Assessment Of Tuberculosis Diagnostic Capacity In Healthcare Facilities In Nairobi City County, Kenya

Abstract

Assessment of tuberculosis diagnostic capacity in healthcare facilities in Nairobi City County, Kenya Background: Early diagnosis of Tuberculosis (TB) is an essential component of the World Health Organization’s (WHO’s) end TB strategy. The Kenya Tuberculosis Prevalence Survey established that TB prevalence in Kenya is higher than had been estimated and that about half of those who fall ill with the disease each year are missed. This calls for early diagnosis of TB that can only be facilitated by a TB laboratory that meets all the necessary requirements. The aim of the study was to determine the tuberculosis diagnostic capacity of healthcare facility laboratories in Nairobi City County. Methodology: A cross sectional study was done in Nairobi City County in 2016. The sample size was 73 randomly selected TB laboratories. The dependent variable was the TB lab sampled. The independent variables evaluated were: presence and use of TB lab guidelines and Standard Operating Procedures (SOPs), TB lab staffing, TB lab External Quality Assurance (EQA), TB lab recording and reporting, TB specimen processing, TB diagnostic equipment, TB diagnostic supplies and TB infection prevention and control (IPC). The evaluation was done using a modified WHO lab accreditation assessment tool. Analysis was based on the 95% threshold proposed in the WHO’s Stepwise Laboratory Improvement Process Towards Accreditation (SLIPTA) for 5-star accreditation. Results: The TB labs did not meet the criteria for 5 star accreditation in the following variables: presence and use of TB lab guidelines and SOPs (83.3%), TB lab EQA (60.7%), TB lab recording xv and reporting (87.1%), TB specimen processing (71.9%), TB diagnostic equipment (72.9%), TB diagnostic supplies (73%). The labs met the threshold in TB infection prevention and control (IPC) 96.2% and TB lab staffing (94.9%). Conclusions: The TB diagnostic capacity of laboratories in Nairobi County did not meet SLIPTA 5-star accreditation in six out of eight areas assessed. Building the capacity on leadership and governance and provision of adequate financing have a role in improving TB diagnostic capacity in a bid to address the highlighted areas of weakness. Recommendations: Building the capacity on leadership and governance and provision of adequate financing have a role in improving TB diagnostic capacity in a bid to address the highlighted areas of weakness. Assessment of the TB laboratory diagnostic capacity using WHO GLI laboratory assessment tool is a useful way of assisting TB laboratories achieve SLIPTA accreditation, ultimately improving TB diagnosis and treatment outcomes. Key words: TB diagnostic capacity, TB Laboratory, Health Systems