Medical Laboratories in Sub-Saharan Africa That Meet International Quality Standards

Schroeder, Lee F.; Amukele, Timothy

doi:10.1309/ajcpq5ktkagsscfn

Cited by 102 publications

(93 citation statements)

References 9 publications

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“…AKI diagnosis and treatment are limited by available resources, including a lack of laboratory supplies and necessary therapeutic armamentarium and adequate medical infrastructure and personnel. 17,18 To better understand the barriers to improving awareness of AKI in developing countries, a questionnaire was developed by a group of 20 nephrologists during the 2014 International Society of Peritoneal Dialysis (ISPD) meetings in Madrid. These nephrologists included physicians from sub-Saharan Africa, Southeast Asia, North and South There were substantial variations noted in available therapies and diagnostic capabilities when comparing rural health centers, district health centers, and regional health centers.…”

Section: Obstacles To Diagnosis and Treatment Of Aki In Developing Comentioning

confidence: 99%

“…Most of the countries (37 of 49) had no laboratories accredited to international quality standards. 18 Moreover, the laboratory services that were available were generally available only in large urban centers. Additional challenges to treat patients with AKI include delays in patients seeking health care and an inability of patients to get to and pay for it.…”

Section: Obstacles To Diagnosis and Treatment Of Aki In Developing Comentioning

confidence: 99%

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Acute kidney injury: risk factors and management challenges in developing countries

Ponce¹,

Balbi²

2016

IJNRD

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Acute kidney injury (AKI) is a major global health problem in both developed and developing nations, negatively affecting patient morbidity and responsible for an estimated 1.4 million deaths per year. Although the International Society of Nephrology set a goal of eliminating preventable deaths from AKI by 2025, implementation of this program in developing countries presents major challenges not only because of the lack of resources but also because of the scarce data addressing the epidemiology and causes of AKI in developing countries, the limited health care resources to diagnose and treat AKI, and the poor awareness of the impact of AKI on patient outcomes.

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Section: Obstacles To Diagnosis and Treatment Of Aki In Developing Comentioning

confidence: 99%

Section: Obstacles To Diagnosis and Treatment Of Aki In Developing Comentioning

confidence: 99%

Acute kidney injury: risk factors and management challenges in developing countries

Ponce¹,

Balbi²

2016

IJNRD

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“…In order to ensure accuracy, laboratory technicians must be properly trained and there must be effective quality control and quality assurance programs in place; however this is often not possible in our experience [16]. A recent survey suggests that many laboratories in Sub-Saharan Africa lack quality control and many are not WHO-accredited [17]. The poor quality of some clinical laboratories leads to a negative impact on healthcare as a whole, perpetuating misdiagnoses and decreasing clinician and community confidence in the use of such services.…”

Section: Introductionmentioning

confidence: 99%

Malaria over-diagnosis in Cameroon: diagnostic accuracy of Fluorescence and Staining Technologies (FAST) Malaria Stain and LED microscopy versus Giemsa and bright field microscopy validated by polymerase chain reaction

