| Summary: | Background: Tuberculosis (TB) remains major cause of morbidity and mortality due to any one
of infectious agent worldwide. In low income countries, Ziehl-Neelsen sputum smear microscopy is
the only cost-effective tool for diagnosis and monitoring of patients on treatment. Refresher
training for laboratory professionals involved in Acid Fast Bacilli (AFB) microscopy at peripheral
health facilities is important. This study aimed to assess factors affecting the quality of microscopic
tuberculosis examination in Madiun, East Java, using a multilevel analysis model.
Subjects and Method: A cross-sectional study conducted at 23 puskesmas (community health
centers) in Madiun, East Java, from March to April 2018. A sample of 230 preparations was
selected by simple random sampling. The dependent variable was quality of microscopic TB
examination. The independent variables were tenure, refresher training, and accreditation status of
puskesmas. The data were collected by questionnaire and analyzed by a multilevel logistic
regression.
Results: Quality of microscopic TB examination was positively associated with tenure ≥3 years
(b= 2.77; 95% CI= 0.81 to 4.73; p= 0.006) and accredited community health center (b= 3.06; 95%
CI= 0.81 to 4.62; p<0.001). The association between refresher training and quality of microscopic
TB examination was not statistically significant (b= -0.51; 95% CI= -2.33 to 1.32; p= 0.580).
Puskesmas had a contextual effect on quality of microscopic TB examination with ICC= 22.01%.
Conclusion: Quality of microscopic TB examination is positively associated with tenure and
accredited puskesmas. Refresher training for laboratory technicians was not effective in improving
the quality of microscopic TB examination Puskesmas has a considerable contextual effect on
quality of microscopic TB examination.
Keywords: microscopic TB examination, quality, tenure, community health center, accreditation,
multilevel analysis
Correspondence:
Sri Hartini, Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36 A,
Surakarta 57126, Central Java. Email: hartinis191@gmail.com
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