Practical recommendations for strengthening national and regional laboratory networks in Africa in the Global Health Security era

Best, Michele L.; Sakandé, Jean

doi:10.4102/ajlm.v5i3.471

Cited by 13 publications

(20 citation statements)

References 9 publications

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“…155 In addition, the professional, academic, and regulatory environment should facilitate implementation of clinical bacteriology in health-care organisation and bio medical curricula. Reference laboratories in low-resource settings should extend their capacity to support basic bacteriology and antimicrobial resistance, 156 rather than perpetuating existing silos through the restriction of their activities to HIV, tuberculosis, or malaria reference work. 41,145 Further opportunities to support the implemen tation of clinical bacteriology are linkage to the WHO prequalification programme of in-vitro diagnostics 157 and extension of the Maputo Declaration goals to include clinical bacteriology.…”

Section: Beyond the Six Building Blocksmentioning

confidence: 99%

Clinical bacteriology in low-resource settings: today's solutions

Ombelet

Ronat

Walsh

et al. 2018

The Lancet Infectious Diseases

149

159

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Low-resource settings are disproportionately burdened by infectious diseases and antimicrobial resistance. Good quality clinical bacteriology through a well functioning reference laboratory network is necessary for effective resistance control, but low-resource settings face infrastructural, technical, and behavioural challenges in the implementation of clinical bacteriology. In this Personal View, we explore what constitutes successful implementation of clinical bacteriology in low-resource settings and describe a framework for implementation that is suitable for general referral hospitals in low-income and middle-income countries with a moderate infrastructure. Most microbiological techniques and equipment are not developed for the specific needs of such settings. Pending the arrival of a new generation diagnostics for these settings, we suggest focus on improving, adapting, and implementing conventional, culture-based techniques. Priorities in low-resource settings include harmonised, quality assured, and tropicalised equipment, consumables, and techniques, and rationalised bacterial identification and testing for antimicrobial resistance. Diagnostics should be integrated into clinical care and patient management; clinically relevant specimens must be appropriately selected and prioritised. Open-access training materials and information management tools should be developed. Also important is the need for onsite validation and field adoption of diagnostics in low-resource settings, with considerable shortening of the time between development and implementation of diagnostics. We argue that the implementation of clinical bacteriology in low-resource settings improves patient management, provides valuable surveillance for local antibiotic treatment guidelines and national policies, and supports containment of antimicrobial resistance and the prevention and control of hospital-acquired infections.

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Section: Beyond the Six Building Blocksmentioning

confidence: 99%

Clinical bacteriology in low-resource settings: today's solutions

Ombelet

Ronat

Walsh

et al. 2018

The Lancet Infectious Diseases

149

159

View full text Add to dashboard Cite

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“…Clinical bacteriology has recently moved from Level ≥ 3 to Level 2, i.e., the district or referral hospital. Adapted from Unicef and WHO (37), Best and Sakande (39), WHO (47), Centers for Disease Control and Prevention (48), Unitaid (24), and WHO (49), which provide complementary information for the tiered work-up of HIV, tuberculosis and malaria and other diagnostics. CBL, clinical bacteriology laboratory; GLASS, Global Antimicrobial Resistance Surveillance System; RDT, rapid diagnostic test.…”

Section: The Need For Bacteriology Laboratories At the Secondary Healmentioning

confidence: 99%

Diagnostic Bacteriology in District Hospitals in Sub-Saharan Africa: At the Forefront of the Containment of Antimicrobial Resistance

