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Knapper J, Whiteford F, Rosen D, Wadsworth W, Stirling J, Mkindi C, Mduda J, Sanga VL, Nyakyi PT, Mboa Nkoudou TH, Jafsia E, Fadanka S, Hummel K, Anandasabapathy S, Bowman R. Developing the OpenFlexure Microscope towards medical use: technical and social challenges of developing globally accessible hardware for healthcare. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2024; 382:20230257. [PMID: 38826050 DOI: 10.1098/rsta.2023.0257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/23/2024] [Indexed: 06/04/2024]
Abstract
The OpenFlexure Microscope is an accessible, three-dimensional-printed robotic microscope, with sufficient image quality to resolve diagnostic features including parasites and cancerous cells. As access to lab-grade microscopes is a major challenge in global healthcare, the OpenFlexure Microscope has been developed to be manufactured, maintained and used in remote environments, supporting point-of-care diagnosis. The steps taken in transforming the hardware and software from an academic prototype towards an accepted medical device include addressing technical and social challenges, and are key for any innovation targeting improved effectiveness in low-resource healthcare. This article is part of the Theo Murphy meeting issue 'Open, reproducible hardware for microscopy'.
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Affiliation(s)
| | | | - Daniel Rosen
- Baylor College of Medicine , Houston, Texas, USA
| | | | | | | | - Joram Mduda
- Ifakara Health Institute , Ifakara, Tanzania
| | | | - Paul T Nyakyi
- Bongo Tech and Research Labs , Dar es Salaam, Tanzania
| | | | - Elisée Jafsia
- Mboalab and African Higher Institute of Open Science and Hardware (AHIOSH) , Yaounde, Cameroon
| | - Stephane Fadanka
- Mboalab and African Higher Institute of Open Science and Hardware (AHIOSH) , Yaounde, Cameroon
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Mensah EA, Gyasi SO, Nsubuga F, Alali WQ. A proposed One Health approach to control yellow fever outbreaks in Uganda. ONE HEALTH OUTLOOK 2024; 6:9. [PMID: 38783349 PMCID: PMC11119388 DOI: 10.1186/s42522-024-00103-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 04/26/2024] [Indexed: 05/25/2024]
Abstract
Yellow Fever (YF) is an acute viral hemorrhagic disease. Uganda is located within the Africa YF belt. Between 2019 and 2022, the Ugandan Health Authorities reported at least one outbreak of YF annually with an estimated 892 suspected cases, on average per year. The persistent recurrence of this disease raises significant concerns about the efficacy of current response strategies and prevention approaches. YF has been recognized as a One Health issue due to its interrelatedness with the animal and environmental domains. Monkeys have been recognized as the virus primary reservoir. The YF virus is transmitted through bites of infected Aedes or Haemagogus species mosquitoes between monkeys and humans. Human activities, monkey health, and environmental health issues (e.g., climate change and land use) impact YF incidence in Uganda. Additionally, disease control programs for other tropical diseases, such as mosquitoes control programs for malaria, impact YF incidence.This review adopts the One Health approach to highlight the limitations in the existing segmented YF control and prevention strategies in Uganda, including the limited health sector surveillance, the geographically localized outbreak response efforts, the lack of a comprehensive vaccination program, the limited collaboration and communication among relevant national and international agencies, and the inadequate vector control practices. Through a One Health approach, we propose establishing a YF elimination taskforce. This taskforce would oversee coordination of YF elimination initiatives, including implementing a comprehensive surveillance system, conducting mass YF vaccination campaigns, integrating mosquito management strategies, and enhancing risk communication. It is anticipated that adopting the One Health approach will reduce the risk of YF incidence and outbreaks.
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Affiliation(s)
- Emmanuel Angmorteh Mensah
- Department of Biostatistics & Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Samuel Ofori Gyasi
- Department of Immunization, Vaccines and Biologicals, World Health Organization Country Office, Kampala, Uganda
| | - Fred Nsubuga
- Division of Immunization and Vaccines, Ministry of Health, Kampala, Uganda
| | - Walid Q Alali
- Department of Biostatistics & Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN, USA.
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Essuman MA, Addy NA, Essien-Baidoo S, Donkoh IE, Botchway FA, Afrifa J, Agyeman P, Amaama LA, Amoah S, Sorvor FBK, Ephraim RKD. Self-reported continuing professional development needs of medical laboratory professionals in Ghana. HUMAN RESOURCES FOR HEALTH 2023; 21:74. [PMID: 37700340 PMCID: PMC10498610 DOI: 10.1186/s12960-023-00859-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/04/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Because of the essential nature of the work of medical laboratory professionals, continuing development in knowledge and skills is indispensable. The study aimed at identifying and prioritizing the development and training needs of medical laboratory professionals in Ghana. This is expected to help in developing focused continuing professional development (CPD) that meets the needs of practitioners as well as the changing medical trends. METHODS An online cross-sectional survey in February 2022 using a structured questionnaire was conducted. Respondents were asked questions that collected demographic and work-related data about them, their participation, preference, and challenges in being part of CPDs. Finally, a list of topics based on (i) quality management systems, (ii) technical competence, (iii) laboratory management, leadership, and coaching, (iv) pathophysiology, and (iv) data interpretation and research were asked with the option to rate them on a 3-point scale (most, moderate, and least) in order of importance. RESULTS A total of 316 medical laboratory professionals participated in the study. Overall, the most frequently selected topics for training based on domains for CPD training and ranking as most important were (i) quality management systems, (mean = 80.59 ± 9.024; 95% CI = 73.04-88.13); (ii) pathophysiology, data interpretation, and research (mean = 78.0 ± 6.973; 95% CI = 73.97-82.03); (iii) technical competence (mean = 73.97 ± 10.65; 95% CI = 66.35-81.59); and (iv) laboratory management, leadership, and coaching (mean = 72.82 ± 9.719; 95% CI = 67.44-78.2). The factors affecting the choice of training needs included the medical laboratory professionals' current place of work, years in service, the reason for attending CPD activities, the period for attending the last CPD, being in a supervisory role, and the number of staff being supervised. Face-to-face presentations, training workshops, and hands-on workshops were the most preferred modes of CPD delivery with financial implications and workload/time constraints being the main challenges impeding CPD participation. CONCLUSION The identified needs will help in developing CPD programs that address what medical laboratory professionals prioritize as training needs. Stakeholders should incorporate these training needs into future programs and address the challenges highlighted in this study to have more relevant training for medical laboratory professionals.
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Affiliation(s)
- Mainprice Akuoko Essuman
- Department of Medical Laboratory Science, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Nii Armah Addy
- Institute of Leadership and Management in Education (InLaME), Accra, Ghana
| | - Samuel Essien-Baidoo
- Department of Medical Laboratory Science, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Irene Esi Donkoh
- Department of Medical Laboratory Science, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Felix A Botchway
- Department of Medical Laboratory Technology, Accra Technical University, Accra, Ghana
| | - Justice Afrifa
- Department of Medical Laboratory Science, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Prince Agyeman
- School of Public Health, University of Ghana, Legon, Ghana
| | - Leticia Awontayami Amaama
- Department of Medical Laboratory Science, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Samuel Amoah
- Laboratory Department, University Health Services, University of Cape Coast, Cape Coast, Ghana
| | | | - Richard K D Ephraim
- Department of Medical Laboratory Science, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana.
