Impact of Introducing Integrated Quality Assessment for Tuberculosis and Malaria Microscopy in Kano; Nigeria

Background: 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. Methodology: 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. Results: 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 malaria microscopy results. At the final assessment; 100specificity 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. Conclusions: 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

My year in vocational training: highlights and horrors.

I am now drawing towards the end of my year in Eastbourne as a vocational trainee on the Brighton Scheme. Eastbourne is a busy seaside resort on the south coast. Rather a lot of 'grannies' reside there; but contrary to popular belief I do not spend all day, every day making and repairing dentures! The work is varied and interesting and I am spending a happy year consolidating my knowledge and becoming more confident at practising dentistry. Here are a few of the best and worst parts of the year.

Foley catheter technique for hysterosalpingography: potential diagnostic error.

The pressure drop which occurs along a narrow Foley catheter used for hysterosalpingography has been measured for radio-opaque contrast media of different viscosity. The difference between the applied pressure and the pressure developed within the uterus is sufficient to mislead the operator in some cases.

Schistosoma mansoni: ultrasonically detectable motor activity responses to 5-hydroxytryptamine in vitro.

The ultrasonic method compared favourably with other methods for monitoring schistosome motor activity in vitro, being able to detect and differentiate between the activity responses of Schistosoma mansoni to 5-hydroxytryptamine at concentrations down to 1 X (10(-6) M. This was taken to indicate suitable sensitivity for the application of the ultrasonic method to other drug studies.

Activity of Schistosoma mansoni over a ten-hour period in vitro, and its modification by oxamniquine.

The activity of pairs of adult Schistosoma mansoni maintained in a continuous flow culture system was monitored for ten hours using the ultrasound method of Brown, Norman, Bell and Chavasse (1978). The results of 75 experiments were collated by computer to demonstrate the average effect of oxamniquine on worm activity in vitro at concentrations from 0.2 microgram/ml to saturation. The averaging technique indicates that oxamniquine concentrations down to 0.2 microgram/ml modify worm activity in vitro.

Schistosoma mansoni: activity responses in vitro to praziquantel.

The effects of praziquantel, a novel antischistosomal compound, on the activity of adult Schistosoma mansoni (Liverpool strain) in vitro were investigated. Worm activity was modified at all concentrations of praziquantel. High concentrations (above 0.5 microgram/ml) produced rapid paralysis, whilst low concentrations of praziquantel stimulated worm activity. It is concluded that such activity modification could lead to worm displacement in vivo.