CLARKE INTERNATIONAL UNIVERSITY

INSTITUTE OF ALLIED HEALTH SCIENCE

MEDICAL PARASITOLOGY PRACTICAL AT LUBAGA HOSPITAL LABORATORY FROM

2ND JAN TO 2ND FEB, 2020

HAMDA H AWIL RAABI

2018-BMLS-FT-A06

SEMESTER: TWO YEAR TWO

A PRACTICUM ATTACHMENT REPORT SUBMITTED IN PARTIAL FULFILLMENT OF

THE REQUIREMENTS FOR THE AWARD OF A BACHELORS DEGREE IN MEDICAL
LABORATORY SCIENCE OF CLARKE INTERNATIONAL UNIVERSITY
 DEDICATION

Firstly, I thank the Almighty Allah for his mercy, wisdom and provision throughout the period of
the laboratory practicum at Lubaga Hospital. I dedicate this report to my beloved mother
ANAAB ABSHIR and Aunt KOWSAR ELIM for their financially support as well as their
advice spiritually and mentally so that I achieve my goals, may the Almighty Allah grant them
paradise.
Cannot forget all my friends and classmates who advised me and supported me during my
session at Lubaga hospital.

DECLARATION
I HAMDA H AWIL RAABI; declares that this is my original work and has never been
submitted to any institution of learning for any academic award.

Sign:…………………………………….Date:…………………………………

ACKNOWLEDGEMENT

Thanks to the Almighty Allah who has enabled me to complete my placement practicum
report. My faithful appreciation goes to all my lovely and caring lectures most specially to my
parasitology lecture Mss NAKAYE MARTHA who has taken me through the basics of
parasitology and also Mr ABDULAZIZ ADNAN who always helps me through practical sessions
alongside the practicum in my stay at lubaga hospital.
I would like to thank the entire staff of lubaga hospital for all their support, comfortability,
hospitality, discussions and critical practical illustrations that thy offered to me. Special thanks
goes to the management of the lubaga hospital and laboratory department for making sure
that the training takes place in their laboratory.
Would like to thank the staff and management of Clarke international university for their
support by letting me learn a lot besides the theoretical knowledge and me fault coordinator
who took his responsibility to take me to the hospital all due to him may the almighty allah
grant who paradise. Am greatful that am at Clarke international university.

APPROVAL

1. Abdulaziz Adnan

Students coordinator
Lubaga hospital
………………………………………………………………………………..
…………………………………………………………………………………..
 2.Kiseka Alex
General laboratory manager

Lubaga hospital

…………………………………………………………………………………………………..

…………………………………………………………………………………………….

