External Quality Assurance Performance of Clinical Research Laboratories in Sub-Saharan Africa

Am J Clin Pathol. 2012 Nov;138(5):720-3. doi: 10.1309/AJCP8PCM4JVLEEQR.


Patient Safety Monitoring in International Laboratories (JHU-SMILE) is a resource at Johns Hopkins University that supports and monitors laboratories in National Institutes of Health-funded international clinical trials. To determine the impact of the JHU-SMILE quality assurance scheme in sub-Saharan African laboratories, we reviewed 40 to 60 months of external quality assurance (EQA) results of the College of American Pathologists (CAP) in these laboratories. We reviewed the performance of 8 analytes: albumin, alanine aminotransferase, creatinine, sodium, WBC, hemoglobin, hematocrit, and the human immunodeficiency virus antibody rapid test. Over the 40- to 60-month observation period, the sub-Saharan laboratories had a 1.63% failure rate, which was 40% lower than the 2011 CAP-wide rate of 2.8%. Seventy-six percent of the observed EQA failures occurred in 4 of the 21 laboratories. These results demonstrate that a system of remote monitoring, feedback, and audits can support quality in low-resource settings, even in places without strong regulatory support for laboratory quality.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Africa South of the Sahara
  • Biomedical Research / standards*
  • Humans
  • Laboratories / standards*
  • Patient Safety / standards
  • Quality Assurance, Health Care / standards*