title: External quality assessment of national public health laboratories in Africa, 2002-2009.
abstract: OBJECTIVE
  To describe findings from an external quality assessment programme involving laboratories in Africa that routinely investigate epidemic-prone diseases.
  
  
  METHODS
  Beginning in 2002, the Regional Office for Africa of the World Health Organization (WHO) invited national public health laboratories and related facilities in Africa to participate in the programme. Three surveys comprising specimens and questionnaires associated with bacterial enteric diseases, bacterial meningitis, plague, tuberculosis and malaria were sent annually to test participants' diagnostic proficiency. Identical surveys were sent to referee laboratories for quality control. Materials were prepared, packaged and shipped in accordance with standard protocols. Findings and reports were due within 30 days. Key methodological decisions and test results were categorized as acceptable or unacceptable on the basis of consensus feedback from referees, using established grading schemes.
  
  
  RESULTS
  Between 2002 and 2009, participation increased from 30 to 48 Member States of the WHO and from 39 to 78 laboratories. Each survey was returned by 64-93% of participants. Mean turnaround time was 25.9 days. For bacterial enteric diseases and meningitis components, bacterial identification was acceptable in 65% and 69% of challenges, respectively, but serotyping and antibiotic susceptibility testing and reporting were frequently unacceptable. Microscopy was acceptable for 73% of plague challenges. Tuberculosis microscopy was satisfactorily performed, with 87% of responses receiving acceptable scores. In the malaria component, 82% of responses received acceptable scores for species identification but only 51% of parasite quantitation scores were acceptable.
  
  
  CONCLUSIONS
  The external quality assessment programme consistently identified certain functional deficiencies requiring strengthening that were present in African public health microbiology laboratories.
authors.affiliation: National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa. johnf@nicd.ac.za
authors.forename: John
authors.initials: J
authors.lastname: Frean
authors.forename: Olga
authors.initials: O
authors.lastname: Perovic
authors.forename: Vivian
authors.initials: V
authors.lastname: Fensham
authors.forename: Kerrigan
authors.initials: K
authors.lastname: McCarthy
authors.forename: Anne
authors.initials: A
authors.lastname: von Gottberg
authors.forename: Linda
authors.initials: L
authors.lastname: de Gouveia
authors.forename: Bhavani
authors.initials: B
authors.lastname: Poonsamy
authors.forename: Leigh
authors.initials: L
authors.lastname: Dini
authors.forename: Jenny
authors.initials: J
authors.lastname: Rossouw
authors.forename: Karen
authors.initials: K
authors.lastname: Keddy
authors.forename: Wondimagegnehu
authors.initials: W
authors.lastname: Alemu
authors.forename: Ali
authors.initials: A
authors.lastname: Yahaya
authors.forename: Antoine
authors.initials: A
authors.lastname: Pierson
authors.forename: Virginie
authors.initials: V
authors.lastname: Dolmazon
authors.forename: Sébastien
authors.initials: S
authors.lastname: Cognat
authors.forename: Jean Bosco
authors.initials: JB
authors.lastname: Ndihokubwayo
mesh_terms: D000349:Africa; D004196:Disease Outbreaks / Q000517:prevention & control*; D019538:Health Care Surveys; D006296:Health Services; D006801:Humans; D007753:Laboratories / Q000592:standards* / Q000706:statistics & numerical data; D008288:Malaria / Q000175:diagnosis; D016920:Meningitis, Bacterial / Q000175:diagnosis; D010930:Plague / Q000175:diagnosis; D011159:Population Surveillance / Q000379:methods*; D011634:Public Health / Q000592:standards* / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care / Q000592:standards* / Q000706:statistics & numerical data; D011786:Quality Control; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis