culture plates to assess the water quality at twenty sampling sites in Kumbo; Cameroon. Culture results from treated and untreated sources were compared to modern bacterial DNA pyrosequencing methods using established bioinformatics and statistical tools. Petrifilms were reproducible between replicates and sampling dates. Additionally; cultivation on Petrifilms suggests that treatment by the Kumbo Water Authority (KWA) greatly improves water quality as compared with untreated river and rainwater. The majority of sequences detected were representative of common water and soil microbes; with a minority of sequences (40) identified as belonging to genera common in fecal matter and/or causes of human disease. Water sources had variable DNA sequence counts that correlated significantly with the culture count data and may therefore be a proxy for bacterial load. Although the KWA does not meet Western standards for water quality (less than one coliform per 100 mL); KWA piped water is safer than locally available alternative water sources such as river and rainwater. The culture-based technology described is easily transferrable to resource-limited areas and provides local water authorities with valuable microbiological safety information with potential to protect public health in developing nations

Mise en place de l'assurance qualite dans un etablissement de transfusion sanguine : l'experience du centre national de transfusion sanguine du Mali

But : Le but de ce travail etait d'aider le CNTS du Mali a mettre en place son systeme d'assurance qualite. Materiels et methodes : Il s'est deroule de 2007 a 2008 au Centre National de Transfusion Sanguine du Mali a Bamako. Nous avons fait d'abord l'etat des lieux ; etudie les connaissances et attitudes pratiques du personnel du CNTS en matiere d'assurance qualite; elabore un plan d'action qui a ete mis en execution. Ensuite nous avons effectue une evaluation de la chaine de froid et du processus de prelevement de sang total en cabine fixe. Resultats : De l'etat des lieux il est ressorti que le systeme d'assurance qualite du CNTS presentait de nombreuses insuffisances comme l'absence de politique qualite; de referentiels; des procedures essentielles; d'organigramme et de fiches de fonction pour le personnel. Par ailleurs l'enquete CAP a montre que 66;6du personnel avaient une connaissance de l'assurance qualite parmi lesquels 36;7avaient recu au moins une formation en AQ. Le plan d'action a ete realise a 58;5. L'evaluation de deux processus critiques dans la transfusion sanguine a montre de nombreuses anomalies. Ce qui necessite une formation du personnel a l'application des procedures. Les bonnes pratiques transfusionnelles et les normes des produits sanguins labiles ont ete adoptees. Conclusion : Malgre ces avancees quelques insuffisances a corriger demeuraient telles que; l'absence de circuit securise des donneurs et des PSL; l'absence d'indicateurs de qualite fiables; et la non adoption de la politique transfusionnelle

Controle de la qualite de quelques molecules antibiotiques utilisees au Senegal

Pour ralentir la propagation de la resistance bacterienne et promouvoir un usage securise des medicaments; il s'avere necessaire de developper des outils de controle et de gestion de leur qualite. Notre travail a pour objectifs d'evaluer la qualite de quelques molecules antibiotiques utilisees au Senegal et de demontrer la pertinence de l'utilisation du mini laboratoire comme outil de controle de cette qualite. Le mini-laboratoire de la German Pharma Health Fund fournit l'ensemble du materiel necessaire a l'etude.Au total; 34 echantillons d'antibiotiques ont ete soumis a une batterie de tests comportant l'inspection physique et visuelle des echantillons; le test de desagregation et la chromatographie sur couche mince pour l'identification et l'appreciation semi quantitative. Sur l'ensemble des non-conformites a l'inspection physique et visuelle; 80proviennent du secteur illicite (non officiel) et 20du secteur prive (officiel). Les non-conformites a l'identification et au dosage concernent l'erythromycine; suivie de l'amoxicilline et de la ciprofloxacine pour 22des cas chacune. Le secteur illicite est egalement le plus touche par ce type de non conformite (45); les secteurs prive et public ne sont pas non plus epargnes avec respectivement 33 et 22des echantillons non-conformes. Il est ainsi important d'assurer un suivi de la qualite desmedicaments en particulier des plus sensibles comme les antibiotiques. En cela ce mini-laboratoire peut etre d'un grand apport

Controle de qualite lors de l'evaluation echographique de la morbidite due a Schistosoma haematobium au Niger

