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Free Content Systematic restaining of sputum smears for quality control is useful in Burundi

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Abstract:

SETTING: Routine tuberculosis control services in Burundi.

OBJECTIVE: To determine whether systematic restaining of sputum smears for acid-fast bacilli (AFB) prior to rechecking quality assessment is necessary.

DESIGN: Blinded rechecking of peripheral routine smears, including a second control of discordants, before and after restaining.

RESULTS: Without restaining, 10/825 (1.2%) negative, and 59/189 (31.2%) positive results were declared false. After restaining, there were 34 (4.1%) false negatives and 13 (6.9%) false positives, both highly significant changes. Before restaining, quantification of positive smears was usually considered too high, while after re-staining 41 out of 42 positives were found to have too low readings.

CONCLUSIONS: Despite mild climatic conditions in Burundi, restaining all slides before rechecking revealed an unrecognised, widespread problem of false negatives, rather than false positives. This indicated the need for critical re-appraisal of the standard procedure using cold staining, rather than re-training, as would have been inferred from results without restaining. Systematic restaining of all slides prior to rechecking may be more widely needed in National Tuberculosis Programmes to cover all possible serious causes of error. Cold staining should be avoided in field programmes since its performance is easily affected by frequently encountered adverse factors.

Keywords: quality control; smear microscopy; stains and staining; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Programme National contre la Lèpre et la Tuberculose, Bujumbura, Burundi 2: Institute of Tropical Medicine, Mycobacteriology, Antwerpen, Belgium

Publication date: May 1, 2003

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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