et al. 2019

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This review provides an update on the factors fuelling antimicrobial resistance and shows the impact of these factors in low-resource settings. We detail the challenges and barriers to integrating clinical bacteriology in hospitals in low-resource settings, as well as the opportunities provided by the recent capacity building efforts of national laboratory networks focused on vertical single-disease programmes. The programmes for HIV, tuberculosis and malaria have considerably improved laboratory medicine in Sub-Saharan Africa, paving the way for clinical bacteriology. Furthermore, special attention is paid to topics that are less familiar to the general medical community, such as the crucial role of regulatory frameworks for diagnostics and the educational profile required for a productive laboratory workforce in low-resource settings. Traditionally, clinical bacteriology laboratories have been a part of higher levels of care, and, as a result, they were poorly linked to clinical practices and thus underused. By establishing and consolidating clinical bacteriology laboratories at the hospital referral level in low-resource settings, routine patient care data can be collected for surveillance, antibiotic stewardship and infection prevention and control. Together, these activities form a synergistic tripartite effort at the frontline of the emergence and spread of multi-drug resistant bacteria. If challenges related to staff, funding, scale, and the specific nature of clinical bacteriology are prioritized, a major leap forward in the containment of antimicrobial resistance can be achieved. The mobilization of resources coordinated by national laboratory plans and interventions tailored by a good understanding of the hospital microcosm will be crucial to success, and further contributions will be made by market interventions and business models for diagnostic laboratories. The future clinical bacteriology laboratory in a low-resource setting will not be an “entry-level version” of its counterparts in high-resource settings, but a purpose-built, well-conceived, cost-effective and efficient diagnostic facility at the forefront of antimicrobial resistance containment.

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“…Moreover, each year over the last 10 years, DGHP expertise both in epidemiology and laboratory has provided support for multiple outbreaks investigations in Kenya and in Africa (Figs. 3 and 4) [21]. In Kenya, DGHP has supported investigations into outbreaks of respiratory diseases (e.g., influenza, pertussis), diarrheal diseases (e.g., cholera, Salmonella Typhi, shigellosis), aflatoxicosis, and vector-borne diseases (e.g., Zika, dengue, chikungunya, Rift Valley fever viruses) ( Fig.…”

Section: Outbreak Investigationsmentioning

confidence: 99%

“…Since 2014, DSLP has joined with other CDC laboratory programs to further build national laboratory capacities, and augment previously established laboratory strengthening efforts. We began by identifying three important gaps within the national system [37]. First, we identified gaps at the national level and augmented the capacity of NPHLS for both reference bacteriology (including antimicrobial resistance [AMR] testing) and influenza diagnostics in order to support the county laboratories.…”

Section: Laboratory Systems and Capacity Buildingmentioning

confidence: 99%

Building laboratory capacity to detect and characterize pathogens of public and global health security concern in Kenya

et al. 2019

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Since 1979, multiple CDC Kenya programs have supported the development of diagnostic expertise and laboratory capacity in Kenya. In 2004, CDC’s Global Disease Detection (GDD) program within the Division of Global Health Protection in Kenya (DGHP-Kenya) initiated close collaboration with Kenya Medical Research Institute (KEMRI) and developed a laboratory partnership called the Diagnostic and Laboratory Systems Program (DLSP). DLSP built onto previous efforts by malaria, human immunodeficiency virus (HIV) and tuberculosis (TB) programs and supported the expansion of the diagnostic expertise and capacity in KEMRI and the Ministry of Health. First, DLSP developed laboratory capacity for surveillance of diarrheal, respiratory, zoonotic and febrile illnesses to understand the etiology burden of these common illnesses and support evidenced-based decisions on vaccine introductions and recommendations in Kenya. Second, we have evaluated and implemented new diagnostic technologies such as TaqMan Array Cards (TAC) to detect emerging or reemerging pathogens and have recently added a next generation sequencer (NGS). Third, DLSP provided rapid laboratory diagnostic support for outbreak investigation to Kenya and regional countries. Fourth, DLSP has been assisting the Kenya National Public Health laboratory-National Influenza Center and microbiology reference laboratory to obtain World Health Organization (WHO) certification and ISO15189 accreditation respectively. Fifth, we have supported biosafety and biosecurity curriculum development to help Kenyan laboratories safely and appropriately manage infectious pathogens. These achievements, highlight how in collaboration with existing CDC programs working on HIV, tuberculosis and malaria, the Global Health Security Agenda can have significantly improve public health in Kenya and the region. Moreover, Kenya provides an example as to how laboratory science can help countries detect and control of infectious disease outbreaks and other public health threats more rapidly, thus enhancing global health security.

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Practical recommendations for strengthening national and regional laboratory networks in Africa in the Global Health Security era

Cited by 13 publications

References 9 publications

Clinical bacteriology in low-resource settings: today's solutions

Clinical bacteriology in low-resource settings: today's solutions

Diagnostic Bacteriology in District Hospitals in Sub-Saharan Africa: At the Forefront of the Containment of Antimicrobial Resistance

Building laboratory capacity to detect and characterize pathogens of public and global health security concern in Kenya

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