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Quality Assurance (QA) Tool in Public Health Campaigns: A Look at the 2017 LLIN Replacement Campaign in Nigeria
Jalal-Eddeen Abubakar Saleh, Wondimagegnehu Alemu, Akubue Augustine Uchenna, Abdullahi Saddiq, Rex Mpazanje, Bala Mohammed Audu
Open Access Library Journal (OALib Journal) , 2018, DOI: 10.4236/oalib.1104701
Background: Although there are various malaria intervention measures, the long-lasting insecticidal nets (LLIN) are considered as the most cost-effective intervention measure for malaria endemic countries. In line with the Global Technical Strategies, and as recommended by the World Health Organization (WHO), the other available malaria preventive measures to achieve malaria control and elimination in especially the malaria endemic countries include the intermittent prophylactic treatment in pregnancy (IPTp), intermittent prophylactic treatment in infants (IPTi), indoor residual spray (IRS), seasonal malaria chemoprophylaxis (SMC), and recently the use of malaria vaccine. This study examines the role of quality assurance (QA) tool as deployed by WHO in the 2017 LLIN replacement campaigns in the states that implemented the campaign in Nigeria—Adamawa, Edo, Imo, Kwara, and Ondo. For the purpose of this study, the QA tool examined four components during the campaign—logistics, strategies, technical, and demand creation. Methods: This is a cross-sectional study using the QA checklist developed and applied by the WHO professional officers intra campaign between April and December 2017. In each of the states, a total of six LGAs were randomly selected using the EPI risk status (AFP performance indicators and the routine immunization coverage). The findings from the QA checklist tool were analyzed using the SPSS version 24 and the results discussed accordingly. Results: The results looked at general and specific issues across the five states. While the general issues are more in Kwara state in comparison to the other four states—logistics (15%), strategies (12%), technical (13%), and demand creation (7%), the specific issues are almost same across the five states; these specific issues are poor crowd control (12%), early closure of distribution sites (14%), mix-up of data at the distribution sites (15%), poor communication medium between supervisors and teams at the field (11%), safety concerns by the recipients (10%), lack of adequate knowledge on the LLIN usage (9%), inadequate LLIN storage sites (13%), and inadequate plans for LLIN movement between the distribution points (16%). In spite this; all the five states had at least 80% in the area of programme ownership. Conclusion: On the overall, the study further underscores the importance of using quality assurance checklists in public health campaigns as they help ensure that campaigns meet the minimum required standard.
The Quality of Medicines in Community Pharmacies in Riyadh, Saudi Arabia: A Lot Quality Assurance Sampling (LQAS)-Based Survey  [PDF]
Hani M. J. Khojah, Henrik Pallos, Naoko Yoshida, Manabu Akazawa, Hirohito Tsuboi, Kazuko Kimura
Pharmacology & Pharmacy (PP) , 2013, DOI: 10.4236/pp.2013.47074
Abstract: Objectives: To classify community pharmacies (CPs) in Riyadh, Saudi Arabia, in terms of the quality of medicines sold by them, using the lot quality assurance sampling (LQAS) technique with a predefined threshold. Methods: Riyadh CPs were divided into 2 categories (“lots” for the purpose of LQAS), i.e., chain and independent CPs. Upper and lower rate thresholds for CPs that sell low-quality medicines were predefined as 20% and 5%, respectively. Consumer and provider risks were predefined as 0.05 and 0.10, respectively. The calculated number of randomly selected CPs required in each lot was 36; then, sale of low-quality medicines in >3 CPs implies a prevalence of >20% of such CPs according to LQAS. A randomly selected brand of amoxicillin (selected as a quality indicator of medicines because it is both widely counterfeited and heat-sensitive) was purchased from each pharmacy by a “mystery shopper”, checked for authenticity, and analyzed for drug content and content uniformity using a validated HPLC method. Results: Substandard amoxicillin was purchased in 9 pharmacies (4 chains and 5 independent). Both lots were thus rejected as unacceptable, which may indicate that consumers in Riyadh are at risk of purchasing substandard medicines at CPs. Conclusions: The quality of medicines sold in CPs in Riyadh did not meet our acceptability criterion, and appropriate intervention by decision makers is recommended. LQAS proved to be a practical, economical, and statistically valid sampling method for surveying the quality of medicines. It should enable decision makers to allocate resources for improvement more efficiently.
International Journal of Engineering Science and Technology , 2011,
Abstract: Lot Quality Assurance Sampling (LQAS), a statistical tool in industrial setup, has been in use since 1980 for monitoring and evaluation of programs on disease control / immunization status among children / health workers performance in health system. While conducting LQAS in the field, there are occasions, even after due care of design, there are practical and methodological issues to be addressed before it is recommended for implementation and intervention. LQAS is applied under the assumption that the items produced in the industry are homogeneous in nature and randomly distributed. In the health field, the assumption of randomness on occurrence of cases (disease condition), unimmunized children (defectives) etc., may not follow strictly random (parametric) distribution. Besides, there are several important practical statistical issues, seem to be simple, yet complex, need to be addressed and examined while applying LQAS for assessing various health programmes. This paper is an attempt in that direction to address some of the practical and methodological issues to be addressed before it could be generalized and recommended for use by the public health administrators.
Multiple Category-Lot Quality Assurance Sampling: A New Classification System with Application to Schistosomiasis Control  [PDF]
Casey Olives,Joseph J. Valadez ,Simon J. Brooker,Marcello Pagano
PLOS Neglected Tropical Diseases , 2012, DOI: 10.1371/journal.pntd.0001806
Abstract: Background Originally a binary classifier, Lot Quality Assurance Sampling (LQAS) has proven to be a useful tool for classification of the prevalence of Schistosoma mansoni into multiple categories (≤10%, >10 and <50%, ≥50%), and semi-curtailed sampling has been shown to effectively reduce the number of observations needed to reach a decision. To date the statistical underpinnings for Multiple Category-LQAS (MC-LQAS) have not received full treatment. We explore the analytical properties of MC-LQAS, and validate its use for the classification of S. mansoni prevalence in multiple settings in East Africa. Methodology We outline MC-LQAS design principles and formulae for operating characteristic curves. In addition, we derive the average sample number for MC-LQAS when utilizing semi-curtailed sampling and introduce curtailed sampling in this setting. We also assess the performance of MC-LQAS designs with maximum sample sizes of n = 15 and n = 25 via a weighted kappa-statistic using S. mansoni data collected in 388 schools from four studies in East Africa. Principle Findings Overall performance of MC-LQAS classification was high (kappa-statistic of 0.87). In three of the studies, the kappa-statistic for a design with n = 15 was greater than 0.75. In the fourth study, where these designs performed poorly (kappa-statistic less than 0.50), the majority of observations fell in regions where potential error is known to be high. Employment of semi-curtailed and curtailed sampling further reduced the sample size by as many as 0.5 and 3.5 observations per school, respectively, without increasing classification error. Conclusion/Significance This work provides the needed analytics to understand the properties of MC-LQAS for assessing the prevalance of S. mansoni and shows that in most settings a sample size of 15 children provides a reliable classification of schools.
Interpreting results of cluster surveys in emergency settings: is the LQAS test the best option?
