Quality and resilience of clinical laboratories in Rwanda: a need for sustainable strategies

Figures & data

Table 1. Interventions per laboratory group between 2010 and 2019 (X indicates the year of intervention).

Laboratory groups & Interventions	2010	2011	2012	2013	2014	2015	2016	2017	2018	2019
Group one laboratories (R1-R5) n=5
Baseline	X
Training in LQMS	X
Mentorship	X	X	X
Exit		X
Follow-up			X
Other assessments								X		X
Group two laboratories (D1-D5) n=5
Baseline		X
Training in LQMS		X
Financial incentives		X	X	X	X	X
Mentorship		X	X	X	X	X	X
Exit			X
Follow-up				X	X	X	X	X	X	X
Group three laboratories (1–37) n=37
Cohort one (# 5)
Baseline				X
Training in LQMS				X
Mentorship				X
Exit					X
Follow-up										X
Cohort two (# 8)
Baseline					X
Training in LQMS					X
Mentorship					X
Exit						X
Follow-up										X
Cohort three (# 9)
Baseline						X
Training in LQMS						X
Mentorship						X
Exit							X
Follow-up										X
Cohort four (# 9)
Baseline							X
Training in LQMS							X
Mentorship							X
Exit								X
Follow-up										X
Cohort five (# 6)
Baseline								X
Training in LQMS								X
Mentorship								X
Exit									X
Follow-up										X

Table 2. Laboratory groups quality performance in star rating from baseline, exit, and follow-up assessments (n = 47).

Laboratory groups assessments	0 star	1 star	2 stars	3 stars	4 stars	5 stars
Group one laboratories (R1-R5) n=5
Baseline	4	1
Exit		1	2	2
Follow-up				2	3
Group two laboratories (D1-D5) n=5
Baseline	5
Exit		1	2	2
Follow-up				2	3
Group three laboratories (1–37) n=37
Baseline	37
Exit	5	10	17	4	1
Follow-up	9	22	4	2

Table 3. Quality performance changes in three laboratory groups with different interventions.

Laboratory groups		Year of assessment	Mean (SD)	[95% CI]	p value
All laboratory groups(n=47)
	Baseline	Different years	35.3(10.1)	[32.3–38.3]
	Exit	Different years	65.8(9.2)	[63.2–68.5]	<0,001
Laboratory group one (n=5)
	Baseline	2010	43(19.8)	[18.3–67.6]
	Exit	2011	69.6(8.8)	[58.6–80.6]	0.02
	Follow-up	2012	85.8(7.2)	[78.0–93.5]	0.01
	2017 assessment	2017	64.6(17.3)	[43.1–86.0]	0.03
	2019 assessment*	2019	69.2(9.6)	[56.7–92.0]	0.03
Laboratory group two (n=5)
	Baseline	2011	29.4(13.0)	[13.1–45.6]
	Exit	2012	70.6(7.3)	[61.5–79.7]	<0,001
	Follow-up	2013	79.8(4.9)	[73.6–85.9]	0.04
	2014 assessment	2014	82.4(4.7)	[76.5–88.2]	0.01
	2015 assessment	2015	87.2(4.7)	[81.2–93.1]	0,002
	2016 assessment	2016	78.4(6.2)	[70.6–86.1]	0.1
	2017 assessment	2017	71.8(9.7)	[59.7–83.8]	0.8
	2018 assessment	2018	75.8(6.1)	[68.1–83.4]	0.2
	2019 assessment	2019	86.6(5.2)	[74.1–87.0]	0.03
Laboratory group three(n=37)
	Baseline	Different years	35.0(7.5)	[32.5–37.5]
	Exit	Different years	64.7(9.3)	[61.6–67.8]	<0,001
	Follow-up	2019	57.3(9.4)	[53.7–59.5]	<0,001

*The comparison was made for four instead of five laboratories as one laboratory did not undergo 2019 assessment. Mean (SD) for the four laboratories at the follow-up assessment (not mentioned in Table 3) =84.4% (6.3), CI [74.3–94.6] and 69.2% (9.6), CI [56.7–92.0] at the exit assessment.

Figure 1. Quality performance in group one laboratories (n = 5).

Figure 2. Overtime quality performance in group two laboratories (n = 5).

Figure 3. Evolution of quality performance at baseline, exit, and follow-up assessments in group three laboratories (n=37).