NTP-BANGLADESH

Quality Assessment in smear sputum microscopy at a district level under the National TB Control Program (NTP), Bangladesh

TB also continues to be a major public health problem in Bangladesh. The country is among the 22 high burden countries in the world. Bangladesh has achieved a remarkable success with almost 100% DOTs coverage, 61% case detection and more than 85% treatment success rate by December 2005. However, the country is short of the Millennium Development Goals (MDGs) targets for TB control. Accelerating case detection while maintaining high quality of sputum microscopy is paramount if MDG targets are to be achieved by the end of 2015. The programme relies on a network of laboratories and ensuring the reliability of laboratory services is critical as the type of drugs for treatment exclusively rely on it. Therefore, quality assurance of AFB sputum smear microscopy is essential. Numerous technical resources for performing quality assurance of direct AFB smear sputum microscopy are available, including those developed by the WHO and IUATLD. However, these international guidelines focus mainly on the technical aspects. These technical guidelines are useful reference material for method selection, implementation, and issues and interpretation that are encountered in a quality assurance programme.

In Bangladesh, quality control of AFB examination, through a countrywide network of nearly 700 diagnostic centres, is a priority challenge being faced by the Programme. The Programme has already received public funding for countrywide implementation of district based external quality assurance (EQA), through Lab Supervisors at the district and Upzila levels. However, the programme lacks context-sensitive operational guidelines and tools for implementing EQA within the context of internally recommended technical guidelines.

The study aim is to develop and evaluate context-sensitive operational guidelines and tools for implementing district based EQA in Bangladesh. The current quality of AFB at the District and Upazila levels will be assessed. The level of performance of existing EQA programmes will be assessed. The study will be conducted in 5 districts and 10 Upazilas. Both qualitative and quantitative methods will be used to collect data. Methods for involving the Lab Supervisors in the quality assurance and tools, guidebook and other guide materials necessary for district and Upazila levels, supervision will be developed and evaluated. The study will assist the NTP to refine the guidelines and materials, and to prepare for scaling up.

The project is expected to help the national TB programme to make efficient use of available resources for countrywide strengthening of district level AFB quality control. The experience and evaluation intended to inform other countries as they evolve their operational strategies for district level AFB quality control. The study will develop and evaluate context-sensitive operational guidelines and tools for implementing district based EQA in Bangladesh or elsewhere. The findings of this research project will be disseminated through local, national and international workshops/conferences and publications.