Health laboratory policy in Tanzania

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Tanzania has not yet designed or developed its specific and more practical check list guide for this deadliest disease to suit its environments and professionals who practice malaria investigation regarding the handling and processing of specimen for malaria parasite. The checklist guidelines should be developed and displayed or posted over the laboratory premises to remand an individual performing laboratory investigation of malaria. Health workers use the general knowledge obtained from training institutions to perform all activities involved in the diagnosis of diseases including malaria. However a code of ethics for health laboratory personnel emphasizes that, laboratory personnel are responsible for the logic process from the acquisition of the specimen to the production of data and final report of test results (1998:11).
An individual working in the health laboratory is responsible to exercise professional judgments, skills and care while meeting established standard. It therefore required that all procedural norms be followed in order to get reliable result (Tanzania Standard Guidelines for Health Laboratory Services, 2003:14- 15). Tanzania, Standard Guidelines for Health Laboratory Services recommend blood film for malaria parasite as essential test and recommend Field stain A and B methods without being diluted. The staining solutions are isotonic with blood plasma; therefore cells and parasite are well preserved during staining especially in fresh blood. If the specimen is to be well made and stained it is essential to use only perfect clean slides that are free from surface-bloom, scratches and grease (Cheesbrough, 1998:37). Clean hands free of greases enhance the reliability
of results in diagnosing malaria parasites.

International policy and procedural norms regarding blood specimen handling and processing for malaria parasite

Internationally accepted normal procedure for handling and processing of blood specimens for malaria parasites include the fact that one or three drops of a blood will suffice for the preparation of thick blood film (Cheesbrough 1998:37). Well-prepared and well-stained thick blood film remains currently the golden standard for detecting and identifying malaria parasites. Thick blood is used to concentrate the parasite. Field stain A and B are the reagents recommended for malaria diagnosis. Field rapid method gives beautiful staining of malaria parasites in thick film. Using field stain, the white cells are well stained also and reticulocytosis can be detected in thick film. Stained white bloo
cells and detection of reticulocytosis assist clinicians in judging the acuteness of malaria attack (Cheesbrough 1998:149).

Sample and Sampling Technique

Blood slide specimens from 85 Pediatric patients were collected from pediatric wards, the pediatric clinic and laboratory itself.
A simple random technique was used to select blood specimens from patients with typical symptoms and a provisional diagnosis of malaria as indicated on their medical records. Observation was done at random, among patients ordered for blood investigation of malaria parasites. Blood specimens were collected from any pediatric patient suspected and provisionally diagnosed malaria in a given time of the day. Each patient in pediatric units, diagnosed of malaria was followed up through file number.
Available nurses responsible for blood collection were assigned these files for blood collections. Observation was done to any available nurse who involved in blood collection. Investigation forms ordered by doctors were given file number. A researcher utilized these file number and added code number for these sample in data collecting tool for follow up purposes (See Annex A). Each person assigned for blood collection was followed up and observation done. Each specimen that was observed during blood collection was also marked for follow up. Laboratory specimen marked for research was communicated to the laboratory. Communications between pediatric units, laboratory
and researcher were established to ensure that all samples of blood collected should also be observed in the laboratory. A researcher followed up all specimens, which are due for examination and for recording. Each specimen was followed in the laboratory utilizing code number and file number in data collecting tool and investigation form.
Observation of the collecting and processing of blood specimen was done with specimens from the different patients available at different time. Specimens were collected during morning, afternoon and evening for seven days of the week. The temporal distribution of blood specimen represented factors such as different categories of health workers, time of the day, the day of the week that could influence results. Malaria blood specimens were observed from the point of collection to the point of microscopic investigation of the specimen at the laboratory in Muhimbili National hospital. Each collected specimen was observed during collection and followed up through to the time of investigation and producing feedback using code number, and patient number available in data collecting tool. Time factor was also considered during observation.

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CHAPTER 1
1.1 INTRODUCTION
1.2 BACKGROUND AND CONTENT OF THE STUDY
1.2.1 Geographical information Of Tanzania
1.2.2 Disease profile
1.2.3 Health system in Tanzania
1.2.4 Laboratory services policy and procedure in Tanzania
1.3 BACKGROUND INFORMATION ABOUT THE RESEARCH PROBLEM
1.3.1 Statement of the research problem
1.4 AIM OF THE RESEARCH
1.5 OBJECTIVES OF THE RESEARCH
1.6 ASSUMPTIONS UNDERLYING THE STUDY OF THE HANDLING AND PROCESSING OF BLOOD SPECIMENS IN MEDICAL LABORATORY SERVICES
1.7 SIGNIFICANCE OF THE STUDY OF HANDLING AND PROCESSING OF BLOOD SPECIMEN
1.8 OPERATIONAL DEFINITIONS OF CONCEPTS USED IN THE RESEARCH REPORT
1.9 SCOPE AND LIMITATIONS OF THE STUDY
1.10 SUMMARY
CHAPTER 2 LITERATURE REVIEW
2.1 INTRODUCTION AND HISTORICAL BACKGROUND
2.2 LITERATURE REVIEW ON HANDLING AND PROCESSING OF SPECIMEN IN MEDICAL LABORATORY
2.2.1 The important role of laboratories as an integral part of effective health services, integration of laboratory services at different level of health care and scope and responsibilities of effective laboratory services
2.2.2 Quality in laboratory services
2.2.3 Factors influencing quality in laboratory services
2.2.4 Policies and procedural norms with regards to diagnosis and treatment of malaria
2.2.4 .1. Health laboratory policy in Tanzania
2.2.4.2 International policy and procedural norms regarding blood specimen handling and processing for malaria parasite
2.2.4.3 International Requirements for specimen handling and processing
2.2.4.4 Procedure for blood specimen collection
2.2.4.5 Procedure for Field’s staining and microscopic examination of blood films
2.3. SUMMARY
CHAPTER 3 RESEARCH METHODOLOGY
3.1. RESEARCH DESIGN
3.2. RESEARCH POPULATION
3.2.1 Type of research population
3.2.2. Sample and Sampling Technique
3.3 APPROACH TO THE RESEARCH
3.4. VALIDITY AND RELIABILITY
3.5 SUMMARY
CHAPTER 4 DATA ANALYSIS AND INTERPRETATION
4.1. INTRODUCTION
4.2. DATA MANAGEMENT AND ANALYSIS
4.3. SUMMARY
CHAPTER 5 CONCLUSIONS AND RECOMMENDATIONS
5.1. CONCLUSION
5.2 RECOMMENDATIONS FOR IMPROVEMENT OF HANDLING AND PROCESSING OF BLOOD SPECIMENS
5.2.1 RECOMMENDATIONS FOR FURTHER STUDY
5.4 SUMMARY
6.0 LIST OF REFERENCES