Assessing Perceived Challenges to Laboratory Testing at a Malawian Referral Hospital

Abstract

Abstract. Adequate laboratory infrastructure in sub-Saharan Africa is vital for tackling the burden of infectious diseases such as human immunodeficiency virus and acquired immune deficiency syndrome, malaria, and tuberculosis, yet laboratories are ill-integrated into the diagnostic and care delivery process in low-resource settings. Although much of the literature focuses on disease-specific challenges around laboratory testing, we sought to identify horizontal challenges to the laboratory testing process through interviews with clinicians involved in the diagnostic process. Based on 22 interviews with physicians, nurses, clinical officers, medical students, and laboratory technicians, technologists and supervisors, we identified 12 distinct challenges in the areas of staff, materials, workflow, and the blood bank. These challenges underscore the informational challenges that compound more visible resource shortages in the laboratory testing process, which lend themselves to horizontal strengthening efforts around the diagnostic process.

Smear Microscopy Examination for Malaria and Tuberculosis at Primary Health Care Unit Level of Guragae Zone, Southern Ethiopia

“…Studies done in Pakistan and Congo showed that external quality assessment methods were found to be feasible and acceptable to improve the reliability of smear microscopy (23). EQA is essential to determine the source of performance problems and take remedial actions (6). EQA for smear microscopy is a process that assesses peripheral laboratory performance by higher-level laboratory and it includes blinded rechecking, on-site evaluation and panel testing (24).…”

“…Laboratory confirmation based disease management may prevent; unnecessary treatments, reduce the potential development of drug resistance (4) and encourage health care providers to search for alternative causes for confirmed negative patients (5). Quality assurance consists of quality control, external quality assurance (EQA), and quality improvement components, which are essential tools to yield reliable and reproducible laboratory results (6).…”

“…Allocation of resources to diagnostic laboratory testing has not been a priority for SSA and access to reliable laboratory diagnostic testing is severely limited in this region (8). Lack of access to good quality diagnostic tests for case management is a major contributor to the enormous burden of diseases in the developing world (6).…”

“…This requires technical competence, access to good-quality reagents, and an understanding of quality control (8). EQA participation is associated with improved laboratory performance over time as it is a system for objectively checking a laboratory's performance (6).…”

Evaluation of continuous quality improvement of tuberculosis and HIV diagnostic services in Amhara Public Health Institute, Ethiopia

“…Equipment down time was also a major cause of test interruptions. Studies in Addis Ababa Ethiopia and in Malawi also revealed that the major reported factors affecting the provision of quality services were a shortage of resources and equipment failure [24,25]. As a quality improvement plan, the laboratory could reduce interruption of tests through rapid implementation of equipment maintenance service agreements, making…”