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Madlala ST, Mvandaba AN. Experiences of nurse educators regarding the use of the clinical skills laboratory at the School of Nursing in the Free State province. Health SA 2023; 28:2077. [PMID: 36873779 PMCID: PMC9982460 DOI: 10.4102/hsag.v28i0.2077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/15/2022] [Indexed: 02/05/2023] Open
Abstract
Background Integration of theory to practice by student nurses is a challenge in most training institutions accredited by the South African Nursing Council (SANC). Nurse educators require a fully equipped and functional clinical skills laboratory to impart clinical competency knowledge to student nurses. Aim The purpose of this study was to understand the experiences of the nurse educators in teaching clinical skills to student nurses using the clinical skills laboratories. Setting The study was conducted at the School of Nursing in the Free State province in 2021. Methods A qualitative descriptive design was employed. Purposive sampling was used to select participants for the study. Unstructured one-on-one interviews were conducted with 17 nurse educators until data saturation was reached. Data were analysed thematically. Results The three major themes that emerged during data analysis and were discussed to make recommendations of the study are as follows: clinical skills laboratory environment; human and material resources; financial constraints. Conclusion This study revealed that there is a need for the use of the clinical skills laboratory by nurse educators to teach clinical practice to student nurses. Therefore, it is imperative that the study recommendations be considered for implementation to improve the use of the clinical skills laboratory. Contribution The importance of integrating theory to practice by using the clinical skills laboratory during clinical practice teaching by nurse educators will be understood.
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Affiliation(s)
- Siphiwe T Madlala
- Department of Nursing Science, Faculty of Science, Agriculture and Engineering, University of Zululand, KwaDlangezwa, South Africa
| | - Agnes N Mvandaba
- Department of Nursing Science, Free State School of Nursing, Eastern Campus, Phuthaditjhaba, South Africa
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Moirongo RM, Aglanu LM, Lamshöft M, Adero BO, Yator S, Anyona S, May J, Lorenz E, Eibach D. Laboratory-based surveillance of antimicrobial resistance in regions of Kenya: An assessment of capacities, practices, and barriers by means of multi-facility survey. Front Public Health 2022; 10:1003178. [PMID: 36518572 PMCID: PMC9742437 DOI: 10.3389/fpubh.2022.1003178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/11/2022] [Indexed: 11/29/2022] Open
Abstract
Background Adequate laboratory capacity is critical in the implementation of coherent surveillance for antimicrobial resistance (AMR). We describe capacities and deficiencies in laboratory infrastructure and AMR surveillance practices among health facilities in Kenya to support progress toward broader sustainable laboratory-based AMR surveillance. Methods A convenience sample of health facilities from both public and private sectors across the country were selected. Information was obtained cross-sectionally between 5th October and 8th December 2020 through online surveys of laboratory managers. The assessment covered quality assurance, management and dissemination of AMR data, material and equipment, staffing, microbiology competency, biosafety and certification. A scoring scheme was developed for the evaluation and interpreted as (80% and above) facility is adequate (60-79%) requires some strengthening and (<60%) needing significant strengthening. Average scores were compared across facilities in public and private sectors, rural and urban settings, as well as national, county, and community levels. Results Among the participating facilities (n = 219), the majority (n = 135, 61.6%) did not offer bacterial culture testing, 47 (21.5%) offered culture services only and 37 (16.9%) performed antimicrobial susceptibility testing (AST). The major gaps identified among AST facilities were poor access to laboratory information management technology (LIMT) (score: 45.9%) and low uptake of external quality assessment (EQA) programs for cultures (score 67.7%). Access to laboratory technology was more than two-fold higher in facilities in urban (58.6%) relative to rural (25.0%) areas. Whilst laboratories that lacked culture services were found to have significant infrastructural gaps (average score 59.4%), facilities that performed cultures only (average score: 83.6%) and AST (average score: 82.9%) recorded significantly high scores that were very similar across areas assessed. Lack of equipment was identified as the leading challenge to the implementation of susceptibility testing among 46.8% of laboratories. Conclusions We identified key gaps in laboratory information management technology, external quality assurance and material and equipment among the surveyed health facilities in Kenya. Our findings suggest that by investing in equipment, facilities performing cultures can be successfully upgraded to provide additional antimicrobial susceptibility testing, presenting a chance for a major leap toward improved AMR diagnostics and surveillance in the country.
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Affiliation(s)
- Rehema Moraa Moirongo
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany,*Correspondence: Rehema Moraa Moirongo
| | - Leslie Mawuli Aglanu
- Global Health and Infectious Diseases Research Group, Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana,Department of Internal Medicine/Infectious Diseases, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Maike Lamshöft
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany,German Center for Infection Research (DZIF), Braunschweig, Germany
| | | | - Solomon Yator
- Department of Biochemistry and Molecular Biology, University of Bremen, Bremen, Germany
| | - Stephen Anyona
- Centre for Microbiology Research (KEMRI-CMR), Kenya Medical Research Institute, Nairobi, Kenya
| | - Jürgen May
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany,German Center for Infection Research (DZIF), Braunschweig, Germany,Department of Tropical Medicine I, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Eva Lorenz
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany,German Center for Infection Research (DZIF), Braunschweig, Germany,Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Daniel Eibach
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
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Musau SK, Mwachari C, Kirui E, Muthoni J, Lascko T, Blanco N, Abimiku A, Koech E. Implementing an intensified mentorship approach towards accelerated medical laboratory accreditation in 10 counties in Kenya. Afr J Lab Med 2022; 11:1814. [PMID: 35937766 PMCID: PMC9350484 DOI: 10.4102/ajlm.v11i1.1814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background Despite Kenya’s roll-out of the Strengthening Laboratory Management Towards Accreditation programme in 2010, most laboratories had not made significant or tangible improvements towards accreditation by 2016. In April 2016, the University of Maryland, Baltimore enrolled 27 facilities in the standard Strengthening Laboratory Management Towards Accreditation programme. Objective This study aimed to describe and evaluate the implementation of an intensified mentorship strategy on laboratory accreditation. Methods In October 2017, the University of Maryland, Baltimore implemented intensive mentorship in 27 hospital laboratories in Nairobi, Kiambu, Meru, Embu, Muranga, Nyeri, Laikipia, Nyandarua, Tharaka-Nithi, and Kirinyaga counties in Kenya. Laboratories were paired with competent mentors whose skills were matched to facility gaps. Baseline and follow-up assessments were done between April 2016 and March 2019 using the World Health Organization’s Stepwise Laboratory Quality Improvement Process Towards Accreditation Checklist and overall scores of the 12 Quality System Essentials and star ratings (from zero to five, based on scores) used to evaluate the effectiveness of the intensified mentorship. Results In September 2017, 14 laboratories scored zero stars, three scored one star, eight scored two stars, one scored three stars, and one laboratory was accredited. By March 2019, eight laboratories were accredited, five scored four stars, 10 scored three stars, three scored two stars, and only one scored one star. The average score change with the intensified approach was 81.5 versus 53.9 for the standard approach. Conclusion The intensified mentorship strategy resulted in fast-tracked progress towards laboratory accreditation and can be adopted in similar resource-limited settings.
