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. This study aimed to determine the effect of in-service training on the quality of microscopic smear for tuberculosis examination, after controlling for the effect of accreditation status. Subject and Method: This was a cross sectional study conducted at 23 Puskesmas (Community Health Center) in Madiun, East Java, from March to April 2018. A sample of 230 subjects was selected for this study by stratified random sampling involving accredited and non accredited Puskesmas. The dependent variable was quality of microscopic smear. The independent variables were in-service training and accreditation status of the Community Health Center. The data were collected by questionnaire and analyzed by a multiple logistic regression model. Results: In-service training was effective in improving the quality of microscopic smear (b= 4.26; 95% CI= 2.28 to 7.95; p<0.001), after controlling for the effect of accreditation status (b= 8.75; 95% CI= 3.75 to 20.43; p<0.001). Adjusted R2= 24.5% Conclusion: In-service training is effective in improving the quality of microscopic smear, after controlling for the effect of accreditation status.
Keywords: quality of microscopic smear, in-service training, accreditation status,