et al. 2017

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BackgroundMalaria is a major world health issue and its continued burden is due, in part, to difficulties in the diagnosis of the illness. The World Health Organization recommends confirmatory testing using microscopy-based techniques or rapid diagnostic tests (RDT) for all cases of suspected malaria. In regions where Plasmodium species are indigenous, there are multiple etiologies of fever leading to misdiagnoses, especially in populations where HIV is prevalent and children. To determine the frequency of malaria infection in febrile patients over an 8-month period at the Regional Hospital in Bamenda, Cameroon, we evaluated the clinical efficacy of the Flourescence and Staining Technology (FAST) Malaria stain and ParaLens AdvanceTM microscopy system (FM) and compared it with conventional bright field microscopy and Giemsa stain (GS).MethodsPeripheral blood samples from 522 patients with a clinical diagnosis of “suspected malaria” were evaluated using GS and FM methods. A nested PCR assay was the gold standard to compare the two methods. PCR positivity, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined.ResultsFour hundred ninety nine samples were included in the final analysis. Of these, 30 were positive via PCR (6.01%) with a mean PPV of 19.62% and 27.99% for GS and FM, respectively. The mean NPV was 95.01% and 95.28% for GS and FM, respectively. Sensitivity was 26.67% in both groups and specificity was 92.78% and 96.21% for GS and FM, respectively. An increased level of diagnostic discrepancy was observed between technicians based upon skill level using GS, which was not seen with FM.ConclusionsThe frequency of malarial infections confirmed via PCR among patients presenting with fever and other symptoms of malaria was dramatically lower than that anticipated based upon physicians’ clinical suspicions. A correlation between technician skill and accuracy of malaria diagnosis using GS was observed that was less pronounced using FM. Additionally, FM increased the specificity and improved the PPV, suggesting this relatively low cost approach could be useful in resource-limited environments. Anecdotally, physicians were reluctant to not treat all patients symptomatically before results were known and in spite of a negative microscopic diagnosis, highlighting the need for further physician education to avoid this practice of overtreatment. A larger study in an area with a known high prevalence is being planned to compare the two microscopy methods against available RDTs.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-017-0251-0) contains supplementary material, which is available to authorized users.

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“…9,10 Although the exact total number of medical laboratories in Africa is not known, Uganda alone had 1234 government laboratories in 2007. 9 This is a clear indication of how few laboratories in Africa have successfully implemented quality management systems with the goal of international accreditation.…”

Section: Introductionmentioning

confidence: 99%

Implementation of the World Health Organization Regional Office for Africa Stepwise Laboratory Quality Improvement Process Towards Accreditation

et al. 2016

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BackgroundThe increase in disease burden has continued to weigh upon health systems in Africa. The role of the laboratory has become increasingly critical in the improvement of health for diagnosis, management and treatment of diseases. In response, the World Health Organization Regional Office for Africa (WHO AFRO) and its partners created the WHO AFRO Stepwise Laboratory (Quality) Improvement Process Towards Accreditation (SLIPTA) program.SLIPTA implementation processWHO AFRO defined a governance structure with roles and responsibilities for six main stakeholders. Laboratories were evaluated by auditors trained and certified by the African Society for Laboratory Medicine. Laboratory performance was measured using the WHO AFRO SLIPTA scoring checklist and recognition certificates rated with 1–5 stars were issued.Preliminary resultsBy March 2015, 27 of the 47 (57%) WHO AFRO member states had appointed a SLIPTA focal point and 14 Ministers of Health had endorsed SLIPTA as the desired programme for continuous quality improvement. Ninety-eight auditors from 17 African countries, competent in the Portuguese (3), French (12) and English (83) languages, were trained and certified. The mean score for the 159 laboratories audited between May 2013 and March 2015 was 69% (median 70%; SD 11.5; interquartile range 62–77). Of these audited laboratories, 70% achieved 55% compliance or higher (2 or more stars) and 1% scored at least 95% (5 stars). The lowest scoring sections of the WHO AFRO SLIPTA checklist were sections 6 (Internal Audit) and 10 (Corrective Action), which both had mean scores below 50%.ConclusionThe WHO AFRO SLIPTA is a process that countries with limited resources can adopt for effective implementation of quality management systems. Political commitment, ownership and investment in continuous quality improvement are integral components of the process.

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Medical Laboratories in Sub-Saharan Africa That Meet International Quality Standards

Abstract: Most SSA countries do not have an accredited clinical laboratory. For those that do, there is a strong correlation between country-specific accredited laboratory density and per-capita health expenditures.

Cited by 102 publications

References 9 publications

Acute kidney injury: risk factors and management challenges in developing countries

Acute kidney injury: risk factors and management challenges in developing countries

Malaria over-diagnosis in Cameroon: diagnostic accuracy of Fluorescence and Staining Technologies (FAST) Malaria Stain and LED microscopy versus Giemsa and bright field microscopy validated by polymerase chain reaction

Implementation of the World Health Organization Regional Office for Africa Stepwise Laboratory Quality Improvement Process Towards Accreditation

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