The Effectiveness of Acid Fast Bacilli (Afb) Smear Microscopy Training in Performance Improvement Among Nigerian Military Hospital TB Laboratory Personnel: Analysis of Pre and Post Training Evaluation Scores

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Authors : Adedamola Amos Ogundeji



This study is planned to determine the effectiveness of AFB smears microscopy training and refresher training on the performance of TB laboratory personnel working in the Nigerian Military Hospital.


With an estimated 9.4 million new cases globally, tuberculosis (TB) continues to be a major public health concern1. Eighty percent of all cases worldwide occur in 22 high-burdens, mainly resource-poor settings of which Nigeria ranked 13th. This devastating impact of tuberculosis on vulnerable populations is also driven by its deadly synergy with HIV. Therefore, building capacity and enhancing universal access to rapid and accurate laboratory diagnostics are necessary to control TB and HIV-TB co-infections in resource-limited countries2. In low income countries (Nigeria inclusive), Ziehl-Neelsen sputum smear microscopy is the only cost-effective tool for diagnosis and monitoring of patients on treatment3. In order to have efficient and reliable AFB microscopy centres, it is very necessary to have continuous refresher training for laboratory professionals and strong External Quality Assessment (EQA) system. However, very little data exists as to the effect of in-service training on performance of laboratory personnel in Nigeria.


A cross-sectional retrospective study was conducted to appraise theoretical and practical performance of TB Laboratory personnel drawn from various Nigerian Military hospitals supported by the joint partnership of Nigerian Ministry of Defence (NMOD)/United States Department of Defense Walter Reed Program-Nigeria (USDOD WRPN), before and after AFB microscopy training. Theoretical assessment was based on standard questions while practical assessment was based on smear reading of 10 standard slides. Data generated from four (4) rounds of a five days AFB Smear Microscopy training at NTBLTC, Zaria, Kaduna State, Nigeria between 2011 and 2013 was retrospectively collated and analyzed using SPSS 16.0 statistical software.


The pre-training mean score of the theoretical knowledge and practical skills were 64.3% and 64.5%, respectively. The post training mean scores were 83.6% and 85.3% for theoretical knowledge and practical skills, respectively. The increase in mean score of both theoretical and practical assessment was statistically significant (p<0.0001). Post training mean score of theoretical knowledge was higher among diploma holders trainees than the BSc degree counter parts (p=0.001). The mean scores on practice before and after training were dependent on participation in previous AFB microscopy trainings (p<0.0001). Proportions of participants with both major and minor errors were found to decrease after they were trained. Trainees who have had previous training were found to commit less error than those who have never participated in previous training (p<0.0001).


This study established that training improved theoretical and practical performance of Medical Laboratory personnel. Training and continuous training irrespective of lab professional’s qualification, service status and service year and sustainable EQA are highly recommended to ensure quality of AFB microscopy services in all NMOD/USDOD supported health facilities across the country.


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