ABSTRACT
Proficiency testing (PT) is an impartial laboratory performance-evaluating system using an independent body. It is a mandatory accreditation requirement and means for improving the laboratory's performance. The study aimed to evaluate the performance of PT, with a focus on identifying and discussing determinants that influence PT performance at comprehensive specialized hospitals in northwest Ethiopia. A retrospective cross-sectional study was carried out from 2020 to 2022. Using a convenient sampling technique, laboratory tests with recorded PT results in each hospital laboratory were included. A data collection template and customized checklists were used to collect the data. Epi Data Version 3.1 for data entry and STATA Version 14.1 for cleaning and analysis were used. Binary logistic regression analyses were used. Variables with p < 0.05 in the multivariable logistic regression were considered to be statistically significant. Over nine cycles, 3807 PT challenges were distributed. The total failure rate of the laboratories was 32.4%, with a peak failure rate of 40.3% in 2020, after which the failure rate was decline to 20.6% in 2022. Among the five laboratory sections, molecular biology had the lowest failure rate (22.2%), while microbiology had the highest failure rate (56.5%). Multivariate logistic regression revealed that PT results reported without appropriate unit of measurement (AOR 7.5), lack of corrective action for PT nonconformance (AOR 7.1), and reagent unavailability (AOR 6.1) had significant effects on PT performance (p < 0.001). The results of this study showed that the overall performance of the laboratory was lower. Reporting PT results without appropriate units of measurement and not taking corrective action for PT nonconformance were the major aggravating factors for high failure rates.
Subject(s)
Clinical Laboratory Services , Retrospective Studies , Ethiopia , Cross-Sectional Studies , HospitalsABSTRACT
External quality assessment is the process of evaluating the performance of a laboratory and the competence of professionals. Participation in EQA and standardizing the quality of laboratory services are a mandatory requirements for accreditation. This review is aimed at identifying and discussing challenges that hinder the effective implementation of an EQA program in countries with resource limited setting. To obtain abundant information, articles were identified by searching the literature publishedin English using the National Library of Medicine, PubMed, Science Direct and AMC digital library databases. The articles identified in the references were manually searched and included. After the article was identified, it was imported to Endnote version 8.1 and exported to Microsoft Word for citation. Based on this review, the major identified challenges that hinder the implementation of an EQA program include the high cost of control materials, malfunction and lack of maintenance for equipment failure and breakdown, a knowledge gap among laboratory professionals, noncommutability of control samples, and difficulty in assigning target values. In addition, failing to participate in EQA and failing to take corrective action are the major challenges identified. As a result, applying to an EQA program in resource-limited counties was highly challenging. To attain high performance in the laboratory and to provide quality laboratory service for patient care, the EQA supplier and the user laboratory must pay attention to these issues and take appropriate corrective actions for ongoing quality improvement and accreditation.
ABSTRACT
Background and Aims: Assuring laboratory quality by minimizing the magnitude of errors is essential. Therefore, this study aimed to assess hematology laboratory performance in the total testing process using quality indicators and sigma metrics. Methods: A cross-sectional study was conducted from April to June 2022. The study included a total of 13,546 samples. Data on included variables were collected using a checklist. Descriptive statistics were used to present the overall distribution of errors. Binary logistic regression models were applied. Furthermore, using a Sigma scale, the percentage of errors was converted to defects per million opportunities to assess laboratory performance. Finally, the defect per million opportunities was converted to a sigma value using a sigma calculator. Results: Of the 13,546 samples and corresponding requests, the overall error rate was 123,296/474,234 (26%): 93,412/47,234 (19.7%) pre-analytical, 2364/474,234 (0.5%) analytical, and 27,520/474,234 (5.8%) post-analytical. Of the overall errors, 93,412/123,296 (75.8%), 2364/123,296 (1.9%), and 27,520/123,296 (22.3%) were pre-analytical, analytical, and post-analytical errors, respectively. The overall sigma value of the laboratory was 2.2. The sigma values of the pre-analytical, analytical, and post-analytical phases were 2.4, 4.1, and 3.1, respectively. The sample from the inpatient department and collected without adherence to the standard operating procedures (SOPs) had a significantly higher (p < 0.05) rejection rate as compared to the outpatient department and collected with adherence to SOPs, respectively. In addition, an association between prolonged turnaround times and manual recording, inpatient departments, and morning work shifts was observed. Conclusion: The current study found that the overall performance of the laboratory was very poor (less than three sigma). Therefore, the hospital leadership should change the manual system of ordering tests and release of results to a computerized system and give need-based training for all professionals involved in hematology laboratory sample collection and processing.
ABSTRACT
BACKGROUND: Children in refugee camps, due to their living conditions, are the most vulnerable groups to suffer from anemia. Nutritional deficiencies, especially iron deficiency is the most common causes of anemia. However, there is limited information on the prevalence and associated factors of anemia in Ethiopia. Hence, this study aimed to assess the prevalence and associated factors of anemia among internally displaced children at Debark refugee camp, Northwest Ethiopia. METHODS: A cross-sectional study was conducted on 354 internally displaced children, at Debark refugee camp from March to May 2022. A systematic sampling technique was employed. The socio demographic characteristics were collected by using structured questionnaire via face-to-face interview with the caregivers. The hemoglobin level was determined using HemoCue301+. Form anemic children, venous blood sample was collected for iron profile analysis. Parasitological and anthropometric measurements were also done. The data were entered using Epi-data version 4.6.0.6 and exported to STATA version 14 for analysis. Bi-variable and multivariable binary logistic regression analysis were done. Both crude odds ratio and adjusted odds ratio with the corresponding 95% confidence interval were calculated to measure the strength of association. P-Value < 0.05 was considered as statistically significant association. RESULTS: From the total of 354 children included in this study, more than half (54.8%) of them were male. The median age of children was 7 years with interquartile range of (4-10) years. The total prevalence of anemia in this study was 33.62% (95% CI:28.7, 38.7). Moderate type anemia was predominant in this study. From anemic children 30 (25.2%) had iron deficiency anemia. In this study, low dietary diversity (AOR = 4.9; 95% CI: 2.0, 11.7), duration in the camp more than six months (AOR = 4.2; 95% CI:1.9, 9.4), presence of diarrhea (AOR = 2.7; 95% CI:1.3, 5.7), fever (AOR = 3.4; 95% CI:1.6, 7.1), and wasting (AOR = 3.6; 95% CI:1.3, 10.3) were significantly associated with the prevalence of anemia. CONCLUSION: Anemia was moderate public health problem in the current study. Focused policies and strategies towards to internally displaced children should be designed to reduce anemia, by preventing the significant risk factors associated with anemia.
