The performance of health laboratories and the quality of malaria diagnosis in six districts of Tanzania
The performance of health laboratories and the quality of malaria diagnosis in six districts of Tanzania
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DOI：
10.1179/136485910x12607012373993
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发表时间：
2010-03-01
影响因子：
--
通讯作者：
Magesa, S. M.
中科院分区：
文献类型：
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作者：
Ishengoma, D. R. S.;Derua, Y. A.;Magesa, S. M.
早期实验室诊断对于人类疟疾的最佳管理至关重要，特别是在采用相对昂贵的青蒿素综合疗法之后。最近在坦桑尼亚六个区的36个保健设施中对实验室的表现和疟疾诊断的质量进行了评估。使用调查表、核对表和观察来收集关于设备的可用性和功能状况以及实验室人员及其在疟疾诊断方面的业绩的信息。被调查的设施共有112名实验室工作人员[其中近一半（41.1%）是实验室助理]和57台显微镜。调查中的27家医疗机构（75.0%）每家只有一台功能显微镜。只有七个（12.3%）的评估显微镜已在过去的2年中进行了维修。在接受评估的38名显微镜医师中，24名（63.2%）重复使用显微镜载玻片，29名（73.5%）制作低质量血涂片，30名（79.0%）使用菲尔德染色剂。尽管设施显微镜工作者在阅读调查小组准备的血涂片时，使用高质量试剂，（kappa=50.769），当阅读使用研究实验室的试剂染色的涂片时，他们的能力要差得多（kappa=50.265-0.489）.坦桑尼亚卫生保健机构的疟疾诊断质量，一般来说，（主要是因为消耗品供应不足，实验室工作人员制备血涂片的技能有限），如果要可持续地利用青蒿素综合疗法，就迫切需要加以改进。
Early laboratory diagnosis is critical for the optimal management of human malaria, particularly following the introduction of relatively expensive, artemisinin-combination therapies ( ACT). The performance of the laboratories and the quality of malaria diagnosis have recently been assessed in 36 healthcare facilities in six districts of Tanzania. Questionnaires, checklists and observations were used to collect information on the availability and functional status of equipment as well as on laboratory personnel and their performance in malaria diagnosis. Together, the surveyed facilities had 112 laboratory staff [almost half (41.1%) of whom were laboratory assistants] and 57 microscopes. Twenty-seven (75.0%) of the healthcare facilities included in the survey had only one functional microscope each. Only seven (12.3%) of the assessed microscopes had been serviced in the previous 2 years. Of the 38 microscopists who were assessed, 24 (63.2%) were re-using microscope slides, 29 (73.5%) were producing bloodsmears of low quality, and 30 (79.0%) were using Field's stain. Although the facility microscopists gave similar results to experienced research microscopists when reading bloodsmears prepared by the survey team, using high-quality reagents (kappa=50.769), they appeared far less competent when reading smears stained using the reagents from the study laboratories (kappa=50.265-0.489).The quality of malaria diagnosis at healthcare facilities in Tanzania, which is generally poor ( largely because of inadequate supplies of consumables and the limited skills of laboratory staff in the preparation of bloodsmears), urgently needs to be improved if the utilization of ACT is to be sustainable.