Table of Contents
DECLARATION..............................................................................................................................................4
Approval..................................................................................................................................................5
DEDICATION................................................................................................................................................6
ACKNOWLEDGEMENT.................................................................................................................................7
1.0 CHAPTER ONE........................................................................................................................................8
Background..............................................................................................................................................8
Vision of Lubaga Hospital........................................................................................................................9
1.2 Mandate of the Institution..............................................................................................................10
MISSION................................................................................................................................................10
1.5 COREVALUES....................................................................................................................................10
LABORATORY MANAGEMENT...............................................................................................................10
Laboratory organogram.........................................................................................................................11
Recruitment...........................................................................................................................................12
Laboratory management system...........................................................................................................13
Record keeping......................................................................................................................................13
DATA MANAGEMENT............................................................................................................................14
BUDGETING AND PROCUREMENT.........................................................................................................14
CHAPTER TWO: METHODOLOGY...............................................................................................................15
2.0 MICROSCOPE...................................................................................................................................15
Centrifuge..............................................................................................................................................18
Refrigerator...........................................................................................................................................20
2.1 Parasitological analytical technique.................................................................................................22
Specimen collection, transportation and storage..............................................................................22
Examination of blood specimens for hemoparasites.........................................................................22
Methods for collecting venous blood....................................................................................................22
 Capillary blood..................................................................................................................................23
Staining blood films with field stains.................................................................................................24
Examination of stool specimens for intestinal parasites........................................................................25
Macroscopic examination of stool.....................................................................................................25
Microscopic examination of stool (wet preparation).........................................................................25
Urinalysis...............................................................................................................................................26
Macroscopic examination..................................................................................................................27
Microscopic examination.......................................................................................................................27
3.0 CHAPTER THREE...................................................................................................................................29
Results and Discussion...........................................................................................................................29
3.1 Parasitological tests.....................................................................................................................29
3.2 Discussion of the result................................................................................................................30
3.3 Case studies.....................................................................................................................................30
3.3.1 Case 1.......................................................................................................................................30
3.3.2 Case 2.......................................................................................................................................31
3.3.3 Case 3.......................................................................................................................................31
Possible diagnosis..............................................................................................................................31
Specimen sample...............................................................................................................................32
Tests done.........................................................................................................................................32
4.0 CHAPTER FOUR....................................................................................................................................33
Achievements........................................................................................................................................33
Challenges.............................................................................................................................................33
Recommendations.................................................................................................................................34
Conclusions............................................................................................................................................34
REFFERENCES............................................................................................................................................35
 ABSTRACT
This report is an account of my laboratory attachment during the period at lubaga hospital. The
attachment was done to equip us with the necessary experience and skills to perform and
interpret the results of parasitological diagnostic tests with competence.

The report contains four chapters, the first of which gives a background of the hospital. The
second chapter provides an insight into the methodology behind the procedures I performed
namely preparation, staining and examination of blood films, stool analysis and urinalysis.
Chapter 3 avails a discussion of the results obtained from the tests, with case scenarios included.
Chapter 4 is an overall evaluation of my experiences at this site, with some limitations and
recommendations provided.

CONCLUSION. The laboratory practicum placement was so advantageous in which we were

able to gain knowledge and skills and put the classwork knowledge in to practical. This
practicum I learnt a lot of parasitological procedures such as blood slides, stool analysis and
urinalysis, and I was able to gain enough confidence that is to say at the phlebotomy room.

The training was so educative and interesting mainly due to the supportive staff member of
lubaga hospital and interactive methods of learning by the staff.
 CHAPTER ONE: INTRODUCTION .
1.0 Background

In 1899, the first missionary sisters arrived in Uganda, reached Kisubi and walked to Rubaga
hill. They were welcomed by white father and several Christians together with then the minister
of justice His Excellence Stanisilas Mugwanya and his family who invited them to his home at
the foot of Rubaga hill.

Ssekabaka (late) Daudi Chwa granted them a plot of land at Rubaga hill where a house was built
for them. They immediately set work to care for the sick. One of the initiatives encouraged by
mother Stefo, father Lawdry Mapeera together with trained sister set up a dispensary which later
was transformed in to a hospital treating sleeping sickness and other contagious diseases. It is
now comprised of many formal buildings housing several departments, labs, maternity, training
school and wards for inpatients and outpatients.

Lubaga hospital is one of the oldest hospitals in Uganda having existed for over 100 years, being
founded in 1899. It is the second oldest hospital in the country and has offered health care to
millions of people during its long history of existence.

Over the years the hospital has built a reputation as a provider of affordable health care services
and therefore has continued to attract and treat people of mainly midlevel and low level status.
The hospital has remained faithful to its founding mission of providing quality health care to the
less privileged. For this reason and considering its age and history the hospital has not expanded
its product line but rather remained a modest general hospital. This makes the Hospital
committed to a holistic integration and sustainable action in health, including treatment,
prevention, health promotion and training of health workers.
 Lubaga Hospital has contributed enormously towards the training of health workers in the
country. The currently 330 graduates of the school of Nursing and midwifery, the school of
laboratory assistants and theatre assistants have produced graduates who will be absorbed in the
labor market of Uganda and will offer services to the population in different health institutions.