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Affiliation(s)
- Susan K. Musau
- Department of Laboratory, Maryland Global Initiatives Corporation (MGIC), Nairobi, Kenya
| | - Christina Mwachari
- Department of Laboratory, Maryland Global Initiatives Corporation (MGIC), Nairobi, Kenya
| | - Elvis Kirui
- Department of Strategic Information, Maryland Global Initiatives Corporation (MGIC), Nairobi, Kenya
| | - Junghae Muthoni
- Laboratory Department, Centers for Disease Control, Nairobi, Kenya
| | - Taylor Lascko
- Center for International Health, Education, and Biosecurity, University of Maryland, Baltimore, Maryland, United States
| | - Natalia Blanco
- Center for International Health, Education, and Biosecurity, University of Maryland, Baltimore, Maryland, United States
| | - Alash’le Abimiku
- School of Medicine, University of Maryland, Baltimore, Maryland, United States
| | - Emily Koech
- Department of Laboratory, Maryland Global Initiatives Corporation (MGIC), Nairobi, Kenya
- Center for International Health, Education, and Biosecurity (CIHEB), Nairobi, Kenya
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Tsere DB, Shirima GM, Grundy BS, Heysell SK, Mpagama SG, Mziray SR, Mbelele PM. Multiple pathogens contribute to human immunodeficiency virus-related sepsis in addition to Mycobacterium tuberculosis: A prospective cohort in Tanzania. Int J Mycobacteriol 2022; 11:241-248. [PMID: 36260441 PMCID: PMC9582297 DOI: 10.4103/ijmy.ijmy_80_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Mortality from tuberculosis (TB) sepsis is common among patients living with human immunodeficiency virus (PLHIV). We aimed to detect M. tuberculosis (MTB) and additional sepsis etiologies, and mortality determinants in PLHIV. Methods This prospective cohort study consented and followed-up PLHIV for 28 days in northern Tanzania. From May through December 2021, patients provided urine and sputum for TB testing in lateral-flow lipoarabinomannan (LF-LAM) and Xpert® MTB/RIF. Bacterial blood culture, cryptococcal antigen, malaria rapid diagnostic, C-reactive-protein (CRP), and international normalized ratio (INR) tests were also performed. Sepsis severity was clinically measured by Karnofsky and modified early warning signs (MEWS) scores. Anti-TB, broad-spectrum antibiotics, and antimalarial and antifungal agents were prescribed in accordance with Tanzania treatment guideline. An independent t-test and Chi-square or Fisher's exact tests compared means and proportions, respectively. P < 0.05 was statistically significant. Results Among 98 patients, 59 (60.2%) were female. Their mean (standard deviation) age was 44 (12.9) years. TB detection increased from 24 (24.5%) by Xpert® MTB/RIF to 36 (36.7%) when LF-LAM was added. In total, 23 (23.5%) patients had other than TB etiologies of sepsis, including Staphylococcus aureus, Streptococcus pneumoniae, Cryptococcus spp., and Plasmodium spp. Twenty-four (94.4%) of 36 patients with TB had higher CRP (≥10 mg/l) compared to 25 (40.3%) non-TB patients (P < 0.001). Nine (9.2%) patients died and almost all had INR ≥1.8 (n = 8), Karnofsky score <50% (n = 9), MEWS score >6 (n = 8), and malnutrition (n = 9). Conclusions MTB and other microbes contributed to sepsis in PLHIV. Adding non-TB tests informed clinical decisions. Mortality was predicted by conventional sepsis and severity scoring, malnutrition, and elevated INR.
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Affiliation(s)
- Donatus Bonphace Tsere
- Department of medical services, Kibong’oto Infectious Diseases Hospital, Siha, Tanzania
- Department of Global Health and Biomedical Sciences, School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Gabriel Mkilema Shirima
- Department of Global Health and Biomedical Sciences, School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Brian S. Grundy
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Scott K. Heysell
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Stellah G. Mpagama
- Department of medical services, Kibong’oto Infectious Diseases Hospital, Siha, Tanzania
| | - Shabani Ramadhani Mziray
- Department of medical services, Kibong’oto Infectious Diseases Hospital, Siha, Tanzania
- Department of Biochemistry and Molecular Biology, Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Peter M. Mbelele
- Department of medical services, Kibong’oto Infectious Diseases Hospital, Siha, Tanzania
- Department of Global Health and Biomedical Sciences, School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
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Wangoye K, Mwesigye J, Tungotyo M, Twinomujuni Samba S. Chronic wound isolates and their minimum inhibitory concentrations against third generation cephalosporins at a tertiary hospital in Uganda. Sci Rep 2022; 12:1195. [PMID: 35075152 PMCID: PMC8786920 DOI: 10.1038/s41598-021-04722-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/30/2021] [Indexed: 02/04/2023] Open
Abstract
Globally, the burden of chronic wound infections is likely to increase due to the rising levels of bacterial resistance to antibiotics. In the United States of America alone, more than 6.5 million chronic wounds with evidence of bacterial infection are diagnosed every year. In addition, the polymicrobial environment in chronic wound infections has been observed from several studies as a risk factor for development of resistance to many antibiotics including the third generation cephalosporins currently used in Mbarara Regional Referral Hospital for treatment of chronic wound infections. Therefore the main objective of this study was to determine the prevalence of chronic wound isolates and their minimum inhibitory concentrations (MIC) against third generation cephalosporins. This study was a cross-sectional descriptive and analytical survey of bacterial isolates from chronic wound infection among 75 study participants admitted in the surgical ward of Mbarara Regional Referral Hospital (MRRH), a tertiary Hospital in Western Uganda. Standard laboratory bacterial culture and identification techniques as well as broth microdilution method were used to isolate, identify pathogens and test for MIC respectively. We found that 69/75 study participants had samples with bacterial growth and the most prevalent pathogens isolated were staphylococcus aureus (40.6%) and Klebsiella spp. (29%). Generally, most isolates were susceptible to cefoperazone + sulbactum 2 g (Sulcef) and ceftriaxone 1 g (Epicephin). The overall prevalence of isolates in chronic wound infection among patients admitted in the surgical ward of MRRH was 92% and the most prevalent isolates were Staphylococcus aureus, Klebsiella species and proteus species respectively. The observed MIC values were higher than the CLSI clinical breakpoint, implying a decreasing trend in susceptibility of chronic wound isolates to third generation cephalosporins.
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Affiliation(s)
- Khalim Wangoye
- Department of Pharmacy and Pharmacology, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda.
| | - James Mwesigye
- Department of Medical Laboratory Science, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Martin Tungotyo
- Department of Surgery, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Silvano Twinomujuni Samba
- Department of Pharmacy and Pharmacology, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
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Khalim W, Mwesigye J, Tungotyo M, Twinomujuni SS. Resistance pattern of infected chronic wound isolates and factors associated with bacterial resistance to third generation cephalosporins at Mbarara Regional Referral Hospital, Uganda. PLoS One 2021; 16:e0261264. [PMID: 34914757 PMCID: PMC8675733 DOI: 10.1371/journal.pone.0261264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/25/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The objectives of this study were; (I) to determine the proportion of pathogens isolated from patients with infected chronic wounds in the surgical ward of MRRH that are resistant to the third-generation cephalosporins and (II) to determine the factors associated with resistance to third-generation cephalosporins in the surgical ward of MRRH. METHOD(S) This study was a descriptive analytical survey of bacterial isolates from infected chronic wounds among patients admitted in the surgical ward of MRRH, Uganda. Seventy five (75) study participants were recruited in the study using convenient sampling technique. Bacterial culture and identification was performed using standard microbiology laboratory procedures whereas broth microdilution method was used to establish the susceptibility of the identified pathogens. Data for objective one (1) was summarized as proportions while the categorized variables were analyzed using logistic regression to determine whether they were associated with the resistance patterns. The level of significance was preset at 5% and p-values less than 0.05 were considered statistically significant. RESULTS Generally, all isolates had complete susceptibility (100%) to Cefoperazone+Sulbactam 2g except 7.1% of proteus spp that were resistant. Of all the bacterial isolates studied, Staphylococcus aureus, Enterobacter agglomerans, providencia spp and pseudomonas earuginosa had complete resistance (100%) to Cefopodoxime 200mg while providencia spp and pseudomomas earuginosa had complete resistance (100%) to Cefixime 400mg and cefotaxime 1g. Finally, higher odds of bacterial resistance to more 2 brands of the third generation cephalosporins were observed among participants who had prior exposure to the third generation cephalosporins (OR, 2.22, 95% CI, 0.80-6.14), comorbidities (OR, 1.76, 95% CI, 0.62-4.96) and those who had more than two hospitalizations in a year (OR, 1.39, 95% CI 0.46-4.25). However, multivariate logistic regression was not performed since no factor was significantly associated with resistance to more than two brands of third generation cephalosporins (p >0.05). CONCLUSION This study found that cefixime and cefpodoixme had high rates of resistance and should not be used in routine management of infected chronic wounds. In addition, the factors investigated in this study were not significantly associated with bacterial resistance to more than two brands of third generation cephalosporins.
