title: Improving sputum microscopy services for the diagnosis of tuberculosis in Peru and Bolivia.
abstract: METHODS
  Sixteen primary care health centres in Peru and Bolivia.
  
  
  OBJECTIVE
  To assess the utilisation of microscopy services in Peru and Bolivia and determine if clinical audit, a quality improvement tool, improves the utilisation of these services.
  
  
  METHODS
  We estimated the percentage of patients with suspected tuberculosis (TB) in whom sputum microscopy was effectively utilised in Peru and Bolivia over two 6-month periods before and after a clinical audit intervention that included standards setting, measuring clinical performance and feedback.
  
  
  RESULTS
  Before the intervention, only 31% (95%CI 27-35) of TB suspects were assessed with sputum microscopy in Peru. In Bolivia, 30% (95%CI 25-35) underwent at least two sputum microscopy examinations. After clinical audit, the availability of sputum microscopy results improved by respectively 7% (95%CI 1-12, P < 0.05) and 23% (95%CI 15-30, P < 0.05) over 2 years in Peru and Bolivia.
  
  
  CONCLUSIONS
  Despite World Health Organization recommendations that all TB suspects should undergo sputum microscopy before treatment, results are available for further assessment for only one third. This is a potentially serious obstacle to TB case detection. Clinical audit can bring some improvement. We recommend regular monitoring of effective utilisation of microscopy services and investigations to ascertain organisational and structural issues in their uptake and use.
authors.affiliation: Nuffield Centre for International Health and Development, Institute of Health Sciences and Public Health Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK. hssks@leeds.ac.uk
authors.forename: K
authors.initials: K
authors.lastname: Siddiqi
authors.forename: J N
authors.initials: JN
authors.lastname: Newell
authors.forename: P
authors.initials: P
authors.lastname: Van der Stuyft
authors.forename: E
authors.initials: E
authors.lastname: Gotuzzo
authors.forename: F
authors.initials: F
authors.lastname: Torrico
authors.forename: A
authors.initials: A
authors.lastname: Van Deun
authors.forename: J
authors.initials: J
authors.lastname: Walley
mesh_terms: D001838:Bolivia / Q000453:epidemiology; D019983:Guideline Adherence; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D015994:Incidence; D008403:Mass Screening / Q000379:methods*; D008485:Medical Audit; D008853:Microscopy / Q000592:standards / Q000706:statistics & numerical data*; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D010568:Peru / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D013183:Sputum / Q000382:microbiology*; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology