Since 2009, the Institute of Tropical Medicine (ITM) in Antwerp, Belgium was organizing a biennial external quality assessment programme (EQAP) to assess the proficiency of laboratories involved in the Buruli ulcer (BU) diagnostics by molecular detection of Mycobacterium ulcerans in clinical samples. The fourth round organized in 2018 was the last one conducted by ITM. ITM announced during the last WHO technical advisory group (TAG) on BU held in Geneva on the 27th of March 2019, that they will be unable to provide further run of EQA. So, WHO TAG recommended that this will be taken by an African endemic country. WHO considers the urgent need to analyse the impact of these four rounds of external evaluation and decide on the way forward, since data presented at the BU meeting on 25th- 27th of March in Geneva demonstrated a continuing poor rate of confirmation of BU cases by PCR.
During these four rounds, 18 laboratories from 13 countries participated in the EQAP amongst them ten laboratories were from eight African endemic countries. Of the ten African laboratories, four participated in the all the four EQAP rounds and three in three rounds; overall results showed that the median performance of these labs improved over the four rounds. However, the proportion of laboratories reporting false positive cases remains high and indicates a problem of specificity probably due to contamination. The proportion of laboratories reporting both false positives and false negatives is still disturbing. This raises the issue of the quality of the data reported by WHO in Africa as well as the results of the studies carried out in these different laboratories in various countries.
By the time ITM ceases the evaluation process, it is important to rapidly propose a model that improves the performance of laboratories involved in the molecular diagnosis of Buruli ulcer in the endemic countries in Africa, to ensure that patients receive correct diagnostic results and that data recorded by WHO are accurate, reliable and comparable with another continent like Australia.
WHO intends to transfer the programme to a volunteer African endemic laboratory which demonstrated good performance during the four rounds of earlier EQAP programme. The Mycobacteriology service of Centre Pasteur du Cameroun (CPC) was judged one of the best performing laboratory.
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Monday, 21 October 2019 (Day 1)
Tuesday, 22 October 2019 (Day 2)
Wednesday, 23 October 2019 (Day 3)
Thursday, 24 October 2019 (Day 4)
During these four rounds, 18 laboratories from 13 countries participated in the EQAP amongst them ten laboratories were from eight African endemic countries. Of the ten African laboratories, four participated in the all the four EQAP rounds and three in three rounds; overall results showed that the median performance of these labs improved over the four rounds. However, the proportion of laboratories reporting false positive cases remains high and indicates a problem of specificity probably due to contamination. The proportion of laboratories reporting both false positives and false negatives is still disturbing. This raises the issue of the quality of the data reported by WHO in Africa as well as the results of the studies carried out in these different laboratories in various countries.
By the time ITM ceases the evaluation process, it is important to rapidly propose a model that improves the performance of laboratories involved in the molecular diagnosis of Buruli ulcer in the endemic countries in Africa, to ensure that patients receive correct diagnostic results and that data recorded by WHO are accurate, reliable and comparable with another continent like Australia.
WHO intends to transfer the programme to a volunteer African endemic laboratory which demonstrated good performance during the four rounds of earlier EQAP programme. The Mycobacteriology service of Centre Pasteur du Cameroun (CPC) was judged one of the best performing laboratory.
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Monday, 21 October 2019 (Day 1)
- 8h-8h30 Arrival of participants
- 8h30-9h00 Opening ceremony – Welcome speech of Centre Pasteur and WHO; Pr Elisabeth Carniel, Dr Phanuel Habimana
- 9h-9h30 Opening lecture: “Overview of Buruli ulcer and efforts to improve diagnosis over the past 10 years ”. Dr Asiedu Kingsley WHO
- 9h30-10h00 Family photograph and coffee break
- 10h00-10h45 Presentation of BU LAB Network Dr Sara Eyangoh
- 10h45-12h15 Discussion and adoption of network functioning; All
- 12h30-13h30 Lunch; All
- 13h30-17h30 Lab’s presentation (11 laboratories): activities, identification of strengths and weaknesses, challenges. Presentation: 10min, discussion: 5 min
Tuesday, 22 October 2019 (Day 2)
- 9h-10h Presentation of SOPs. Synthesis of materiel and methods used by the 11 labs; Dr Estelle Marion
- 10h00-12h00 Discussion of SOPs: DNA extraction, mix preparation, DNA standard, primers and probe, PCR reagents; All
- 12h00-13h00; All
- 13h00-15h00 Harmonization and adoption of the SOPs;All
- 15h00-17h00 Discussion of a new model EQA program. Country visit planning; All
Wednesday, 23 October 2019 (Day 3)
- 9h00-10h30 Challenges for each lab to implement the harmonized SOPs (5mn presentation of each lab); All
- 10h30-12h30;Group1: discussion on Integrated laboratory (NTDs) and role of national programmes; Experts and 5 labs;
Group 2: Multicentric studies using the network; Experts and 5 labs; - 12h00-13h30 Lunch; All
- 13h30-15h30 Restitution of each group and discussion;
- 15h30-17h00 Recommendations and Closing remarks;
Thursday, 24 October 2019 (Day 4)
- Field visit to Akonolinga District Hospital