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Affiliation(s)
- Wangoye Khalim
- Department of Pharmacy and Pharmacology, Mbarara University of Science and Technology, Mbarara City, Uganda
- Department of Pharmacy, Kiboga general Hospital, Kiboga Town Council, Kiboga, Uganda
| | - James Mwesigye
- Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Martin Tungotyo
- Department of Surgery, Mbarara Regional Referral Hospital, Mbarara City, Uganda
- Department of Surgery, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Silvano Samba Twinomujuni
- Department of Pharmacy and Pharmacology, Mbarara University of Science and Technology, Mbarara City, Uganda
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Begg S, Wright A, Small G, Kirby M, Moore S, Koudou B, Kisinza W, Abdoulaye D, Moore J, Malima R, Kija P, Mosha F, Edi C, Bates I. Multi-site comparison of factors influencing progress of African insecticide testing facilities towards an international Quality Management System certification. PLoS One 2021; 16:e0259849. [PMID: 34780512 PMCID: PMC8592480 DOI: 10.1371/journal.pone.0259849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 10/27/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Insecticidal mosquito vector control products are vital components of malaria control programmes. Test facilities are key in assessing the effectiveness of vector control products against local mosquito populations, in environments where they will be used. Data from these test facilities must be of a high quality to be accepted by regulatory authorities, including the WHO Prequalification Team for vector control products. In 2013-4, seven insecticide testing facilities across sub-Saharan Africa, with technical and financial support from Innovative Vector Control Consortium (IVCC), began development and implementation of quality management system compliant with the principles of Good Laboratory Practice (GLP) to improve data quality and reliability. METHODS AND PRINCIPLE FINDINGS We conducted semi-structured interviews, emails, and video-call interviews with individuals at five test facilities engaged in the IVCC-supported programme and working towards or having achieved GLP. We used framework analysis to identify and describe factors affeting progress towards GLP. We found that eight factors were instrumental in progress, and that test facilities had varying levels of control over these factors. They had high control over the training programme, project planning, and senior leadership support; medium control over infrastructure development, staff structure, and procurement; and low control over funding the availability and accessibility of relevant expertise. Collaboration with IVCC and other partners was key to overcoming the challenges associated with low and medium control factors. CONCLUSION For partnership and consortia models of research capacity strengthening, test facilities can use their own internal resources to address identified high-control factors. Project plans should allow additional time for interaction with external agencies to address medium-control factors, and partners with access to expertise and funding should concentrate their efforts on supporting institutions to address low-control factors. In practice, this includes planning for financial sustainability at the outset, and acting to strengthen national and regional training capacity.
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Affiliation(s)
- Sara Begg
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - Alex Wright
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, United Kingdom
| | - Graham Small
- Innovative Vector Control Consortium, Pembroke Place, Liverpool, United Kingdom
| | - Matt Kirby
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, United Kingdom
- KCMUCo-PAMVERC, KCMUCo-PAMVERC Test Facility, Moshi, Tanzania
| | - Sarah Moore
- Ifakara Health Institute, Off Mlabani Passage, Ifakara, Tanzania
| | - Ben Koudou
- Centre Suisse de Recherches Scientifques en Côte D’Ivoire, Route de Dabou, Abidjan, Côte d’Ivoire
| | - William Kisinza
- National Institute of Medical Research, Amani Centre, Amani Medical Research Centre, Muheza, Tanzania
| | - Diabate Abdoulaye
- Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso, Côte d’Ivoire
| | - Jason Moore
- Ifakara Health Institute, Off Mlabani Passage, Ifakara, Tanzania
| | - Robert Malima
- National Institute of Medical Research, Amani Centre, Amani Medical Research Centre, Muheza, Tanzania
| | - Patrick Kija
- National Institute of Medical Research, Amani Centre, Amani Medical Research Centre, Muheza, Tanzania
| | - Frank Mosha
- KCMUCo-PAMVERC, KCMUCo-PAMVERC Test Facility, Moshi, Tanzania
| | - Constant Edi
- Centre Suisse de Recherches Scientifques en Côte D’Ivoire, Route de Dabou, Abidjan, Côte d’Ivoire
| | - Imelda Bates
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
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11
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Mulleta D, Jaleta F, Banti H, Bekele B, Abebe W, Tadesse H, Eshetu L, Zewdu A, Botore A, Tadesse L, Debela T. The Impact of Laboratory Quality Management System Implementation on Quality Laboratory Service Delivery in Health Center Laboratories of Oromia Region, Ethiopia. PATHOLOGY AND LABORATORY MEDICINE INTERNATIONAL 2021. [DOI: 10.2147/plmi.s314656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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12
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Adu P. A cross-case analyses of laboratory professionals-patients interaction for patients accessing laboratory services at University of Cape Coast hospital and Ewim Polyclinic in the Cape Coast Metropolis, Ghana. BMC Health Serv Res 2021; 21:520. [PMID: 34049548 PMCID: PMC8160390 DOI: 10.1186/s12913-021-06560-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 05/07/2021] [Indexed: 11/19/2022] Open
Abstract
Background There is scarcity of data on experiences of patients who access laboratory services during hospital visits in sub-Saharan Africa. This study sought to evaluate the depth of laboratory professionals-patient interactions during pre- and post-sampling period at two hospitals in Ghana. Methods This study used real time observations of patient-laboratory staff interactions to collect first-hand data. Additionally, two separate sets of semi-structured questionnaires were used to collect data on the experiences of patients and laboratory professionals. Data were entered into Microsoft Excel and analysed using SPSS version 25. Results Inadequate laboratory space is a major factor limiting adequacy of patients-laboratory professionals’ interactions. Overall, even though the laboratory professionals (93.3%) overwhelmingly agreed to the need to inform patients about the turnaround time of the respective laboratory testing, this was not routinely done. Irrespective of patients’ educational attainment, patients were poorly informed about their respective laboratory tests. Although both patients and laboratory professionals (60.0% vs 63.6% respectively) indicated that the test requester has responsibility to inform patients about their laboratory testing, only 29.1% of patients indicated having received such explanations. Furthermore, although 28.1% of patients indicated knowing the specifics of their respective test requisition, only 15% could correctly identify their requested laboratory testing. Conclusion There is the need for standard operating protocols to standardize practitioner-patient interaction at the two facilities. Moreover, there is the need for laboratory staff-test requester engagement to clearly delineate who has what responsibilities regarding informing patients about laboratory testing. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06560-8.