Lubaga Hospital is owned by the Board of Trustees of Kampala Archdiocese hence is an

Institution of the Catholic Church. The hospital is under the Uganda Catholic Medical Bureau
(UCMB) which is an umbrella organization to which all Catholic Hospitals in Uganda subscribe
and are managed in accordance with the rules and regulations set by UCMB.

The hospital is managed by a Hospital Administration Team (HAT) under the leadership of the
Executive Director. On top of the Management there is a Board of Governors which is comprised
of Management and appointments committee, Finance, Audit and development committee,
Ethical, Disciplinary and Education committees. The Hospital Administrative Team (HAT) is
currently composed of 14 members ie executive Director, Medical Director, hospital
administrator, principal nursing officer and head of public health department among others.

There is a medical core team that meets daily to discuss the daily management issues in the
hospital and make way forward for the smooth running of the hospital activities. This is
composed of the Executive Director, Hospital Administrator, Medical Director, Finance and
manager.

Vision of Lubaga Hospital

To be a sustainable, affordable quality private-not for Profit Health care provider of choice.

1.2 Mandate of the Institution

The hospital is intended to give practical witness to Christian charity and love in giving medical
services to all who are in need irrespective of their religion, tribe, race or political affiliation. The
hospital is also concerned with preservation and maintenance of life in human dignity, generally
the hospital is intended to give services to the poor.

MISSION
To promote Christ's mission of life and healing through providing sustainable, quality and
affordable health care services without discrimination, especially against the less privileged.

1.5 COREVALUES
a) Respect for life and human dignity

b) Justice, equality and equity

c) Efficient, patient centered quality care

d) Integrity, transparency and accountability

e) Good stewardship and commitment

f) Teamwork and respect for each other

g) Professionalism.

LABORATORY MANAGEMENT
The laboratory was well managed according to my observation. This was characterized by team
work, good coordination, and management, smooth and systematic flow of work that yielded
fast, accurate and good services.

Laboratory organogram
Below is an illustration of the Lubaga laboratory organogram.
 LABORATORY DIRECTOR
(Medical Director and Lab Manager)
DR. PETER KIBUUKA/MR. KISSEKA ALEX

Quality Manager:
ReginahNakyeyune
Quality Team: All Department
heads

Specimen Hematolog Clinical and Logistics Microbiology Satellite

Reception
y ImmunoChemi Departmen and Parasitology Labs
and
Departmen stry t Department Departmen
Manageme Head: Alex
t Department Head: Winnie t
nt Head: Richard Kisekka
Head: Head: Aziz Nalukenge Head:
Musoke
DeoGaalya Adnan Vincent
Gaalya Team Sekibaala
Team Members Team Team Members
Robert Team
Members Josephine Team Members Members
Nabukenya Mulumba Members
Peter kyagulanyi Sr. Jane Francis Musoke
Robert Rhoda Kizza RitahNdagire
Josephine Richard Winnie
Muweebwa Maria Nanyanzi Marvin
Stephen Lydia Nakitto Namuli Nakiboneka Lubwama
Gyagenda Winnie ReginahNakyeyu
James Nalukenge ne
Balimanyankya

Recruitment
Only trained, skilled and qualified persons were fit to be offered employment in Lubaga
laboratory.
Recruitment was thought of after loss, expulsion or need for new employees. Application for
positions in the laboratory was as done in a normal. Application forms were brought to the
hospital human resource office. Screening was done and followed by interviews. Successful
members we offered jobs in the laboratory.

Workers conducted themselves in a professional and respectable way observing professional and
ethical code of conduct. Some employees served during day while others during night to handle
night emergencies. The laboratory therefore had a 24 hour service something I thought as being
nice.

Competence, and good performance and coordination was emphasized aimed at creating a
friendly environment out of which smart and quality results were realized.

