New Policies, New Technologies : Modelling the Potential for Improved Smear Microscopy Services in Malawi

New Policies, New Technologies : Modelling the Potential for Improved Smear Microscopy Services in Malawi

BACKGROUND: To quantify the likely impact of recent WHO policy recommendations regarding smear microscopy and the introduction of appropriate low-cost fluorescence microscopy on a) case detection and b) laboratory workload. METHODOLOGY/PRINCIPAL FINDINGS: An audit of the laboratory register in an ur...

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Main Authors: Ramsay, A., Cuevas, L. E., Mundy, C. J., Nathanson, C. M., Chirambo, P., Dacombe, R., Squire, S. B., Salaniponi, F. M., Munthali, S.
Format: Journal Article
Language:EN
Published: 2012
Subjects:
Clinical chemistry
Female
Humans
Hospital laboratories
Light
Malawi
Male
Fluorescence microscopy
Sputum
Time Factors
Tuberculosis
Online Access:http://hdl.handle.net/10986/5127
id okr-10986-5127
recordtype oai_dc
spelling okr-10986-51272021-04-23T14:02:21Z New Policies, New Technologies : Modelling the Potential for Improved Smear Microscopy Services in Malawi Ramsay, A. Cuevas, L. E. Mundy, C. J. Nathanson, C. M. Chirambo, P. Dacombe, R. Squire, S. B. Salaniponi, F. M. Munthali, S. Clinical chemistry Female Humans Hospital laboratories Light Malawi Male Fluorescence microscopy Sputum Time Factors Tuberculosis BACKGROUND: To quantify the likely impact of recent WHO policy recommendations regarding smear microscopy and the introduction of appropriate low-cost fluorescence microscopy on a) case detection and b) laboratory workload. METHODOLOGY/PRINCIPAL FINDINGS: An audit of the laboratory register in an urban hospital, Lilongwe, Malawi, and the application of a simple modelling framework. The adoption of the new definition of a smear-positive case could directly increase case detection by up to 28%. Examining Ziehl-Neelsen (ZN) sputum smears for up to 10 minutes before declaring them negative has previously been shown to increase case detection (over and above that gained by the adoption of the new case definition) by 70% compared with examination times in routine practice. Three times the number of staff would be required to adequately examine the current workload of smears using ZN microscopy. Through implementing new policy recommendations and LED-based fluorescence microscopy the current laboratory staff complement could investigate the same number of patients, examining auramine-stained smears to an extent that is equivalent to a 10 minutes ZN smear examination. CONCLUSIONS/SIGNIFICANCE: Combined implementation of the new WHO recommendations on smear microscopy and LED-based fluorescence microscopy could result in substantial increases in smear positive case-detection using existing human resources and minimal additional equipment. 2012-03-30T07:31:26Z 2012-03-30T07:31:26Z 2009 Journal Article Plos One 1932-6203 (Electronic) 1932-6203 (Linking) http://hdl.handle.net/10986/5127 EN http://creativecommons.org/licenses/by-nc-nd/3.0/igo World Bank Journal Article Malawi
repository_type Digital Repository
institution_category Foreign Institution
institution Digital Repositories
building World Bank Open Knowledge Repository
collection World Bank
language EN
topic Clinical chemistry
Female
Humans
Hospital laboratories
Light
Malawi
Male
Fluorescence microscopy
Sputum
Time Factors
Tuberculosis
spellingShingle Clinical chemistry
Female
Humans
Hospital laboratories
Light
Malawi
Male
Fluorescence microscopy
Sputum
Time Factors
Tuberculosis
Ramsay, A.
Cuevas, L. E.
Mundy, C. J.
Nathanson, C. M.
Chirambo, P.
Dacombe, R.
Squire, S. B.
Salaniponi, F. M.
Munthali, S.
New Policies, New Technologies : Modelling the Potential for Improved Smear Microscopy Services in Malawi
geographic_facet Malawi
relation http://creativecommons.org/licenses/by-nc-nd/3.0/igo
description BACKGROUND: To quantify the likely impact of recent WHO policy recommendations regarding smear microscopy and the introduction of appropriate low-cost fluorescence microscopy on a) case detection and b) laboratory workload. METHODOLOGY/PRINCIPAL FINDINGS: An audit of the laboratory register in an urban hospital, Lilongwe, Malawi, and the application of a simple modelling framework. The adoption of the new definition of a smear-positive case could directly increase case detection by up to 28%. Examining Ziehl-Neelsen (ZN) sputum smears for up to 10 minutes before declaring them negative has previously been shown to increase case detection (over and above that gained by the adoption of the new case definition) by 70% compared with examination times in routine practice. Three times the number of staff would be required to adequately examine the current workload of smears using ZN microscopy. Through implementing new policy recommendations and LED-based fluorescence microscopy the current laboratory staff complement could investigate the same number of patients, examining auramine-stained smears to an extent that is equivalent to a 10 minutes ZN smear examination. CONCLUSIONS/SIGNIFICANCE: Combined implementation of the new WHO recommendations on smear microscopy and LED-based fluorescence microscopy could result in substantial increases in smear positive case-detection using existing human resources and minimal additional equipment.
format Journal Article
author Ramsay, A.
Cuevas, L. E.
Mundy, C. J.
Nathanson, C. M.
Chirambo, P.
Dacombe, R.
Squire, S. B.
Salaniponi, F. M.
Munthali, S.
author_facet Ramsay, A.
Cuevas, L. E.
Mundy, C. J.
Nathanson, C. M.
Chirambo, P.
Dacombe, R.
Squire, S. B.
Salaniponi, F. M.
Munthali, S.
author_sort Ramsay, A.
title New Policies, New Technologies : Modelling the Potential for Improved Smear Microscopy Services in Malawi
title_short New Policies, New Technologies : Modelling the Potential for Improved Smear Microscopy Services in Malawi
title_full New Policies, New Technologies : Modelling the Potential for Improved Smear Microscopy Services in Malawi
title_fullStr New Policies, New Technologies : Modelling the Potential for Improved Smear Microscopy Services in Malawi
title_full_unstemmed New Policies, New Technologies : Modelling the Potential for Improved Smear Microscopy Services in Malawi
title_sort new policies, new technologies : modelling the potential for improved smear microscopy services in malawi
publishDate 2012
url http://hdl.handle.net/10986/5127
_version_ 1764394045352706048

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