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Affiliation(s)
- Patrick Adu
- Department of Medical Laboratory Science, School of Allied Health Science, University of Cape Coast, Cape Coast, Ghana. .,Lancaster University Management School, Lancaster, UK.
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13
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Moirongo RM, Lorenz E, Ntinginya NE, Dekker D, Fernandes J, Held J, Lamshöft M, Schaumburg F, Mangu C, Sudi L, Sie A, Souares A, Heinrich N, Wieser A, Mordmüller B, Owusu-Dabo E, Adegnika AA, Coulibaly B, May J, Eibach D. Regional Variation of Extended-Spectrum Beta-Lactamase (ESBL)-Producing Enterobacterales, Fluoroquinolone-Resistant Salmonella enterica and Methicillin-Resistant Staphylococcus aureus Among Febrile Patients in Sub-Saharan Africa. Front Microbiol 2020; 11:567235. [PMID: 33101240 PMCID: PMC7546812 DOI: 10.3389/fmicb.2020.567235] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/08/2020] [Indexed: 11/16/2022] Open
Abstract
Background Antimicrobial resistance (AMR) thwarts the curative power of drugs and is a present-time global problem. We present data on antimicrobial susceptibility and resistance determinants of bacteria the WHO has highlighted as being key antimicrobial resistance concerns in Africa, to strengthen knowledge of AMR patterns in the region. Methods Blood, stool, and urine specimens of febrile patients, aged between ≥ 30 days and ≤ 15 years and hospitalized in Burkina Faso, Gabon, Ghana, and Tanzania were cultured from November 2013 to March 2017 (Patients > 15 years were included in Tanzania). Antimicrobial susceptibility testing was performed for all Enterobacterales and Staphylococcus aureus isolates using disk diffusion method. Extended-spectrum beta-lactamase (ESBL) production was confirmed by double-disk diffusion test and the detection of blaCTX–M, blaTEM and blaSHV. Multilocus sequence typing was conducted for ESBL-producing Escherichia coli and Klebsiella pneumoniae, ciprofloxacin-resistant Salmonella enterica and S. aureus. Ciprofloxacin-resistant Salmonella enterica were screened for plasmid-mediated resistance genes and mutations in gyrA, gyrB, parC, and parE. S. aureus isolates were tested for the presence of mecA and Panton-Valentine Leukocidin (PVL) and further genotyped by spa typing. Results Among 4,052 specimens from 3,012 patients, 219 cultures were positive of which 88.1% (n = 193) were Enterobacterales and 7.3% (n = 16) S. aureus. The prevalence of ESBL-producing Enterobacterales (all CTX-M15 genotype) was 45.2% (14/31; 95% CI: 27.3, 64.0) in Burkina Faso, 25.8% (8/31; 95% CI: 11.9, 44.6) in Gabon, 15.1% (18/119; 95% CI: 9.2, 22.8) in Ghana and 0.0% (0/12; 95% CI: 0.0, 26.5) in Tanzania. ESBL positive non-typhoid Salmonella (n = 3) were detected in Burkina Faso only and methicillin-resistant S. aureus (n = 2) were detected in Ghana only. While sequence type (ST)131 predominated among ESBL E. coli (39.1%;9/23), STs among ESBL K. pneumoniae were highly heterogenous. Ciprofloxacin resistant nt Salmonella were commonest in Burkina Faso (50.0%; 6/12) and all harbored qnrB genes. PVL were found in 81.3% S. aureus. Conclusion Our findings reveal a distinct susceptibility pattern across the various study regions in Africa, with notably high rates of ESBL-producing Enterobacterales and ciprofloxacin-resistant nt Salmonella in Burkina Faso. This highlights the need for local AMR surveillance and reporting of resistances to support appropriate action.
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Affiliation(s)
- Rehema Moraa Moirongo
- Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Eva Lorenz
- Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Heidelberg, Munich, Tübingen, Germany.,Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Nyanda E Ntinginya
- National Institute for Medical Research-Mbeya Medical Research Center, Mbeya, Tanzania
| | - Denise Dekker
- Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Heidelberg, Munich, Tübingen, Germany
| | - José Fernandes
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon.,Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Jana Held
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Heidelberg, Munich, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon.,Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Maike Lamshöft
- Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Heidelberg, Munich, Tübingen, Germany
| | - Frieder Schaumburg
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon.,Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Chacha Mangu
- National Institute for Medical Research-Mbeya Medical Research Center, Mbeya, Tanzania
| | - Lwitiho Sudi
- National Institute for Medical Research-Mbeya Medical Research Center, Mbeya, Tanzania
| | - Ali Sie
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Aurelia Souares
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Heidelberg, Munich, Tübingen, Germany.,Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg, Germany
| | - Norbert Heinrich
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Heidelberg, Munich, Tübingen, Germany.,Department of Infectious Diseases & Tropical Medicine, Ludwig Maximilians University of Munich, Munich, Germany
| | - Andreas Wieser
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Heidelberg, Munich, Tübingen, Germany.,Department of Infectious Diseases & Tropical Medicine, Ludwig Maximilians University of Munich, Munich, Germany.,Faculty of Medicine, Max Von Pettenkofer Institute, Ludwig Maximilians University of Munich, Munich, Germany
| | - Benjamin Mordmüller
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Heidelberg, Munich, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon.,Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany.,German Center for Infection Research (DZIF), African Partner Institution, Lambaréné, Gabon
| | - Ellis Owusu-Dabo
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi, Ghana
| | - Akim Ayola Adegnika
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon.,Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany.,German Center for Infection Research (DZIF), African Partner Institution, Lambaréné, Gabon
| | | | - Jürgen May
- Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Heidelberg, Munich, Tübingen, Germany
| | - Daniel Eibach
- Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Heidelberg, Munich, Tübingen, Germany
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14
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Green AD, Kavanagh-Wright L, Lee GR. Investigation of the long-term yield of auditing for conformity with the ISO 15189:2012 quality standard in a hospital pathology laboratory. Pract Lab Med 2020; 20:e00159. [PMID: 32258329 PMCID: PMC7109451 DOI: 10.1016/j.plabm.2020.e00159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/14/2020] [Accepted: 02/28/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction Pathology laboratories are increasingly seeking accreditation to quality standards to assure Quality of Service (QoS). However, there is little data available regarding the value of this in laboratories with well-established Quality Management Systems (QMS). Moreover, critics of accreditation claim it redirects resources toward trivial issues. Our objective was to investigate the value of auditing for conformity with the ISO 15189:2012 standard in such laboratories. Design and Methods: In total, 483 Audit-Identified Non-Conformities (AINCs) were documented within our department since transitioning to an ISO 15189:2012 compliant QMS. The potential consequences of these were assessed by three clinical laboratorians who assigned them into categories based on their likely impact. These were: Unlikely (no clear consequences); Possible (potential for poor QoS/harm); and Probable (Likely to cause poor QoS/harm). Additionally, total numbers/severity of Real-Time Non-Conformities (RTNCs) detected outside of auditing were examined to provide additional insight into the effects of accreditation on QoS. Results According to majority decision: 395 (81.8%) of AINCs were classified Unlikely, 88 (18.2%) were Possible, and none were Probable. The relative proportion of Unlikely AINCs also rose over time. Total numbers and severity of RTNCs dropped in the short-term following transition to an ISO 15189:2012 QMS, but steadily rose thereafter. Conclusions Our data suggest auditing for conformity with ISO 15189:2012 standards may be effective in attaining accreditation, but may have diminishing returns in the long-term once the QMS is established, unless there is continual improvement in the audit process to promote better use of resources.
