Improving microscope quality is a good investment for under-resourced laboratories

Opoku-Okrah, Clement; Rumble, R.; Bedu-Addo, George; Bates, Imelda

doi:10.1016/s0035-9203(00)90097-x

Cited by 11 publications

(5 citation statements)

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“…Previous studies from Africa highlight inadequate laboratory capacity as the most common barrier to laboratory testing, 2,7,9,12 but we show that, in Ghana, laboratory services were available routinely, quality controlled, and perceived as accurate by physicians. Our observations reflect prior efforts by Ghanaians to improve intra-and inter-laboratory accuracy [18][19][20] and participate in international collaborations. 8,[28][29][30] Other studies from sub-Saharan Africa have suggested physicians' perceived lack of consumables, 9,13 inadequate test availability, 13 and poor quality of testing 6,15 as barriers to test use.…”

Section: Discussionsupporting

confidence: 84%

“…Ghana, while economically similar to most sub-Saharan African nations, 11 has made significant health-related advances in recent years including improvements in laboratory capacity, [18][19][20] affording a unique setting for this study. We examined physician use of laboratory tests for the diagnosis and treatment of infectious diseases at a large teaching center in Kumasi, Ghana.…”

Section: Introductionmentioning

confidence: 99%

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Laboratory Use in Ghana: Physician Perception and Practice

Polage

Bedu-Addo

Owusu-Ofori

et al. 2006

The American Journal of Tropical Medicine and Hygiene

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Clinical diagnosis of infectious diseases in Africa has been associated with increased misdiagnosis and mortality, but when laboratory testing is available, it remains underused. We retrospectively compared infectious diagnoses, test results, anti-microbial use, and patient cost with laboratory and physician surveys at a teaching hospital in Ghana to evaluate the potential barriers to laboratory use and financial impact for patients. Laboratory capacity was high, but physician survey results and objective data indicated a reliance on clinical judgment and empirical therapy. For the study period, 9-15% of malaria diagnoses, 34-43% of urinary tract infections (UTIs), and 62% of meningitis cases were supported by abnormal laboratory results. For the same period, 0.82-2.09 units of antibiotics were consumed per patient day, and patient cost for antibiotics was 4.8-21.6 times that of laboratory testing. Physician perception regarding the value of diagnostic testing is potentially a major barrier to laboratory use, resulting in empiricism, disproportionate anti-microbial administration, and cost to patients.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Laboratory Use in Ghana: Physician Perception and Practice

Polage

Bedu-Addo

Owusu-Ofori

et al. 2006

The American Journal of Tropical Medicine and Hygiene

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“…The simple presence or absence of parasitaemia may not distinguish severe disease from malaria. The microscope will continue to be needed for a variety of other diagnoses in the clinical setting [16,17]. Accuracy and cost effectiveness of simplified malaria diagnosis (e.g.…”

Section: Discussion and Evaluationmentioning

confidence: 99%

Establishing a malaria diagnostics centre of excellence in Kisumu, Kenya

Ohrt

Obare

Na-Nakorn

et al. 2007

Malar J

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Background: Malaria microscopy, while the gold standard for malaria diagnosis, has limitations. Efficacy estimates in drug and vaccine malaria trials are very sensitive to small errors in microscopy endpoints. This fact led to the establishment of a Malaria Diagnostics Centre of Excellence in Kisumu, Kenya. The primary objective was to ensure valid clinical trial and diagnostic test evaluations. Key secondary objectives were technology transfer to host countries, establishment of partnerships, and training of clinical microscopists.

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“…118 The key issue is how to make this conceptual framework, the undoubted policy development, and the stated international commitment work in practice. Encouraging examples of progress include eff orts to protect health-care workers, 119 initiatives to share and maintain laboratory equipment across diff erent diseasespecifi c programmes, 120 and use of the DOTS model to …”

Section: Interaction With General Health Systemsmentioning

confidence: 99%

The HIV-associated tuberculosis epidemic—when will we act?

et al. 2010

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Journal LancetRights Reproduced on this site with permission of Elsevier Ltd. Please see [url] Tuberculosis 3The HIV-associated tuberculosis epidemic-when will we act? Anthony D Harries, Rony Zachariah, Elizabeth L Corbett, Stephen D Lawn, Ezio T Santos-Filho, Rhehab Chimzizi, Mark Harrington, Dermot Maher, Brian G Williams, Kevin M De Cock Despite policies, strategies, and guidelines, the epidemic of HIV-associated tuberculosis continues to rage, particularly in southern Africa. We focus our attention on the regions with the greatest burden of disease, especially sub-Saharan Africa, and concentrate on prevention of tuberculosis in people with HIV infection, a challenge that has been greatly neglected. We argue for a much more aggressive approach to early diagnosis and treatment of HIV infection in aff ected communities, and propose urgent assessment of frequent testing for HIV and early start of antiretroviral treatment (ART). This approach should result in short-term and long-term declines in tuberculosis incidence through individual immune reconstitution and reduced HIV transmission. Implementation of the 3Is policy (intensifi ed tuberculosis case fi nding, infection control, and isoniazid preventive therapy) for prevention of HIV-associated tuberculosis, combined with earlier start of ART, will reduce the burden of tuberculosis in people with HIV infection and provide a safe clinical environment for delivery of ART. Some progress is being made in provision of HIV care to HIV-infected patients with tuberculosis, but too few receive co-trimoxazole prophylaxis and ART. We make practical recommendations about how to improve this situation. Early HIV diagnosis and treatment, the 3Is, and a comprehensive package of HIV care, in association with directly observed therapy, short-course (DOTS) for tuberculosis, form the basis of prevention and control of HIV-associated tuberculosis. This call to action recommends that both HIV and tuberculosis programmes exhort implementation of strategies that are known to be eff ective, and test innovative strategies that could work. The continuing HIV-associated tuberculosis epidemic needs bold but responsible action, without which the future will simply mirror the past.

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Improving microscope quality is a good investment for under-resourced laboratories

Cited by 11 publications

References 1 publication

Laboratory Use in Ghana: Physician Perception and Practice

Laboratory Use in Ghana: Physician Perception and Practice

Establishing a malaria diagnostics centre of excellence in Kisumu, Kenya

The HIV-associated tuberculosis epidemic—when will we act?

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