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New policies, new technologies: modelling the potential for improved smear microscopy services in Malawi.

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Ramsay, Andrew, Cuevas, Luis ORCID: https://orcid.org/0000-0002-6581-0587, Mundy, Catherine, Nathanson, Carl-Michael, Chirambo, Petros, Dacombe, Russell ORCID: https://orcid.org/0000-0002-6705-1537, Squire, Bertie ORCID: https://orcid.org/0000-0001-7173-9038, Salaniponi, Felix and Munthali, Sera (2009) 'New policies, new technologies: modelling the potential for improved smear microscopy services in Malawi.'. PLoS ONE, Vol 4, Issue 11, e7760.

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Abstract

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.

Item Type: Article
Subjects: QY Clinical Pathology > Diagnostic Tests > QY 120 Sputum
QY Clinical Pathology > Diagnostic Tests > QY 250 Immunodiagnostic tests
WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General)
WF Respiratory System > Tuberculosis > WF 220 Diagnosis. Prognosis
Faculty: Department: Groups (2002 - 2012) > Clinical Group
Digital Object Identifer (DOI): https://doi.org/10.1371/journal.pone.0007760
Depositing User: Users 379 not found.
Date Deposited: 30 Oct 2012 16:23
Last Modified: 06 Feb 2018 13:05
URI: https://archive.lstmed.ac.uk/id/eprint/3069

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