Failure of employees to conform to the required standards, incompetence, unprofessionalism and

inconsistence general failure in performance and duties invited a verbal warning. Failure to
change, a written warning would follow before the management would handle the issue to decide
on the disciplinary action.

Motivation to workers

The hospital management gave incentives, break tea, lunch allowance to the employees for the
great and dedicated service at the end of the day. This did not only encourage them to work
harder but also gave them a feeling that their good work is recognized and well appreciated.

Leaves were offered to the employees prior to the desired time on a one by one basis.

Laboratory management system

The laboratory had a laboratory information /database management system where patient’s
information on the request forms was entered into the database before tests were carried out.
With locally networked computers, these forms were accessible to laboratory technicians who
had accounts with the laboratory management software. Before a test was performed, the
technicians had to verify whether a particular test had been paid and requested.

After the test has been accurately carried out, results were entered into the computer via the
technicians account, saved, authenticated and printed.

Record keeping.
This involved recording and storing information on the patients’ information/results and the daily
consumption in the laboratory.

Besides the information management system, data and record management systems used
included record books and files. An example of these books was a daily consumption book, stock
management forms and patients’ forms that were kept in files and stored in the drawers.
Reagents and materials brought in the laboratory were recorded in the stock cards that contained
lists of the delivered reagents, date received and their quantities.

Some of these record books were designed by the hospital and those from government and non-
governmental organization like those for HIV and TB.

These helped in the follow up of patients, staff performance and stock management and budget
making so as to aid in the procurement process.

Results obtained in the laboratory were entered into the computer and printed out in form of
patient’s result form. These Forms were issued out at the reception to patients to be taken to the
doctor for interpretation and recommendation.

The bench operating manuals containing the standard operating procedures were safely put in
files for reference and kept in the drawers under the working benches.
DATA MANAGEMENT.
All incoming information was received at the reception mostly inform of request forms. This
information was entered into the computer systems of the hospital and a unique laboratory
number was issued to every patient.

Each of the samples was received and given a number, the system was used to avoid making
mistakes. After the required tests were performed, the results were recorded in the system for
future reference.

The same results were recorded in a counter book as hard copies. The information was then
attained by the requesting clinicians.

BUDGETING AND PROCUREMENT.

The hospital had a financial manager and his team. The accounts office handled all the money
issues.

The laboratory in charge would do the financial year budgeting. In his budget, he listed the
number of tests expected to be carried out in the laboratory, find out the requirements for each
test and the cost of each using catalogues, provided by local suppliers of laboratory equipment.

The laboratory in charge also estimated what was needed for the whole month and finally the
whole year. He would then write a local purchase order and then took it to the chief accountant,
for approval. The local purchase order was then sent to the managing director who would
authorize it. It was then sent to the supplier who must deliver the goods with the invoice which
indicate the right quantity, Batch number and expiry date of the goods that were requested.

The in charge would then confirm this and endorse it with a signature. After receiving the items,
the in charge would then write a note and attach it to the local purchase order, together with the
proforma invoices of the supplier paid within one month
CHAPTER TWO: METHODOLOGY

2.0 Laboratory Equipment’s and Instrumentation in Parasitology Laboratory:

Microscope

Centrifuge

Refrigerator

OTHER MATERIALS INCLUDE

 Gloves
 Slides
 Pipettes
 Rugs

2.2.1 MISCROSCOPE.
A microscope is parasitological instrument used to view small organisms that cannot
be by naked eyes

PURPOSE.

It’s used to examine blood smears in both thick and thin smears and wet
preparations

PRINCIPLE OF OPERATION.

 A microscope is a magnifying instrument. The magnified image of the object is first

produced by a lens close to the object called the objective.
 This collects light from the specimen and forms the primary image. A second lens near
the eye called the eye piece enlarges the primary image, converting it into one that can
enter the pupil of the eye.
 The magnification of the objective multiplied by that of the eyepiece, gives the total
magnification of the image seen in microscopes having a mechanical tube length (MTL)
of 160mm.
  The mechanical is the distance between the shoulder of an objective and the rim of the
eye.

