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

Abstract

Introduction Information on laboratory test availability and current testing scope among general hospitals in Kenya is not readily available. We sought to explore the reporting trends and test availability within clinical laboratories in Kenya over a 24-months period through analysis of the laboratory data reported in the District Health Information System (DHIS2). Methods Monthly hospital laboratory testing data were extracted from the Kenyan DHIS2 between January 2018 and December 2019. We used the national laboratory testing summary tool (MoH 706) to identify the tests of interest among 204 general hospitals in Kenya. A local practitioner panel consisting of individuals with laboratory expertise was used to classify the tests as common and uncommon. We compared the tests on the MoH 706 template with the Essential Diagnostic List (EDL) of the World Health Organisation and further reclassified them into test categories based on the EDL for generalisability of our findings. Evaluation of the number of monthly test types reported in each facility and the largest number of tests ever reported in any of the 24 months were used to assess test availability and testing scope, respectively. Results Out of the 204 general hospitals assessed, 179 (179/204) reported at least one of the 80 tests of interest in any of the 24 months. Only 41% (74/179) of the reporting hospitals submitted all their monthly DHIS2 laboratory reports for the entire 24 months. The median testing capacity across the hospitals was 40% with a wide variation in testing scope from one hospital laboratory to another (% IQR: 33.8–51.9). Testing scope was inconsistent within facilities as indicated by often large monthly fluctuations in the total number of recommended and EDL tests reported. Tests of anatomical pathology and cancer were the least reported with 4 counties’ hospitals not reporting any cancer or anatomical pathology tests for the entire 24 months. Conclusion The current reporting of laboratory testing information in DHIS2 is poor. Monitoring access and utilisation of laboratory testing across the country would require significant improvements in consistency and coverage of routine laboratory test reporting in DHIS2. Nonetheless, the available data suggest unequal and intermittent population access to laboratory testing provided by general hospitals in Kenya.

Reporting of rapid diagnostic testing in Kenya's health system, 2018-2020: triangulation of routine and survey data

“…Based on the KMLTTB checklist supplemented with local lab technician\technologist knowledge and informed by literature, we assigned the facility levels at which each RDT was expected and classi ed tests as common or uncommon [13]. The triangulation list comprised ten RDTs: malaria, HIV, blood grouping, urine chemistry, Treponema Pallidum Hemagglutination (TPHA), Venereal Disease Research Laboratory (VDRL), Human Chorionic Gonadotropin (HCG-pregnancy), HB estimation, blood sugar (random blood sugar) and Cryptococcal Antigen (CRAG) tests (Table 1).…”

“…Medical laboratories in Kenya also fall under similar ownership categories and may be located either within a health facility or as stand-alone facilities, both of which are regulated by the Kenya Medical Laboratory Technicians and Technologists Board (KMLTTB) [13]. The diagnostic tests available in Kenya range from simple RDTs to complex laboratory tests, the availability of which is variable and may correspond to the ownership and level of the health facility.…”

“…In Kenya, several other variables besides a lack of capacity for health facilities have contributed to nonreporting. First, zero reports (no testing) in DHIS2 are usually converted to missing values by the DHIS2 system [13,19]. This makes it impossible to distinguish between zero reports and non-reporting.…”

“…Since 2011, the platform has provided routine data on tests done at a facility level every month in Kenya. Despite the availability of routine data across the country for an entire year, data quality has been a concern, primarily due to nonreporting and incomplete entries across health facilities [13,15,[19][20][21][22][23]. Dealing with these challenges requires an understanding of the causes driving non-reporting.…”

“…A comprehensive understanding of access to, and availability of RDTs in LMICs, remains a crucial priority in advancing the UHC agenda [7] and reducing accessibility gaps. Routine data [13][14][15] have been widely used in monitoring progress in health service provision, including laboratory testing across health systems [3]. For example, test volumes of RDTs across health facilities can be compared with the population needing diagnostic testing to determine unmet needs, ensuring e cient use and allocation of resources in the community.…”