title: External quality assurance performance of clinical research laboratories in sub-saharan Africa.
abstract: Patient Safety Monitoring in International Laboratories (JHU-SMILE) is a resource at Johns Hopkins University that supports and monitors laboratories in National Institutes of Health-funded international clinical trials. To determine the impact of the JHU-SMILE quality assurance scheme in sub-Saharan African laboratories, we reviewed 40 to 60 months of external quality assurance (EQA) results of the College of American Pathologists (CAP) in these laboratories. We reviewed the performance of 8 analytes: albumin, alanine aminotransferase, creatinine, sodium, WBC, hemoglobin, hematocrit, and the human immunodeficiency virus antibody rapid test. Over the 40- to 60-month observation period, the sub-Saharan laboratories had a 1.63% failure rate, which was 40% lower than the 2011 CAP-wide rate of 2.8%. Seventy-six percent of the observed EQA failures occurred in 4 of the 21 laboratories. These results demonstrate that a system of remote monitoring, feedback, and audits can support quality in low-resource settings, even in places without strong regulatory support for laboratory quality.
authors.affiliation: Dept of Pathology, Johns Hopkins School of Medicine, Meyer B-125D, Baltimore, MD 21287, USA. tamukel1@jhmi.edu
authors.forename: Timothy K
authors.initials: TK
authors.lastname: Amukele
authors.forename: Kurt
authors.initials: K
authors.lastname: Michael
authors.forename: Mary
authors.initials: M
authors.lastname: Hanes
authors.forename: Robert E
authors.initials: RE
authors.lastname: Miller
authors.forename: J Brooks
authors.initials: JB
authors.lastname: Jackson
mesh_terms: D017954:Africa South of the Sahara; D035843:Biomedical Research / Q000592:standards*; D006801:Humans; D007753:Laboratories / Q000592:standards*; D061214:Patient Safety / Q000592:standards; D011785:Quality Assurance, Health Care / Q000592:standards*