CARE AND MAINTENANCE

 The microscope was kept away from direct sunlight and any source of heat
 It was switched off after use
 And also un plug from the socket to avoid any electrical shock
 Cleaned with dry and clean soft materials such as tissue
 The microscope was place on firm leveled benches

CENTRIFUGE.

A centrifuge is laboratory equipment its driven by a motor spins liquid samples at high speed

PURPOSE.

It’s used for separation of liquid and gas based on density and this separation is achieved by the
spinning of the vessels containing materials at high speed and the centrifugal forces pushes the
material outside that are heavy outside the vessel.

PRINCIPAL OF OPERATION.

 Particles suspended in a fluid move, under the influence of gravity, towards the bottom of
a vessel at a rate that depends on their size and density.
 Centrifugation is a technique designed to use centrifugal forces which are greater than the
force of gravity, to speed up the sedimentation rate of particles.
 The more the speed of rotation, the rapid and effective is the sedimentation

Care and maintenance

 Centrifuges were placed on a firm bench out of direct sunlight.

  We would follow the Manufacturer’s instructions and was never operated at a higher
speed than the manufacturer’s recommendation.
 The buckets of the centrifuge were cleaned regularly with a cloth soaked in a non-
corrosive disinfectant such as 70% alcohol or 10% formalin.
 The buckets of the centrifuge were always balanced

Refrigerator
 It consisted of two storage compartments; one for frozen items and another for low
temperatures.

Purpose

 Laboratory refrigerators are used for keeping cool samples, culture media or specimens
for preservation.

Principle

 A liquid circulates as gas within the evaporator tubes located in the cabinets.
 Conversion of a liquid to gas requires latent heat of vaporization which the liquid
withdraws from the surrounding thus lowering the temperatures in the cabinet. The
refrigerant then circulates in condenser coils located outside the refrigerator as a
liquid. In condensing from vapour to liquid there is loss of heat energy to the
surrounding.
 A compressor increases the pressure in the condenser facilitating condensation. A
valve releases this high pressure as the liquid is evaporated in the cabinets and the
cycle continues.
 Parasitological specimens
Blood.

Purpose.

Examination of blood smear was requested for specific diagnosis of blood parasites
that may be present for example, in malaria parasites are found in redblood cells

Stool.
Macroscopic examination
Consistency: formed, semi-formed, watery or bloody.
Coloure: black, brown and bloody stained

Microscopic examination

 Place a drop of normal saline on a slide.

 Use an applicator stick to pick up a small portion of stool and mix with the saline.
 Place a cover slip on the preparation.
 Examine microscopically under x10
 If cysts, trophozoites or eggs are seen, add a drop of iodine and examine under x40
 Discard all used materials immediately.

Results

Presence or absence of;

 Ova
 Cysts
 Oocysts
 Adult worms
Purpose.

Examination of stool was to investigate intestinal parasites infections and also those
helminthic parasites that may be harmful
Stool samples examinations was also to diagnose certain conditions affecting the
digestive track that may parasites or bacteria
The examination of trophozoites in the active or cystic form in chronic phase may be
detected as its in host and also fresh stool and this infection may as results of
ingestion of anything that contaminated with faces

Urine.
Materials
 Centrifuge tubes
 Slides
 Cover slips
 Urine sample
 Gloves
 Strips ( for chemistry examination)
 Microscope

Macroscopic.

The urine seen whether it is pale yellow, dark yellow, clear, amber, bloody, turbid

Microscopic

The urine is centrifuged to obtain some sediment that may be used to examine the
presence of the crystals, casts, redblood cell, epithelia cells and parasites that may be
present
Method

 Label a centrifuge tube with the laboratory number of the sample.

