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ZAMBIA TUBERCULOSIS LABORATORY NETWORK 18TH NOVEMBER 2003 NAIROBI KENYA

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ZAMBIA TUBERCULOSIS LABORATORY NETWORK 18TH NOVEMBER 2003 NAIROBI KENYA

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    1. ZAMBIA TUBERCULOSIS LABORATORY NETWORK 18TH NOVEMBER 2003 NAIROBI KENYA BWALYA RUTH TEMBWE PRINCIPAL SCIENTIFIC OFFICER CHEST DISEASES LABORATORY NATIONAL REFERENCE LABORATORY FOR TUBERCULOSIS LUSAKA ZAMBIA

    2. MAP OF ZAMBIA

    3. Zambia TB laboratory network ADMINISTRATIVELY ZAMBIA IS DIVIDED INTO 9 PROVINCES. EACH PROVINCE IS DIVIDED INTO DISTRICTS. 72 DISTRICTS. MINISTRY OF HEALTH IS THE POLICY MAKING ORGAN CENTRAL BOARD OF HEALTH (CBoH) IS THE IMPLEMENTING ORGAN. LABORATORIES FALL UNDER THE DIRECTORATE OF CLINICAL CARE IN THE CBoH

    4. LAB NETWORK CONSISTS OF THE FOLLOWING LEVELS. NATIONAL REFERENCE LABORATORY-CHEST DISEASES LABORATORY. SPECIALISED AND CENTRAL HOSPITALS (LEVEL III) PROVINCIAL HOSPITAL LABORATORIES (LEVEL II ) DISTRICT HOSPITAL LABORATORIES (LEVEL I ) HEALTH CENTRE LABORATORIES

    5. TB LAB NETWORK MICROSCOPY IS DONE IN ALL THE LABORATORIES (154 DIAGNOSTIC CENTRES). CULTURE AND SUSCEPTIBILITY TESTING ROUTINELY IS ONLY DONE AT THE REFERENCE LABORATORY. ONE SPECIALISED LABORATORY PERFOMING CULTURE AND SUSCEPTIBILITY ON PROJECT BASIS.

    6. MICROSCOPY ALL DIAGNOSTIC CENTRES PERFORM ZIEHL NEELSEN STAIN REFERENCE LABORATORY AND UNIVERSITY TEACHING HOSPITAL TB LABORATORY PERFORM AURAMINE BUT CONFIRM ALL POSITIVES WITH ZN.

    7. CULTURE AND SUSCEPTIBILITY TESTING DECONTAMINATION IS BY PETROFFS METHOD. INOCULATION IS ON LOWENSTEIN-JENSEN MEDIA. UTH USES BOTH LIQUID (MIGIT 960)AND SOLID. SUSCEPTIBILITY-PROPORTION METHOD.

    8. SUPPLIES SUPPLIES ARE PROCURRED CENTRALLY . PREVIOUSLY PROGRAM WAS SUPPORTED BY KNCV BUT WITH THE INTRODUCTION OF REFORMS KNCV STOPPED THE SUPPORT. LAST SUPPLY WAS 1997. NEW SUPPLY RECENTLY ARRIVED IN THE COUNTRY -SEPT 2003 JICA. SUPPLIES ONLY GIVEN ON REFERENCE LAB RECEIVING DEMAND FORM.

    9. TRAINING TRAININGS ARE CONDUCTED BY THE REFERENCE LABORATORY. CAPACITY IS BEING BUILT AT EVERY LEVEL OF CARE. IN PROCESS OF UPDATING THE AFB TRAINING MANUAL -TO BE IN CONJUCTION WITH CDC DEVELOPING A TRAINER OF TRAINERS MANUAL.

    10. SUPERVISION QUARTERLY ASSESSMENTS ARE PERFORMED BY EVERY LEVEL OF CARE.THESE ARE INTERGRATED WITH OTHER AREAS. REFERENCE LAB GIVES SUPPORTIVE VISITS AND THERE IS A NEED TO STRENGTHEN THE VISITS.

    11. QUALITY CONTROL/ASSURANCE INTERNAL QUALITY CONTROL IS EMPHASISED DURING TRAININGS. EACH LAB IS EXPECTED TO HAVE IQC THROUGHOUT SPECIMEN PROCESSING. EXTERNAL QUALITY ASSESSMENT PREVIOUSLY THERE WAS NO ORGANISED SYSTEM FOR ENSURING RELIABILITY OF SPUTUM SMEAR RESULTS THROUGH OUT THE COUNTRY

    12. QUALITY CONTROL/ASSURANCE IN PROCESS OF IMPLEMENTING AN EQA PROGRAM FOR AFB MICROSCOPY-ASSISTANCE FROM CDC. USING INTERNATIONAL GUIDELINES. IMPLEMENTATION IS IN PHASES. BEGAN WITH THE PROVINCIAL HOSPITAL LABORATORIES (SPECIALISED,LEVEL III AND LEVELII).

    13. QUALITY CONTROL/ASSURANCE ALL THREE COMPONENTS OF EQA HAVE BEEN IMPLEMENTED AT PROVINCE LEVEL. ON SITE EVALUATION PANEL TESTING RANDOM BLINDED RECHECKING NEXT STEP IS TO ROLL OUT TO THE DISTRICTS BUT HAVE TWO PILOT PROVINCES. RECHECKING LUSAKA PROVINCE IS BEING DONE AS A TWO YEAR PROJECT UNDER THE JICA HIV/STI/TB PROJECT.

    14. CONSTRAINTS REFERENCE LAB STAFF SHORTAGE (5 STAFF ,1 IS AT SCHOOL 1 RETIRES IN DECEMBER )2003. TRANSPORTATION OF STAFF OF STAFF TO THE LAB. TRANSPORT FOR CONDUCTING SUPERVISORY VISITS. LAB EQUIPMENT BREAKDOWN eg INCUBATORS. LACK OF FINANCIAL RESOURCES. TRANSPORTATION OF SAMPLES FROM AROUND THE COUNTRY TO CHEST DISEASES LAB.

    15. CONSTRAINTS DIAGNOSTIC CENTRES ARE NOT EASILY ACCESSIBLE BY PATIENTS. (THEREFORE IN PROCESS OF WORKING OUT LOGISTICS OF TRANSPORTING SPECIMENS). SUPPLIES STOCK OUTS. SHORTAGE OF STAFF

    16. THANKYOU

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