Introduction
Tuberculosis is a major health problem in Lusaka, Zambia, where 16% of the people of productive age was infected with HIV. DOTS coverage is 100% with 81% case detection and 73% cure rate.Following the spread of HIV infection, the number of tuberculosis patients has been increasing. Within this context, the HIV/AIDS and TB Control Project established a model external quality assessment (EQA) system for AFB microscopy service at peripheral laboratories.This study aims to show importance of EQA in quality NTP laboratory system.
Methods
All 22 diagnostic centers in Lusaka during the period from July 2003 to September 2005 were evaluated following internationally recognized guidelines. Sample slides were taken randomly from among slides read at peripheral diagnostic centers and were blindly rechecked by controllers at the quality assurance (QA) center. Quality of smear preparation was also assessed.
Results and Discussions
Between 2003 and 2005, major reading errors (discrepancy: two reading scales and over) found by controllers decreased from 5% of sample slides to 0.7%, and minor errors (one scale discrepancy) from 3.4% to 0.3%. The number of diagnostic centers without any errors was only 3 at the beginning of study and this number increased to 17 at the end. Quality of smear preparation such as thickness, size and evenness also improved based on international standards. These results highlighted the effectiveness of the quality assurance system (blinded rechecking of sample slides and effective feedback with frequent visits to peripheral diagnostic centers) in terms of maintaining the proficiency of AFB microscopy service. EQA system should be expanded in the areas where both HIV and TB prevalence is high. The effective implementation of EQA service in the NTP is the essential factor for the success of DOTS strategy and may contribute ultimately to prevent new tuberculosis infection among persons, including HIV-infected.

This study was undertaken to elucidate the usefulness and problems of autologous blooddonation for the patients with low-lying placenta. Seventy-eight women with low-lying placentawho gave birth in our institution were retrospectively analyzed. Autologous blood donation wasperformed in 58 patients (74%). The median volume of donated blood was 300 mL. Patients withor without autologous blood donation showed no significant difference in the distance betweenthe edge of the placenta and the internal os of the uterus. Median blood loss due to intrapartumhemorrhage was 1183 mL. All 7 patients with blood loss of more than 2000 mL had donatedautologous blood. The donated blood was transfused in 9 of the 58 patients (16%) who underwentautologous blood donation. No patients underwent allogenic blood transfusion. Althoughautologous blood donation was expected to be useful for avoiding allogenic blood transfusion inthese patients with low-lying placenta, the high discard rate suggests the need for a strategy toselect those patients at high risk for blood loss requiring transfusion.