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Affiliation(s)
- Alastair David Green
- Department of Clinical Chemistry and Diagnostic Endocrinology, Mater Misericordiae University Hospital, Eccles St Dublin 7, Dublin, Ireland
| | - Lucille Kavanagh-Wright
- Department of Clinical Chemistry and Diagnostic Endocrinology, Mater Misericordiae University Hospital, Eccles St Dublin 7, Dublin, Ireland
| | - Graham Robert Lee
- Department of Clinical Chemistry and Diagnostic Endocrinology, Mater Misericordiae University Hospital, Eccles St Dublin 7, Dublin, Ireland
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15
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Mills D, Staley S, Aisu S, Kunde T, Kimsey P, Lewis K. International Public Health Laboratory Twinning: An Innovative Approach to Strengthen the National Health Laboratory System in Uganda, 2014-2017. Public Health Rep 2020; 134:37S-42S. [PMID: 31682560 PMCID: PMC6832031 DOI: 10.1177/0033354919836957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
International initiatives to strengthen national health laboratory systems in resource-poor countries are often hampered by unfamiliarity with the country's health laboratory environment and turnover of international partners during the initiative. This study provides an overview of, and lessons learned from, the use of a laboratory long-term partnership approach (ie, "twinning") to strengthen the national public health laboratory system in an international setting. We focused on the partnering of the Uganda Ministry of Health Central Public Health Laboratory (CPHL) with the New Mexico State Public Health Laboratory to help the CPHL become Uganda's national public health reference laboratory (Uganda National Health Laboratory Services [UNHLS] Institute) and leader of its nascent Uganda National Health Laboratory Network (UNHLN). Via twinning, CPHL leadership received training on laboratory leadership and management, quality systems, facility management, and the One Health environmental strategy (ie, that the health of persons is connected to the health of animals and the environment), and drafted a National Health Laboratory Policy, UNHLS Institute business plan, and strategic and operating plans for the UNHLS Institute and UNHLN. The CPHL is now responsible for the UNHLS Institute and coordinates the UNHLN. Lessons learned include (1) twinning establishes stable long-term collaborations and (2) success requires commitment to a formal statement of activities and objectives, as well as clear and regular communication among partners.
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Affiliation(s)
- David Mills
- Scientific Laboratory Division, New Mexico Department of Health, Albuquerque, NM, USA
| | - Sherrie Staley
- Global Health Program, Association of Public Health Laboratories, Silver Spring, MD, USA
| | - Steven Aisu
- Central Public Health Laboratory, Uganda Ministry of Health, Kampala, Uganda
| | - Twila Kunde
- Scientific Laboratory Division, New Mexico Department of Health, Albuquerque, NM, USA
| | - Paul Kimsey
- California State Public Health Laboratory, Richmond, CA, USA
| | - Kim Lewis
- Association of Public Health Laboratories, Pringle Bay, West Cape, South Africa
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16
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Kiwanuka SN, Namuhani N, Akulume M, Kalyesubula S, Bazeyo W, Kisakye AN. Uganda's laboratory human resource in the era of global health initiatives: experiences, constraints and opportunities-an assessment of 100 facilities. HUMAN RESOURCES FOR HEALTH 2020; 18:13. [PMID: 32070361 PMCID: PMC7029471 DOI: 10.1186/s12960-020-0454-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 02/03/2020] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Laboratories are vital in disease diagnosis, prevention, treatment and outbreak investigations. Although recent decades have seen rapid advancements in modernised equipment and laboratory processes, minimal investments have been made towards strengthening laboratory professionals in Africa. This workforce is characterised by insufficient numbers, skewed rural-urban distribution, inadequate qualifications, inadequate skill-mix and limited career opportunities. These factors adversely affect the performance of laboratory professionals, who are the backbone of quality services. In the era of Global Health Initiatives, this study describes the status of laboratory human resource and assesses the experiences, constrains and opportunities for strengthening them in Uganda. METHODS This paper is part of a study, which assessed laboratory capacity in 21 districts during December 2015 to January 2016. We collected data using a laboratory assessment tool adapted from the WHO and USAID assessment tool for laboratory services and supply chain (ATLAS), 2006. Of the 100 laboratories, 16 were referral laboratories (hubs). To assess human resource constraints, we conducted 100 key informant interviews with laboratory managers and in charges. RESULTS Across the facilities, there was an excess number of laboratory technicians at Health Center (HC) IV level by 30% and laboratory assistants were in excess by 90%. There was a shortage of laboratory technologists with only 50% of the posts filled at general hospitals. About 87.5% of hub laboratories had conducted formal onsite training compared to 51.2% of the non-hub laboratories. Less than half of HC III laboratories had conducted a formal onsite training; hospital laboratories had not conducted training on the use and maintenance of equipment. Almost all HC III laboratories had been supervised though supervision focused on HIV/AIDS. Financial resources, workload and lack of supervision were major constraints to human resource strengthening. CONCLUSION Although opportunities for continuous education have emerged over the past decade, they are still threatened by inadequate staffing, skill mix and escalating workload. Moreover, excesses in staffing are more in favour of HIV, TB and malaria. The Ministry of Health needs to develop work-based staffing models to ensure adequate staff numbers and skill mix. Staffing norms need to be revised to accommodate laboratory technologists and scientists at high-level laboratories. Training needs to extend beyond HIV, TB and malaria.
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Affiliation(s)
| | - Noel Namuhani
- School of Public Health, Makerere University, Kampala, Uganda
| | - Martha Akulume
- School of Public Health, Makerere University, Kampala, Uganda
| | - Simeon Kalyesubula
- East African Public Health Laboratory Networking Project (EAPHLNP), Kampala, Uganda
| | - William Bazeyo
- School of Public Health, Makerere University, Kampala, Uganda
| | - Angela N. Kisakye
- School of Public Health, Makerere University, Kampala, Uganda
- African Field Epidemiology Network, Kampala, Uganda
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17
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Humphrey JM, Mpofu P, Pettit AC, Musick B, Carter EJ, Messou E, Marcy O, Crabtree-Ramirez B, Yotebieng M, Anastos K, Sterling TR, Yiannoutsos C, Diero L, Wools-Kaloustian K. Mortality Among People With HIV Treated for Tuberculosis Based on Positive, Negative, or No Bacteriologic Test Results for Tuberculosis: The IeDEA Consortium. Open Forum Infect Dis 2020; 7:ofaa006. [PMID: 32010735 PMCID: PMC6984675 DOI: 10.1093/ofid/ofaa006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 01/08/2020] [Indexed: 11/16/2022] Open
Abstract
Background In resource-constrained settings, many people with HIV (PWH) are treated for tuberculosis (TB) without bacteriologic testing. Their mortality compared with those with bacteriologic testing is uncertain. Methods We conducted an observational cohort study among PWH ≥15 years of age initiating TB treatment at sites affiliated with 4 International epidemiology Databases to Evaluate AIDS consortium regions from 2012 to 2014: Caribbean, Central and South America, and Central, East, and West Africa. The exposure of interest was the TB bacteriologic test status at TB treatment initiation: positive, negative, or no test result. The hazard of death in the 12 months after TB treatment initiation was estimated using a Cox proportional hazard model. Missing covariate values were multiply imputed. Results In 2091 PWH, median age 36 years, 53% had CD4 counts ≤200 cells/mm3, and 52% were on antiretroviral therapy (ART) at TB treatment initiation. The adjusted hazard of death was higher in patients with no test compared with those with positive test results (hazard ratio [HR], 1.56; 95% confidence interval [CI], 1.08–2.26). The hazard of death was also higher among those with negative compared with positive tests but was not statistically significant (HR, 1.28; 95% CI, 0.91–1.81). Being on ART, having a higher CD4 count, and tertiary facility level were associated with a lower hazard for death. Conclusions There was some evidence that PWH treated for TB with no bacteriologic test results were at higher risk of death than those with positive tests. Research is needed to understand the causes of death in PWH treated for TB without bacteriologic testing.
