Browsing by Author "Jegede, F.E."
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Item Evaluation of Laboratory Performance with Quality Indicators in Infectious Disease Hospital, Kano, Nigeria(2015) Jegede, F.E.; Mbah, H.A.; Aminu, M.; Yakubu, T.N; Torpey, KBackground: In January 2010, the implementation of quality management systems toward WHO AFRO laboratory accreditation commenced in the Antiretroviral Treatment Laboratory of the In fectious Disease Hospital, Kano, Nigeria. Quality improvement projects were instituted in 2011 in line with ISO 15189 requirements for accreditation of medical laboratory. In this study we eva luated the performance of the laboratory through some set of quality indicators (QI). Methodology: This was a retrospective study to evaluate laboratory QIs monitored from January 2011 to De cember 2013. The QIs were specimen rejection rate (SSR), turnaround time (TAT), proficiency testing performance (PTP) and client satisfaction survey (CSS). Data was collected into an excel file for analysis and percentage performance compared among years. SSR & TAT were evaluated with the Sigma scale. Results: A total of 7920 (2194 in 2011, 2715 in 2012, 3011 in 2013) speci mens were received for testing. 22 (0.28%) specimens were rejected and 81 (1.02%) specimens’ results were reported after the acceptable TAT, giving a Sigma level of 4.27 and 3.82 for SSR and TAT respectively. There was steady improvement in PTP: CD4+ from 67% in 2011 to 90% in 2013, hematology from 81% in 2012 to 83% in 2013, blood film reading 79% in 2011 to 83% in 2013 and chemistry from 90% in 2011 to 93% in 2013. HIV serology recorded 100% throughout. CSS increased from 59% in 2012 to 78% in 2013. However, there was no statistically significance dif ference reported for PTP and CSS over the years (P > 0.05). Conclusion: The study highlights the need to continuously evaluate QIs and calls for more effort to improve on PTP and focuses on un derstanding and improving on clients concerns.Item Laboratory Quality Audit in 25 Anti-Retroviral Therapy Facilities in North West of Nigeria(Open Journal of Clinical Diagnostics, 2014) Jegede, F.E.; Mbah, H.A.; Torpey, K.; et al.Introduction: A laboratory’s ability to consistently produce high-quality and reliable results hinges on adopting laboratory standards that guide daily practices to ensure steady quality improvement. Although assessment is an extremely rewarding exercise in health care quality improvement processes, it is always considered very time consuming and expensive in developing world set tings. A quarterly internal audit was conducted in 25 FHI360 supported Antiretroviral Treatment laboratories in the North West of Nigeria which can surely provide reference for other countries. Methodology: A checklist adapted from the World Health Organization/African Regional Office la boratory accreditation checklist was used to quantitatively evaluate 7 quality essentials (QEs). A team composed of technical staff from FHI360, State Ministry of Health and facility laboratory heads, conducted the audits, developed and monitored intervention plans. Information obtained with the checklist was captured in excel, validated and imported into Grappa Prism software ver sion 5.0 for analysis. Results: Most (92%) facilities were at secondary level with (8%) at tertiary level. The mean total score on all QEs across the facilities was 63.34 ± 9.77 in quarter (Q) 1, 68.8 ± 10.91 in Q2, 72.59 ± 8.02 in Q3 and 72.72 ± 9.16 in Q4 (p ≤ 0.0001). The most improved QE through Q1-Q4 was organization and personnel (32.2%), while signage/bench top reference had an 18.6% point decline. In ranking facilities based on differences of total scores between Q4 and Q1, Kachia General Hospital was the highest with 27 point increase. Considering the mean percentage score for all quarters per facility, 4 had ≥ 80%, 19 had between 60% - 80% and 2 had ˂60%. The total non-conformities cited for QI-Q4 were 185, 100, 78 and 64 respectively with highest recorded in internal and external quality control and the least in facility and safety. Conclusion: We recorded some improvement in most QEs confirming the benefits of internal audits, reviews and follow-up. However, much more is needed in terms of technical assistance, capacity building, mentorship, and commitment at facility and state level to meet minimum acceptable laboratory quality standards.Item Performance evaluation of BD FACSPresto™ point of care CD4 analyzer to enumerate CD4 counts for monitoring HIV infected individuals in Nigeria(Public Library of Science, 2017) Negedu-Momoh, O.R.; Jegede, F.E.; Yakubu, A.; Balogun, O.; Abdullahi, M.; Badru, T.; Oladele, E.A.; Agbakwuru, C.; Khamofu, H.; Torpey, K.Background: Despite the upsurge in support and intervention of donor agencies in HIV care and treatment programing in Sub-Sahara African, antiretroviral (ART) programs are still confronted with access and coverage challenges which influence enrolment of new patients. This study investigated the validity of point of care BD FACSPresto™ CD4 analyzer for CD4+ cell count, overall agreement, correlation, sensitivity, and specificity in comparison to a reference standard flow cytometry method. We also assessed the feasibility of use among nonlaboratorians. Methods Blood samples from 300 HIV infected individuals were analyzed for CD4+ T cell and CD4%, using finger prick capillary sample from 150 PMTCT clients and 150 ART clients at Murtala Mohammed Specialist Hospital, Kano, Nigeria. Their venous samples were compared on a flow cytometry reference method using BD FACSCount CD4+ count system. The accuracy of the BD FACSPresto machine in comparison to BD FACSCount was evaluated. Statistical analysis was carried out using STATA (version 12). Bland-Altman method and correlation analysis were used to analyze agreement between both measurements. In addition, sensitivity and specificity of both measurements were determined. Statistical significance was set at p-value <0.05. Results The mean bias and limit of agreement for CD4+ count between BD FACSPresto and BD FACS count machine were 7.49 (95% CI: 2.44 to 12.54) and -8.14 to 96.39 respectively. Further analysis revealed close agreement between BD FACSPresto and BD FACSCount with no significant difference between the two methods (p = .0.95). Using a threshold of 500 cells/μL, sensitivity and specificity of BD FACSPresto were 95.1% and 97.1% respectively, compared to BD FACSCount. There was no statistically significant difference in the misclassification between BD FACSPresto and BD FACSCount results (p = 0.23). Furthermore, sensitivity and specificity were similar when BD FACSPresto machine was operated by a nurse or laboratory scientist, there was no substantial difference in testing variability observed between laboratory and non-laboratory operators using the BD FACSPresto analyzer. Conclusions Overall, BD FACSPresto Point of Care CD4+ count finger stick capillary blood results is a reliable method in comparison to venous sample cytometry method and no significant difference variability observed between laboratory personnel and non-laboratory operators. The BD FACSPresto is simple, more robust and easy to use equipment without significant variability in reliability by non-laboratory health care workers hence will be a valuable instrument in increasing access and coverage of CD4 estimations in developing countries. The introduction of the BD FACSPresto POC analyzer has a high potential in reducing patients waiting time and improving the overall quality of ART service and clients' satisfaction especially in rural settings. © 2017 Negedu-Momoh et al. 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