Lors d'un programme de lutte contre la bilharziose urinaire au Niger; il a ete procede a un controle de qualite au cours d'enquetes d'eva l u ation ech ographique de la morbidite due a Schistosoma haematobium. L'objectif etait d'evaluer la vari abilite et la r ro d u c t ibilite des donnees epidemiologiques fournies par deux observat e u rs independants specialement fo rmes. Trois types d'enquetes ont ete menes : etude de la variabilite inter- observateur sur donnees appariees; etude de la vari abilite inter- observateur au niveau communautaire sur les memes sujets ou des sujets differents; y compris apres traitement parpra z i q u a n t e l ; etude de la va ri ab ilite intra- observateur. Au total; 1416 habitants de 10 vill ages hyperendemiques; dont 70 p. 100 d'enfants scolarises; ont subi 1750 examens ech ographiques selon le protocole OMS du Caire legerement modifie. La vari abilite inter- o b s e rvateur au niveau individuel etait elevee pour certaines anomalies vesicales elementaires. Elle etait d'environ 20 p. 100 pour les deux indicat e u rs synthetiques que sont la presence d'au moins une anomalie urinaire et la dilat ation du tractus uri n a i re superi e u r. Au niveau communautaire; la vari abilite inter- observateur etait moderee et les deux observat e u rs donnaient globalement le meme diagnostic sur le niveau de morbidite lie a S chistosoma haemat o b i u m. Les vari ations de morbidite liees au niveau d'endemicite etait percues para llelement. Les memes observations au niveau individuel ou communautaire ont ete faites quant a la variabilite intra - o b s e rvateur. Au cours d'un programme de controle; les ultrasons sont senses fournir des indicateurs epidemiologiques de morbidite afin d'orienter les activites de lutte (selection des communautes a risque; periodicite des traitements). Dans cette optique; les variations d'eva l u ation de la morbidite liees a l'ech ograp h i s t e observees au Niger sont accep t ables au niveau communautaire

"A Study of the Pharmaceutical Quality of Chloroquine and Paracetamol Products Sold in a Major Nigerian ""Market"""

"Malaria is a major public health problem in endemic countries; and the quality of anti-malarial products is a concern in the therapeutic management of individual patient. In this study; we have evaluated the pharmaceutical quality of chloroquine and paracetamol oral products obtained from a major Nigerian drug ""market"" using a less elaborate sampling procedure. Results have shown that there are still some defects in the pharmaceutical quality of these drugs; despite the activities of the Nigeria's drug regulatory agency (National agency for Food and Drug Administration and Control; NAFDAC). 21(7/34) of the drug products were not registered by NAFDAC. The pharmaceutical properties of the products indicated that 6; 15; 9; and 9of them failed tests for disintegration; dissolution; crushing strength; and percentage of active content; respectively. 4 out of the 6 chloroquine liquid preparations evaluated had inadequate active content. These defects could have resulted from deliberate counterfeiting; poor quality control during manufacture or decomposition of the products. However; this could not be ascertained from the data available to us in this study. The implication of these findings; however; is that the newer anti-malarial drugs that have recently been introduced into the Nigerian market should be safeguarded; if their therapeutic usefulness must be sustained."

The quality of water in small community supplies of Kingolwira village; Morogoro; Tanzania

Water quality is an important aspect in human health; as the majority of infectious diseases that cause morbidity and mortality in population are water related. The present study was undertaken to assess the quality of water in Kingolwira; Morogoro Rural District; Tanzania. Water was collected from different sites in the village and analysed for a period of six months. Physical; chemical and microbiological qualities of water were examined. The pH of the water ranged from 7.02 to 7.20 and the water temperature ranged from 25.70C to 27.00C. The total dissolved solids of the water samples ranged from 110 to 510 ppm. The water contained considerable levels of lead and copper ranging from 0.034 to 0.090 ppm and 0.022 to 0.030 ppm; respectively. Total water hardness ranged from 19.60 to 228.10 ppm as calcium carbonate. The total viable counts and faecal coliform counts ranged from 2.75x103 to 5.4 x 103 c.f.u/ml and 0.93 x102 to 2.1x102 counts/100ml; respectively. Overall; water supplies in the village were judged as of poor quality. Water is usually used for domestic purposes including cooking; drinking; washing and preparation of infant foods without any treatment. In conclusion therefore; water in Kingolwira village is of poor quality and needs to be treated before consumption. Theres is also a need for the rural population to be educated on hazards of using untreated water. In general; sanitary facilities in rural areas in Tanzania need to be improved in order to avoid health hazards

