title: Quality assessment of sputum smear microscopy for detection of acid fast bacilli in peripheral health care facilities in Dar es Salaam, Tanzania.
abstract: BACKGROUND
  There is no published information regarding the quality of sputum smear microscopy in Tanzania.
  
  
  OBJECTIVE
  To evaluate technical quality and results of smear microscopy for acid-fast bacilli (AFB) in peripheral health care facilities in Kinondoni and Ilala Districts in Dar es Salaam, Tanzania.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  All tuberculosis diagnostic centres in Dar es Salaam, Tanzania.
  
  
  RESULTS
  The proportion of well prepared smears was 86.2% and that of well stained smears was 81.2%. The overall average agreement in reading was (89.2%). The overall sensitivity was 88.5% and specificity was 100%. High false negatives (HFN) were the major errors found in this study and Low false negative (LFN) and quantification errors (QE) were the minor errors found. There were no false positive errors. Minor errors occurred more frequently in hospitals than dispensaries, while major errors occurred more frequently in dispensaries than in hospitals.
  
  
  CONCLUSIONS
  The types of errors found in this survey, HFN, LFN and QE, suggest a systematic under-reading of smears in all the surveyed health facilities, probably due to a number of technical factors (quality of smears, poor stains, bad microscopes, or inadequate training) and other factors such as overwork and lack of motivation which need to be addressed.
  
  
  CONCLUSIONS
  Regular supervision using the new WHO quality assurance guidelines should be conducted countrywide. We do recommend that blind re-checking as the most efficient means of making the first broad assessment of sputum smear microscopy in Tanzania.
authors.affiliation: National Tuberculosis and Leprosy Programme, Ministry of Health, P.O. Box 9083, Dar es Salaam, Tanzania.
authors.forename: D
authors.initials: D
authors.lastname: Basra
authors.forename: M I N
authors.initials: MI
authors.lastname: Matee
authors.forename: R
authors.initials: R
authors.lastname: McNerney
mesh_terms: D001431:Bacteriological Techniques / Q000592:standards*; D003430:Cross-Sectional Studies; D019538:Health Care Surveys; D006801:Humans; D007753:Laboratories / Q000592:standards; D008853:Microscopy / Q000592:standards*; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D011786:Quality Control; D013048:Specimen Handling; D013183:Sputum / Q000382:microbiology*; D013194:Staining and Labeling; D013636:Tanzania; D014397:Tuberculosis, Pulmonary / Q000382:microbiology*