 Centrifuge 10mls of the sample at 3000rpm for minutes.
 Decant the supernatant into a bucket of disinfectant
 Re-suspend the deposit by tapping the bottom of the centrifuge tube.
 Transfer a small quantity of the deposit on a slide.
 Apply a cover slip and examine under x10 and x40
 Record the findings

parasites that may present in urine;

 Schistosoma haematobium ova and other species

 Trichomonas vaginalis trophozoites
 Wuchereria bancrofti, oncocera volvulus

Parasitological Analytical Techniques

Phlebotomy:
This is the process of drawing and collecting blood from the patients
 I collected blood with care adequate safety precautions ensure test results are reliable,
avoided contamination of the sample any infection from transmissible pathogen that
may present
I wore protective gloves while collecting blood from the patients as well as handling
blood samples, discarded the used lancets, needles and also the gloves in the
biohazards bins named accordingly
The phlebotomy processing begins from the labelling of the spacemen containers
with the name, age, sex of the patients and test requested

Procedures for Collecting of Blood Samples:

Capillary blood
Materials used when collecting capillary blood.

 Pricker
 Sterile cotton wool/ gauze
 Slides
 Gloves
 Disinfectant e.g. 70% alcohol

Purpose.

Capillary blood is mainly collected for blood slides this is because the malaria parasites in their
cycle tend to be more in the peripherals

This is another fact that anti-coagulated blood is more easily washed off the slides during
staining, microfilaria or when the patient is young children the volume of blood is small for
example measuring the haemoglobin and also other parasitological tests
 Sites for Capillary Blood Sampling

Capillary blood can be sampled from the earlobe, heels mostly for infants below 6months, toes,
ringfinger

Method.

 Clean the puncture area with a disinfectant and allow it to dry

 Using the pricker make a rapid puncture deep enough to allow free flow of blood
 Wipe the first drop of blood with cotton wool, use the next drops of blood
 When sufficient blood has been collected, cover the punctured area with a cotton wool
until bleeding stops

Venous blood.

Materials used when collecting venous blood.

 Disinfectants e.g 70% alcohol

 Syringe and needles
 Tourniquet
 Blood collection container
 Cotton wool vacutainer needles
 Vacutainers holder ( this can be purple top, red top, green top etc)

Purpose.

Collecting of venous blood involves the drawing of large volumes of the blood to perform tests
that require such large amount of blood

When several further tests would be required or serum from clotted blood sample is needed e.g.
for antibody test

Sites for Venous Blood Sample

  Venous blood would be sample from,
 At the tip of the finger
 Femoral vein

Method.

It can be done for neonates its site is free of arterial flow and the skin is pierced with a sterile
lancet and after the drop of blood is formed the venous blood is captured by capillary tube, and
the blood drops have a tendency of haemolysis especially if the finger is squeed to obtain more
of the blood.

Staining Blood Films with Field Stains

Principles

 When romanowsky stains are diluted, they are ionised into basic methylene blue and
acidic eosin.
 Basic methylene blue stains the acidic part of the cell and acidic eosin stains the basic
part of the cell.

 Materials
 Field stain A $ B
 Clean water
 Staining jars
 Drying rack
 Methanol
  Gloves
 Slides

Methods for staining a thin blood film

 Fixed the smear in methanol for one minute and allowed to air dry.
 Dipped the film in fields stain B for three seconds and drained off the excess.
 Rinsed in clean water for five seconds
 Dipped the film in fields stain A for five seconds
 Rinsed in clean water for five seconds
 Placed the slide upright on a rack to dry

Methods for staining thick films

 Dipped the smear in field stain A for four seconds and drained off the excess.
 Rinsed gently in a clean water for five seconds.
 Dipped the smear in field stain B for four seconds.
 Rinsed in clean water for 5 seconds
 Cleaned the slide and placed it on the rack to dry.
3.0 CHAPTER THREE
Results and discussion
Parasitological tests