Oleg O Bilukha, Curtis Blanton
Emerging Themes in Epidemiology , 2008, DOI: 10.1186/1742-7622-5-25
Abstract: Cluster surveys are often used in humanitarian emergencies to measure important nutrition and health indicators. A majority of such surveys measure the prevalence of global acute malnutrition (GAM) in children aged 6 to 59 months, a key nutritional indicator used to define the presence and gravity of an emergency. Important decisions about implementing large-scale interventions, such as general food distribution and/or feeding programs, are often based principally or in part on the prevalence of GAM. Several international organizations have published guidelines for implementing food and nutrition interventions in emergencies, where the need for such interventions is determined on the basis of the prevalence of GAM relative to pre-determined thresholds (5%, 10%, 15%) and the presence of aggravating factors, such as high mortality rates, epidemics of certain infectious diseases, or poor food security [1,2].A conventional way of analyzing GAM in a population is to estimate the prevalence from a cluster survey and then compute a 95% confidence interval around the estimate [3,4]. Deitchler and colleagues [5,6] recently proposed using decision rules based on the lot quality assurance (LQAS) method to classify the prevalence of GAM in cluster emergency nutrition surveys vis-à-vis pre-established thresholds. The authors also proposed using cluster designs with a reduced number of individuals per cluster and a reduced overall sample size of about 200, compared with 900 individuals in a "conventional" 30 × 30 (30 clusters by 30 children) design. The implications of these proposed designs on precision, validity and resources required to complete the survey have been discussed in detail in a recent paper [7].Since the LQAS method has not been routinely used to analyze nutrition cluster survey data, we consider it important to provide a simple explanation to field practitioners of how this test is conducted, what it means, and why there may be apparent discrepancies between the
Using lot quality-assurance sampling and area sampling to identify priority areas for trachoma control: Viet Nam
Myatt,Mark; Mai,Nguyen Phuong; Quynh,Nguyen Quang; Nga,Nguyen Huy; Tai,Ha Huy; Long,Nguyen Hung; Minh,Tran Hung; Limburg,Hans;
Bulletin of the World Health Organization , 2005, DOI: 10.1590/S0042-96862005001000012
Abstract: objective: to report on the use of lot quality-assurance sampling (lqas) surveys undertaken within an area-sampling framework to identify priority areas for intervention with trachoma control activities in viet nam. methods: the lqas survey method for the rapid assessment of the prevalence of active trachoma was adapted for use in viet nam with the aim of classifying individual communes by the prevalence of active trachoma among children in primary school. schoolbased sampling was used; school sites to be sampled were selected using an area-sampling approach. a total of 719 communes in 41 districts in 18 provinces were surveyed. findings: survey staff found the lqas survey method both simple and rapid to use after initial problems with area-sampling methods were identified and remedied. the method yielded a finer spatial resolution of prevalence than had been previously achieved in viet nam using semiquantitative rapid assessment surveys and multistage cluster-sampled surveys. conclusion: when used with area-sampling techniques, the lqas survey method has the potential to form the basis of survey instruments that can be used to efficiently target resources for interventions against active trachoma. with additional work, such methods could provide a generally applicable tool for effective programme planning and for the certification of the elimination of trachoma as a blinding disease.
Sh. Salarilak,A. Gashtasb I,A. Nadim
Iranian Journal of Public Health , 1999,
Abstract: To determine the coverage rate, timeliness and quality of ante-natal care in rural areas under the coverage of Health Houses in West Azerbaijan province, 30 Health Houses (HH) were randomly selected out of 731 HH in the province. In each HH, using the method of Lot Quality Assurance Sampling (LQAS) 28 women having recently born babies was selected. Data were collected using check-list for facilities, and questionnaires and forms to be completed from the files by interview. The study showed that the method of LQAS is quite effective for evaluation of this service at HH level. The weighted total coverage of ante-natal care was 46.2%. Quality of care was acceptable for 53.9% of mothers. The weighted average of time lines of care was 49.8%. Availability of facilities in delivery of this service was 100%, showing there was no short coming in this respect.