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Affiliation(s)
- John M Humphrey
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Philani Mpofu
- Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Indiana, USA
| | - April C Pettit
- Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Vanderbilt Tuberculosis Center, Nashville, Tennessee, USA
| | - Beverly Musick
- Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Indiana, USA
| | - E Jane Carter
- Department of Medicine, Brown University School of Medicine, Providence, Rhode Island, USA
| | - Eugène Messou
- University of Bordeaux, Centre INSERM U1219, Bordeaux Population Health, Bordeaux, France.,Centre de Prise en Charge de Recherche et de Formation (Aconda-CePReF), Abidjan, Côte d'Ivoire
| | - Olivier Marcy
- University of Bordeaux, Centre INSERM U1219, Bordeaux Population Health, Bordeaux, France.,Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | | | - Marcel Yotebieng
- The Ohio State University, College of Public Health, Columbus, Ohio, USA
| | - Kathryn Anastos
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Timothy R Sterling
- Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Vanderbilt Tuberculosis Center, Nashville, Tennessee, USA
| | - Constantin Yiannoutsos
- Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Indiana, USA
| | - Lameck Diero
- Department of Medicine, Moi University College of Health Sciences, Eldoret, Kenya
| | - Kara Wools-Kaloustian
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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18
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A study to better understand under-utilization of laboratory tests for antenatal care in Senegal. PLoS One 2020; 15:e0225710. [PMID: 31917797 PMCID: PMC6952088 DOI: 10.1371/journal.pone.0225710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 11/11/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To better understand factors contributing to underutilization of laboratory services for health care delivery in sub-Saharan Africa, we conducted a study in Senegalese Antenatal Care clinics (ANC) and laboratories to determine the extent of underutilization, contributing factors, and bottlenecks in the cascade of care from first ANC visit, test uptake, to availability of test results and appropriate clinical management. METHODS At 16 health facilities, pregnant women attending for their first ANC visit were consecutively recruited and information was prospectively collected on the request, execution, results and clinical management of seven nationally recommended laboratory screening tests for normal pregnancy: hemoglobin concentration (Hb), syphilis serology, HIV serology, determination of proteinuria (PU), determination of blood group and Rhesus factor, Emmel test to detect sickle cell disease, and glycaemia. Health facility staff were interviewed on human resource capacity, management of the ANC and the laboratory, and availability and use of guidelines. RESULTS Of 1246 ANC attendants, 400 (32%) had complete results. Completeness varied between facilities from 0-99%. In multilevel logistic regression analysis of women nested in facilities, complete uptake was lower if women started ANC later in pregnancy; very low in rural ANC attendants who ever delivered compared to urban primigravidae (OR 0.064; 95%CI 0.00-0.52); and higher if the facility routinely recommended all seven tests. In the cascade from test request to clinical management, the most frequent bottleneck was non-execution of requested tests, while unavailability of results for executed test was uncommon (<2%). Overall, of 525 abnormal test results 97(18%) had a record of adequate clinical management. CONCLUSION Our study illustrates challenges to test uptake even when laboratory testing capacity is in place, with large differences between facilities, and underscores the importance of management, policy, and the importance of considering local context in order to improve service delivery to expectant mothers.
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19
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Yee MF, Emmel GN, Yang EJ, Lee E, Paek JH, Wu BM, Kamei DT. Ionic Liquid Aqueous Two-Phase Systems for the Enhanced Paper-Based Detection of Transferrin and Escherichia coli. Front Chem 2018; 6:486. [PMID: 30386770 PMCID: PMC6198035 DOI: 10.3389/fchem.2018.00486] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/24/2018] [Indexed: 01/08/2023] Open
Abstract
Aqueous two-phase systems (ATPSs) have been widely utilized for liquid-liquid extraction and purification of biomolecules, with some studies also demonstrating their capacity as a biomarker concentration technique for use in diagnostic settings. As the limited polarity range of conventional polymer-based ATPSs can restrict their use, ionic liquid (IL)-based ATPSs have been recently proposed as a promising alternative to polymer-based ATPSs, since ILs are regarded as tunable solvents with excellent solvation capabilities for a variety of natural compounds and proteins. This study demonstrates the first application of IL ATPSs to point-of-care diagnostics. ATPSs consisting of 1-butyl-3-methylimidazolium tetrafluoroborate ([Bmim][BF4]) and sodium phosphate salt were utilized to quickly concentrate biomarkers prior to detection using the lateral-flow immunoassay (LFA). We found the phase separation speed of the IL ATPS to be very rapid and a significant improvement upon the separation speed of both polymer-salt and micellar ATPSs. This system was successfully applied to both sandwich and competitive LFA formats and enhanced the detection of both Escherichia coli bacteria and the transferrin protein up to 8- and 20-fold, respectively. This system's compatibility with a broad range of biomolecules, rapid phase separation speed, and tunability suggest wide applicability for a large range of different antigens and biomarkers.
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Affiliation(s)
- Matthew F Yee
- Kamei Laboratory, UCLA, Department of Bioengineering, Los Angeles, CA, United States
| | - Grace N Emmel
- Kamei Laboratory, UCLA, Department of Bioengineering, Los Angeles, CA, United States
| | - Eric J Yang
- Kamei Laboratory, UCLA, Department of Bioengineering, Los Angeles, CA, United States
| | - Eumene Lee
- Kamei Laboratory, UCLA, Department of Bioengineering, Los Angeles, CA, United States
| | - Justin H Paek
- Kamei Laboratory, UCLA, Department of Bioengineering, Los Angeles, CA, United States
| | - Benjamin M Wu
- Wu Laboratory, UCLA, Department of Bioengineering, Los Angeles, CA, United States
| | - Daniel T Kamei
- Kamei Laboratory, UCLA, Department of Bioengineering, Los Angeles, CA, United States
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A Cross-Sectional Study to Assess Capacity of Health Facility Laboratories in Zone One of Afar Regional State, Ethiopia. J Trop Med 2018; 2018:9274127. [PMID: 30174697 PMCID: PMC6106800 DOI: 10.1155/2018/9274127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 07/12/2018] [Accepted: 07/22/2018] [Indexed: 11/17/2022] Open
Abstract
Role of laboratory service in patient care is well recognized in developed compared to developing countries like Ethiopia where most medical decisions are based on clinical judgment. Laboratory based medical decisions save life and resources. Thus, health facilities (HFs) having capacitated laboratories provide better health care service. Thus, this study assessed capacity of laboratories found in all nine HFs in zone one of Afar region, Ethiopia. Cross-sectional study was conducted from January to May 2015. Data were collected using questioner from medical laboratory professionals (MLPs) and using cheek list from laboratory registration books. Collected data was analyzed using SPSS. Availability of laboratory related national guidelines and standard operating procedure varies among HFs studied. In 42 selected laboratory equipment and materials assessed, their availability shows variations among HFs from 13 (30.2%) to 32 (74.4%). Among different laboratory tests recommended to be performed at health center (HC) level by World Health Organization (WHO), six tests were not performed in all HC laboratories. Moreover, 11 (31.4%) MLPs received in-service training in the past one year. Internal quality control measures were done in 3 (33.3%) laboratories. However, all laboratories were involved in external quality assurance with varied schedules. Specimens after testing and specimen with prolonged transit time were discarded using standard rejection criteria in 8 (88.9%) and 3 (33.3) laboratories, respectively. Study showed that laboratories assessed have good capacities in involving external quality assurance and having proper laboratory test request format. But capacity of laboratories assessed is limited and unsatisfactory in number of laboratory tests performed at HC laboratories, in internal quality control measure implementation, and in getting up-to-date in-service training to staff. Thus, to enhance capacity of laboratories in HC, responsible bodies shall avail basic laboratory materials and equipment, make fair distribution of MLPs, provide up-to-date training, and implement internal quality control measures in laboratories.
