Histology and Cytopathology Capacity in the Public Health Sector in Kenya

Abstract

PurposeHistology and cytopathology services are necessary for cancer diagnosis and treatment. However, the current capacity of Kenya’s pathology laboratories is unknown. A national survey was conducted among public sector pathology laboratories to assess their capacity to perform histology, fine-needle aspiration, and bone marrow aspiration.MethodsBetween April and June 2017, we identified all public hospitals that provide pathology services in Kenya. In total, two national and 13 county referral hospitals met the inclusion criteria and were sent a standardized, pretested, self-administered questionnaire.ResultsA total of 11 hospitals (73%) completed the survey. The reported total caseload of histology, fine-needle aspiration, and bone marrow aspiration for 2016 was 26,472. All of the facilities staffed a pathologist and were providing cancer-related diagnostic services. Nine (82%) of the hospitals maintain a register of diagnosed cancer cases, but only one (11%) of those uses an electronic system. Six (55%) of the surveyed hospitals were able to perform histology with a median turnaround time of 14 days. Six (55%) laboratories regularly referred some specimens elsewhere for interpretation, but three of these centers relied on patients for transportation of the specimen to the referral institution. No laboratories were accredited by an external organization; however, 10 (91%) of the laboratories were working toward achieving accreditation, but only for clinical pathology services.ConclusionThis study describes the current status of histology and cytopathology capacity in Kenya’s public sector hospitals. It provides useful baseline information needed by the Ministry of Health to develop necessary capacity building and referral-strengthening interventions. A high proportion of hospitals are working to achieve accreditation points toward their commitment to providing quality services to the Kenyan public.

Reporting of diagnostic and laboratory tests by general hospitals as an indication of access to diagnostic laboratory services in Kenya

“…According to Wilson et al tests of anatomical pathology may require up to three personnel; a histotechnologist to process tissues, a cytotechnologist to process fluids and a pathologist to examine the slides and make a diagnosis [1]. Most general hospitals in Kenya do not have qualified full-time pathologists, making anatomical pathology testing almost unachievable [31]. Unfortunately, save for donor funded programs such as HIV and TB, most of the laboratories in Kenyan public hospitals do not have systems in place to support specimen referral.…”