No abstract

BackgroundIn 2002, the Ministry of Health (MoH) of Botswana began its journey toward laboratory accreditation in an effort to enhance the quality of laboratory services. After a difficult start, the MoH recognised the need for a more practical and sustainable method for change that could be implemented nationally; they therefore adopted the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme.ObjectiveThis study describes the process and lessons learned in implementing SLMTA and the role of supplemental training and mentoring so as to achieve Botswana’s national laboratory quality improvement goal.MethodsEight laboratories were enrolled into the SLMTA programme in 2010, which included a series of workshops and improvement projects conducted over nine months. Four of these laboratories received supplementary training and focused mentorship from the Botswana Bureau of Standards (BOBS). Laboratory performance was measured at baseline and exit using the World Health Organization Regional Office for Africa’s Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist. One laboratory did not receive an exit audit and was thus excluded from the analysis.ResultsAn 18 percentage-point improvement was observed when comparing the median baseline score (53%) to the median exit score (71%) for the seven laboratories. Laboratories that received additional training and mentorship from BOBS improved 21 percentage points, whilst non-BOBS-mentored laboratories improved eight percentage points. Hospital management buy-in and strong laboratory staff camaraderie were found to be essential for the positive changes observed.ConclusionSLMTA facilitated improvements in laboratory quality management systems, yielding immediate and measurable results. This study suggests that pairing the SLMTA programme with additional training and mentorship activities may lead to further increases in laboratory performance; and that SLMTA is a practical approach to extending quality improvement to MOH laboratories.

Background: Central nervous system (CNS) infections are an important cause of childhood morbidity and mortality in high HIV prevalence settings of Africa. We evaluated the epidemiology of pediatric meningitis in Botswana during the rollout of antiretroviral therapy, pneumococcal conjugate vaccine (PCV13), and Haemophilus influenzae type B (HiB) vaccine. Methods: We performed a cross-sectional study of children (<15 years) evaluated for meningitis by cerebrospinal fluid (CSF) examination from 2000-2015, with complete national records for 2013-2014. Clinical and laboratory characteristics of microbiologically-confirmed and culture-negative meningitis were described and incidence of Streptococcus pneumoniae, Haemophilus influenzae and cryptococcal meningitis estimated for 2013-2014. Results: 6,796 unique cases were identified. Median age was 1 year (IQR 0-3); 10.4% (435/4,186) of children with available HIV-related records were known HIV-infected. Overall, 30.4% (2,067/6,796) had abnormal CSF findings (positive microbiological testing or CSF pleocytosis). Ten-percent (651/6,796) had a confirmed microbiological diagnosis; including 26.9% (175/651) Cryptococcus, 18.9% (123/651) Streptococcus pneumoniae, 20.3% (132/651) Haemophilus influenzae, and 1.1% (7/651) Mycobacterium tuberculosis. During 2013-2014, national cryptococcal meningitis incidence was 1.3 cases/100,000 person-years (PYO)

s u m m a r yObjectives: Data on meningitis epidemiology in high HIV-prevalence African settings following antiretroviral therapy scale-up are lacking. We described epidemiology of adult meningitis in Botswana over a 16-year period. Methods: Laboratory records for adults undergoing lumbar puncture (LP) 20 0 0-2015 were collected, with complete national data 2013-2014. Cerebrospinal fluid (CSF) findings and linked HIV-data were described, and national incidence figures estimated for 2013-2014. Temporal trends in meningitis were evaluated. Results: Of 21,560 adults evaluated, 41% (8759/21,560) had abnormal CSF findings with positive microbiological testing and/or pleocytosis; 43% (3755/8759) of these had no confirmed microbiological diagnosis. Of the 5004 microbiologically-confirmed meningitis cases, 89% (4432/5004) were cryptococcal (CM) and 8% (382/5004) pneumococcal (PM). Seventy-three percent (9525/13,033) of individuals undergoing LP with identifiers for HIV registry linkage had documented HIV-infection. Incidence of LP for meningitis evaluation in Botswana 2013-2014 was 142.6/10 0,0 0 0 person-years (95%CI:138.3-147.1); incidence of CM was 25.0/10 0,0 0 0 (95%CI:23.2-26.9), and incidence of PM was 2.7/10 0,0 0 0 (95%CI:2.4-3.1). In contrast to previously reported declines in CM incidence with ART roll-out, no significant temporal decline in pneumococcal or culture-negative meningitis was observed.Conclusions: CM remained the predominant identified aetiology of meningitis despite ART scale-up. A high proportion of cases had abnormal CSF with negative microbiological evaluation.