Conditions d'utilisation et contrôle de qualité des lecteurs de glycémie capillaire au chu de conakry avec l'hemocue b glucose

Les objectifs de l'étude étaient de préciser les conditions d'utilisation et la fiabilité des résultats des lecteurs de glycémie utilisés par le personnel soignant au Centre Hospitalier et Universitaire (CHU) de Conakry. Chaque lecteur en utilisation (n=21) a été testé sur les mêmes prélèvements capillaires, en normoglycémie et en hyperglycémie par rapport à la valeur cible de référence : l'analyseur HemoCue B glucose®. Des données complémentaires ont été recueillies au près de chaque utilisateur qui a été ensuite soumis à une observation directe pendant qu'il effectuait une glycémie. Les appareils recensés étaient de la marque Life scan® (n=17) et Roche® (n=4). Le modèle le plus utilisé était le One Touch Basic® (n=7). En moyenne, les résultats rendus par les différents lecteurs de glycémies s'écartaient de la référence de 0,09 g/L (soit 9,7% de la valeur de référence) en normoglycémie et de 1,40g/l (soit 26%) en hyperglycémie. Les valeurs obtenues par 81% des lecteurs de glycémie étaient à plus de 15% de la valeur cible de référence. Aucun utilisateur n'employait les bandelettes de contrôle. Deux lecteurs étaient souillés de sang et aucun port de gants lors de la réalisation des glycémies n'a été observé. La formation des utilisateurs et un contrôle de qualité régulier des lecteurs de glycémies pourraient prévenir le risque induit de traitement inadapté ou de transmission nosocomiale d'infection

Controle de qualite post-marketing de medicaments uu Burkina Faso : des resultats satisfaisants

N.A.

Les médicaments de la rue à Niamey : modalités de vente et contrôle de qualité de quelques médicaments anti-infectieux

La vente des médicaments dans le circuit informel est extrêmement populaire au Niger ou les vendeurs des rues sont légions et ou le phénomène semble prendre une ampleur grandissante. Les produits sont parfois de provenances mal établies et conservés à des températures élevées, peuvent être de qualité douteuse. Ils sont vendus par des gens dont le niveau de formation n'est pas connu, et leurs notions sur les indications, les posologies et les effets secondaires sont incertaines. La contrefaçon est bien présente sur le marché informel des médicaments à Niamey. Le marché des médicaments de la rue à Niamey permet a n'importe qui d'acheter d'importe quel médicament, pour n'importe quel usage. Parmi les 45 molécules anti-infectieuses passées au contrôle de qualité, plus de la moitié des produits ne répondaient pas aux normes en vigueur. Il est probable que ce type d'utilisation n'est aucun impact sur la santé des populations pauvres qui constituent la plus grosse partie de la clientèle. L'élimination de ce marché illicite des médicaments exige un véritable engagement politique au- delà des discours. L'application des textes réglementaires relatifs au médicament est une priorité de santé publique

Controle de qualite inter-laboratoires centraux pour le diagnostic microscopique de la tuberculose a Madagascar en 2000

"Tuberculosis diagnosis by microscopy in Madagascar : quality control comparison of the two central laboratories"" : Since June 1997; a quarterly quality control of sputum smear exam for the tubercle diagnosis; depending on double reading of slides; was implemented between both central laboratories of the Mycobacteria National Reference Centre in Madagascar (mycobactoria laboratories of Institut Pasteur Madagascar [IPM] and Institut Hygiene Sociale [IHS] - Health Ministry). In 2000; four controls were done; in the course of which 240 slides were coloured by auramine; coming both from IPM and IHS; and another 80 slides from IHS were coloured by Ziehl-Neelsen. All the results were in agreement for the samples stained with auramine; while two false negatives were found for the samples stained with Ziehl-Neelsen. The maintenance of this quality control between the two laboratories is necessary to insure the reliability of their results and the controls that they make for the peripheral laboratories."