Résumé
Aim:This study sought to assess factors that influence adherence to malaria microscopy diagnosis in the treatment of out-patients in the hospital.Methods:From April to June 2018, a cross-sectional study was conducted. Semi-structured questionnaires were administered on clinicians and microscopists, while prescription practices of pharmacy personnel and clinicians were observed. To determine microscopy performance, systematically sampled thick blood smears, which had been used to diagnose malaria in out-patients were re-examined for presence or absence of malaria parasites by independent expert microscopists. Each thick blood smear was re-examined by two independent expert microscopists, and in case of discordant results a tie-breaker expert provided reference results for performance measures. Test validity and reliability were determined using Graph Pad Prism v5.01. Results:Three (30%) clinicians strictly (100%) adhered to malaria microscopy diagnosis during treatment of out-patients, had refresher training on malaria case management and were aware that the laboratory participates in national quality assurance (QA) scheme. At the pharmacy-level adherence tomicroscopy results during treatment was generally 100% and >98% for clinicians. However, 13 (11%) malaria false-positive participants still received Artemether-Lumefantrine. Of 375 selected blood slides, 118(31.5%) were read as positive at the health facility, while 105 (28%) were read as positive by the experts, (P <0.01). Overall, 96% of test results were concordant with expert reference. The overall inter-reader agreement between hospital diagnosis and experts microscopists was κ=0.91 (95% CI: 0.87-0.96). Sensitivity was; 99.1% (95% CI: 94.9-100), specificity; 95.2% (95% CI: 91.9-97.4), Positive Predictive Value; 89% (95% CI: 81.9-94) and Negative Predictive Value; 99.6 (95% CI: 97.9-100). Conclusion:Our results show commendable adherence to malaria microscopy during treatment of out-patients in Kisumu County Referral Hospital. Refresher training on malaria case management for clinician and awareness by clinicians that the hospital laboratory participates in national QA scheme had positive influence on the adherence to malaria microscopy during treatment of out-patients. Malaria microscopy test validity and reliability were commendable
Résumé
Aim:This study sought to evaluate Pronto dry rapid urease® diagnostic test and compare its performance with culture.Study Design:Cross-sectional study.Place and Duration:From September 2017 to July 2018, across-sectional study was conducted at the Aga Khan University Hospital.Methodology:Patients attending endoscopy unit at the hospital were randomly sampled to provide gastric biopsy specimen. One specimen was tested for presence or absence of H. pylori using Pronto dry rapid urease® test and another specimen subjected to in vitro culturetest which were then compared with histology reference results. Test validity and reliability was determined using Graph Pad Prism v5.01. Results:Of 274 study specimens, 121(44%) were positive for histology. Ninety-one (33%) of the study specimen were positive for culture compared to 147(54%) for Pronto dry rapid urease®. Pronto dry rapid urease® test had sensitivity of 100% (97.5%-100%) against 73.6% (64.8%-81.3%) for culture. Specificity was 96.1% (91.1%-98.7%) for Pronto dry rapid urease® compared to 35.3% (95% CI 24.1%-47.8%) for culture. Positive predictive value was 96.7% (92.5-98.9%) for Pronto dry rapid urease® compared to 97.8% (92.3%-99.7%) for culture. Negative predictive value was 100% (97%-100%) for Pronto dry rapid urease® against 82.5% (76.2%-87.7%) for culture. There was significant difference between both Pronto dry rapid urease® and culture test performance with histology in all validity measures, P< 0.001. On the other hand, there was no significant difference between Pronto dry rapid urease® and culture in all validity measures due to overlapping confidence intervals.Conclusion:Pronto dry rapid urease® out-performed culture in sensitivity and NPV. It would be the method of choice in H. pylori detection where histology is untenable and antimicrobial profiling which require culturing the bacterium is needless