Improving the quality of laboratory diagnostic services in support of primary healthcare and public health in Africa
Improving the quality of laboratory diagnostic services in support of primary healthcare and public health in Africa
Jane Carter's investigation consists of two parts.
Part 1: Laboratory testing is essential to accurately identify diseases and ensure patients receive correct treatment. Without laboratory diagnosis, clinicians often need to rely on patients’ symptoms which leads to wrong diagnoses and ineffective treatment. Laboratory testing therefore plays a critical role in providing quality health services and is essential for achieving Universal Health Coverage. In developed countries, up to 80% of the most burdensome health conditions require diagnostic testing; this figure may be even higher in tropical countries where infectious diseases are common. In developing countries, laboratory testing is vital in small facilities where most community members make their first contact with a health worker; in Kenya, a study showed that more than 60% of patients attending health centres required laboratory tests to guide the best treatment. Despite government commitments and projects in recent years, laboratories in under-developed countries remain poorly supported and give poor quality services, especially in peripheral centres. However, accurate laboratory testing can be effectively carried out in small facilities in rural and remote areas if tests are carefully selected, staff are properly trained and supervised, and the right equipment and supplies are available. To make sure laboratory tests are accurate, laboratories can participate in programmes that regularly assess laboratory quality; these programmes are effective in improving and maintaining laboratory quality. Rapid diagnostic tests that can be performed without equipment or qualified technical staff have been developed for many diseases, making it easier to bring laboratory testing closer to communities, however test performance must be carefully evaluated.
Part 2: Laboratory testing is necessary to determine what diseases are present in communities and to investigate the causes of disease outbreaks. Laboratory tests can also be used to conduct surveys of diseases in communities, such as COVID-19, making it possible for health authorities to determine where diseases are spreading and how many people are affected. Other health issues that need to be surveyed and require laboratory testing include checking to see if parasites, bacteria and viruses are resistant to commonly used antibiotics. Laboratory testing is therefore essential to maintain the overall health of communities as well as to guide treatment of individual patients. However, many of the tests used to identify the causes of disease outbreaks are complex and can only be performed in specialised laboratories in major cities, which may be far from the sites of disease outbreaks or from where community surveys need to be done. Transporting samples over long distances is logistically difficult, time consuming and expensive. New, basic rapid tests are being developed for important diseases that cause outbreaks, so initial testing can be performed quickly on-site. These tests use small volumes of blood and are more acceptable to communities. However, it is important that these rapid tests are accurate so the results are reliable. Rapid tests for various diseases are constantly under development and need to be tested in community settings to make sure they provide accurate results.