Tracking the Quality of Care for Sick Children Using Lot Quality Assurance Sampling: Targeting Improvements of Health Services in Jigawa, Nigeria  [PDF]
Edward Adekola Oladele, Louise Ormond, Olusegun Adeyemi, David Patrick, Festus Okoh, Olusola Bukola Oresanya, Joseph J. Valadez
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0044319
Abstract: Background In Nigeria, 30% of child deaths are due to malaria. The National Malaria Control Program of Nigeria (NMCP) during 2009 initiated a program to improve the quality of paediatric malaria services delivered in health facilities (HF). This study reports a rapid approach used to assess the existing quality of services in Jigawa state at decentralised levels of the health system. Methods NMCP selected Lot Quality Assurance Sampling (LQAS) to identify the variation in HF service quality among Senatorial Districts (SD). LQAS was selected because it was affordable and could be used by local health workers (HW) in a population-based survey. NMCP applied a 2-stage LQAS using a structured Rapid Health Facility Assessment (R-HFA) tool to identify high and low performing SD for specified indicators. Findings LQAS identified variations in HF performance (n = 21) and enabled resources to be targeted to address priorities. All SD exhibited deficient essential services, supplies and equipment. Only 9.7% of HF had Artemisinin-based Combination Therapies and other first-line treatments for childhood illnesses. No SD and few HF exhibited adequate HW performance for the assessment, treatment or counselling of sick children. Using the IMCI algorithm, 17.5% of HW assessed the child’s vaccination status, 46.8% assessed nutritional status, and 65.1% assessed children for dehydration. Only 5.1% of HW treatments were appropriate for the assessment. Exit interviews revealed that 5.1% of caregivers knew their children’s illness, and only 19.9% could accurately describe how to administer the prescribed drug. Conclusion This R-HFA, using LQAS principles, is a rapid, simple tool for assessing malaria services and can be used at scale. It identified technical deficiencies that could be corrected by improved continuing medical education, targeted supervision, and recurrent R-HFA assessments of the quality of services.
Evaluation of primary immunization coverage of infants under universal immunization programme in an urban area of Bangalore city using cluster sampling and lot quality assurance sampling techniques
Punith K,Lalitha K,Suman G,Pradeep B
Indian Journal of Community Medicine , 2008,
Abstract: Research Question: Is LQAS technique better than cluster sampling technique in terms of resources to evaluate the immunization coverage in an urban area? Objective: To assess and compare the lot quality assurance sampling against cluster sampling in the evaluation of primary immunization coverage. Study Design: Population-based cross-sectional study. Study Setting: Areas under Mathikere Urban Health Center. Study Subjects: Children aged 12 months to 23 months. Sample Size: 220 in cluster sampling, 76 in lot quality assurance sampling. Statistical Analysis: Percentages and Proportions, Chi square Test. Results: (1) Using cluster sampling, the percentage of completely immunized, partially immunized and unimmunized children were 84.09%, 14.09% and 1.82%, respectively. With lot quality assurance sampling, it was 92.11%, 6.58% and 1.31%, respectively. (2) Immunization coverage levels as evaluated by cluster sampling technique were not statistically different from the coverage value as obtained by lot quality assurance sampling techniques. Considering the time and resources required, it was found that lot quality assurance sampling is a better technique in evaluating the primary immunization coverage in urban area.
Sh. Salarilak,Gh. Garmarudi,A. Nadim
Iranian Journal of Public Health , 1999,
Abstract: Povinding quality health care services, without constant qualitative and quantitative studeies/evaluation, seem to be impossible. High rate of children immunization coverage in Iran, however, represents parts of a quality assessment of mother and child health care services in rural areas of West-Azerbaijan Province, Iran. In this cross-sectional study, LQAS method was employed for the purpose of quality assessment. Children between 10 to 36 months old from the pre-mentions areas constitute the study population of present report. Sample was selected through a multistage sampling method and a questionnaire together with a checklist was utilized for data collection. Findings demonstrate a very high rate immunization coverage of children (>96%). Mother’s knowledge about the data of next vaccination and DPT potential side effect's are estimated to be 32%, and 58%, respectively. Children's overall immunization adequacy rate, despite the high rate coverage, equalled to 59% which does not represent a high quality service in this respect. This study approves the reliability and practicality of LQAS method for quality assurance of health services.
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