Proficiency testing for HIV, tuberculosis and malaria diagnosis in clinical laboratories in Nigeria

Background

Proficiency testing (PT) is a means of verifying the reliability of laboratory results, but such programmes are not readily available to laboratories in developing countries. This project provided PT to laboratories in Nigeria.

Objectives

To assess the proficiency of laboratories in the diagnosis of HIV, tuberculosis and malaria.

Methods

This was a prospective study carried out between 2009 and 2011. A structured questionnaire was administered to 106 randomly-selected laboratories. Forty-four indicated their interest in participation and were enrolled. Four rounds of pre-characterised plasma panels for HIV, sputum films for tuberculosis and blood films for malaria were distributed quarterly by courier over the course of one year. The results were returned within two weeks and scores of ≥ 80% were reported as satisfactory. Mentoring was offered after the first and second PT rounds.

Results

Average HIV PT scores increased from 74% to 95% from the first round to the third round, but decreased in the fourth round. For diagnosis of tuberculosis, average scores increased from 42% in the first round to 78% in the second round; but a decrease to 34% was observed in the fourth round. Malaria PT performance was 2% at first, but average scores increased between the second and fourth rounds, culminating in a fourth-round score of 39%. Many participants requested training and mentoring.

Conclusions

There were gross deficiencies in the quality of laboratory services rendered across Nigeria. In-country PT programmes, implemented in conjunction with mentoring, will improve coverage and diagnosis of HIV, tuberculosis and malaria.

Improving quality in national reference laboratories: The role of SLMTA and mentorship

Background

The Nigerian Institute of Medical Research houses two reference laboratories: the virology and tuberculosis laboratories. Both were enrolled in the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme.

Objective

To describe the impact of SLMTA and discuss factors affecting the results, with an emphasis on mentorship.

Methods

The SLMTA programme was implemented from April 2010 through November 2012. Participants attended three workshops and executed quality improvement projects; laboratory auditors evaluated performance using a standard checklist. The virology laboratory did not receive mentorship; however, the tuberculosis laboratory had an international mentor who visited the laboratory four times during the programme, spending two to four weeks embedded within the laboratory during each visit.

Results

There was an overall improvement in the performance of both laboratories, with the virology laboratory increasing 13% (from 80% at baseline to 93% at exit audit) and the tuberculosis laboratory increasing 29% (from 66% to 95%). These scores were maintained nine months later at the surveillance audit.

Conclusion

The SLMTA programme resulted in improved and sustained quality management performance for both laboratories. Mentoring was a possible factor in the substantial improvement made by the tuberculosis laboratory and should be considered in order to augment the training received from the SLMTA workshops.

Microbiological status of periodontal diseases in Lagos, Nigeria

OBJECTIVES

The dynamic nature of oro-facial infections made it imperative to study the epidemiology of gingivitis and periodontitis which are significant clinical conditions in the Nigerian environment.

METHODS

The clinical and microbiological features of 162 patients with periodontal diseases (gingivitis 68, periodontitis 94) were analysed. The advantage of routine antibiotic susceptibility testing for oral pathogens in patients' management was investigated.

RESULTS

The incidence of periodontal diseases was more in females than males with a ratio of 0.53 though the difference was not significant. A high incidence of gingivitis (55.9%) occurred within the first 29 years with a cluster of cases (48.6%) between 10 and 29 years of age with incidence tending to decline with advancing age. Though the incidence ofperiodontitis was highest amongst adults over 40 years (42.6%), the incidence of 8.5% in children below 10 years of age was high. Polybacterial aetiology was characteristic; aerobes were the predominant flora in gingivitis with a preponderance of Streptococcus spp, while anaerobes predominated in periodontitis with such species as Porphyromonas, Prevotella, Fusobacterium and Actinobacillus. Significant reduction in duration of treatment was obtained when patients were treated based on susceptibility results as opposed to empirical knowledge (p < 0.05).

CONCLUSION

The diversity of microbial aetiology of periodontal infections may put much demand on routine laboratory investigations for patient management, but it may be necessary to weigh the benefit of additional cost against the cost of treatment failure associated with antibiotic resistance in bacteria.

Bacteriological and clinical evaluation of twelve cases of post-surgical sepsis of odontogenic tumours at a referral centre

OBJECTIVE

To determine the bacterial aetiology of sepsis occurring following surgery of odontogenic tumours and assess the effect of prompt and proper antibiotic usage.

DESIGN

A prospective study.

SETTING

A tertiary referral centre in Lagos, Nigeria.

SUBJECTS

Twelve patients with odontogenic tumours that developed sepsis postoperatively. Eight of the patients were referred from private hospitals, the remaining were in-patients who sought for alternative medical attention following interruption of health care services at the referral centre.

INTERVENTION

Adequate review of patient's medical history, bacteriological investigations and antibiotic therapy.

MAIN OUTCOME MEASURES

Bacteriological and clinical cure following antibiotic therapy based on susceptibility test results.

RESULTS

Two categories of patients were identified; those who completed the course of antibiotics prescribed post-surgery and patients who failed to conform to antibiotic prescription. Sepsis developed in the non-compliance group much earlier than in the group that complied (p<0.001). Infections were polybacterial with aerobes accounting for 77.4% (alpha-haemolytic streptococci 29.0%, Streptococcus pyogenes 16.1%, Staphylococcus aureus 16.1%, diphtheroids 9.7%, Klebsiella pneumoniae 6.5%) and anaerobes 22.6% (Porphyromonas gingivalis 9.7%, Peptostreptococcus spp. 6.5%, Prevotella melaninogenica 3.2%, Clostridium perfringens 3.2%). Mixed aerobic and anaerobic aetiology occurred more in osteosarcoma and fibrosarcoma. Clostridium perfringens was isolated from a case of osteosarcoma with necrotic tissues. The anaerobic bacteria were 100% sensitive to metronidazole, ciprofloxacin and augmentin, 65-85% sensitivity to ampicloxacillin, amoxicillin and erythromycin. Over 92% of the streptococci were sensitive to the beta-Lactams contrast low susceptibility with S. aureus and K. pneumoniae.

CONCLUSION

Interruption of healthcare service was the sole factor identified in the development of sepsis as the patients could not be monitored to ensure compliance to prescription.