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Berehe TT, Bekele GE, Yimer YS, Lozza TZ. Assessment of clients satisfaction with outpatient services at Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia. BMC Res Notes 2018; 11:507. [PMID: 30053830 PMCID: PMC6063000 DOI: 10.1186/s13104-018-3603-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 07/13/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE This study aimed at assessing clients' satisfaction and associated factors among adults. A cross sectional facility based study was conducted on 420 clients of Yekatit 12 Hospital Medical College from 1 June 2016 to 1 July 2016. Data was entered, cleaned, and analyzed using SPSS statistical package. Data was analyzed using a multivariable logistic regression model to find out the most significant predictors for clients satisfaction with outpatient services at Yekatit 12 Hospital Medical College. RESULTS This study showed that the overall clients' satisfaction level towards out-patient health service at Yekatit 12 Hospital Medical College was 47% at 95% CI (42.5, 51.7%). The most frequently identified problems were: lack of clean toilet in nearby the waiting areas, lack of waiting area particularly at pharmacy, inadequate furniture like chair, lack of adequate drugs and supplies, lack of privacy at the examination room, lack of direction signs, and poor communication between clients and health service providers. In conclusion the overall satisfaction level of the patients is low, so this demands the Hospital to take further action on the identified problems to improve the services delivered to the patients.
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Affiliation(s)
- Tirhas T Berehe
- Department of Public Health, College of Medicine, Yekatit 12 Hospitals, Addis Ababa, Ethiopia.
| | - Getabalew E Bekele
- Department of Public Health, College of Medicine, Yekatit 12 Hospitals, Addis Ababa, Ethiopia
| | - Yimer S Yimer
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Taye Z Lozza
- Department of Public Health, College of Medicine, Yekatit 12 Hospitals, Addis Ababa, Ethiopia
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Dabaro D. Factors affecting tuberculosis case detection in Kersa District, South West Ethiopia. J Clin Tuberc Other Mycobact Dis 2017; 9:1-4. [PMID: 31723710 PMCID: PMC6850251 DOI: 10.1016/j.jctube.2017.08.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 08/09/2017] [Accepted: 08/10/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Tuberculosis is one of the deadly communicable diseases which claim the lives of millions in the world. Early case detection and prompt treatment cures the patients, breaks the transmission and improves the control program. OBJECTIVE The aim of this study was to investigate the factors affecting tuberculosis case detection in Kersa District, south west Ethiopia. METHOD Facility based cross sectional study design was employed in four directly observed treatment short course service providing public health centers. Three hundred eighty four patient folders were reviewed. In-depth interviews was conducted with 18 health care workers including heads of health centers, tuberculosis focal persons, clinicians, laboratory technicians, tuberculosis program coordinator and head of health office. RESULT Significant number, 135(35.2%) of tuberculosis suspects were not requested for microscopic examination of sputum smear, the laboratory results 21(8.4%) of requested patients were not recorded in both patient folders and laboratory registers. Only 10 (4.4%) of those examined and recorded were smearing positive. Participants described that the shortage and irregular supply of acid fast bacilli reagents and consumable, inadequate infrastructures, frequent electricity interruption, shortage of trained care providers, negligence of care providers, weakness of laboratory quality assurance system and poor health information use culture were major factors for low case identification. CONCLUSION The resource shortage, electricity interruption, low commitment of care providers, weak quality assurance practice and poor health information use culture were major factors for low tuberculosis case identification and should be considered.
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Evidence-based practice and its associated factors among medical laboratory professionals in West Amhara hospitals, Northwest Ethiopia. INT J EVID-BASED HEA 2017; 16:66-72. [PMID: 28937412 DOI: 10.1097/xeb.0000000000000122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Healthcare and clinical laboratory practices are constantly evolving, leading a need for evidence-based practice (EBP) among all laboratory professionals. However, EBP among laboratory professionals has not yet been studied in Ethiopia. AIMS This study aimed to determine EBP and associated factors among medical laboratory professionals in West Amhara hospitals, Northwest Ethiopia. METHODS An analytic and descriptive cross-sectional study was conducted in West Amhara hospitals from February to March 2014. Data were collected using a pretested, structured self-administered questionnaire. Bivariate and multivariate logistic regressions were performed to identify factors associated with evidence-based laboratory practice. Odds ratios with 95% confidence interval (CI) were computed and the level of significance determined. RESULTS A total of 169 respondents completed the questionnaire (response rate 95.4%), 40.8% (n = 69) of whom had a good level of EBP. Knowledge about EBP [adjusted odds ratio (AOR) = 2.22, 95% CI: 1.10-4.49], internet access (AOR = 2.43, 95% CI: 1.12-5.29), adoption EBP (AOR = 2.79, 95% CI: 1.41-5.52) and being single in marital status (AOR = 2.21, 95% CI: 1.08-4.51) were factors associated with EBP in multivariable logistic regression after controlling the effects of the confounding variables. CONCLUSION EBP among laboratory professionals was found to be low. Having good knowledge towards EBP, organizational adoption of EBP, having internet access in their organization and being single in marital status were factors associated with EBP.
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Tadeu BTM, Geelhoed D. "This thing of testing our blood is really very important": a qualitative study of primary care laboratory services in Tete Province, Mozambique. Int J Equity Health 2016; 15:133. [PMID: 27558247 PMCID: PMC4997755 DOI: 10.1186/s12939-016-0418-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 08/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Laboratory services are essential for diagnosis and management of patients, and for disease control, and should form an integral part of primary health services capable of contributing to Universal Health Coverage. Nevertheless, they remain among the most neglected health services in resource-poor countries, including Mozambique. The Health Directorate of Tete Province, Mozambique, developed this study to analyse the role and perceived impact of laboratory services in primary healthcare on access, perceived service quality and disease control. METHODS Qualitative research was done in three primary health facilities with and three without a laboratory in Tete Province, purposively sampled for their available services, accessibility and size. The role of the laboratory in primary health care was explored by reviewing documents, including records and monthly reports, interviews with clinicians, laboratory technicians and key informants (community leaders), and through focus group discussions with beneficiaries. Numeric data were summarized in Microsoft™ Excel. Qualitative data were analysed for content within generated categories, interpreted within the concept of Universal Health Coverage, cross validated between the researchers. RESULTS The results showed a greater use of health services, with more frequent diagnosis and monitoring of prevalent diseases, in facilities with a laboratory as compared with facilities without. Clinicians, patients and community leaders in facilities with a laboratory perceived an improved possibility of diagnosing and treating prevalent diseases, resulting in greater satisfaction with the provided services. Laboratory technicians confirmed that patients appreciated having access to laboratory tests. Clinicians, patients and community leaders in facilities without a laboratory protested its lack, claiming that it increased the likelihood of costly referrals, delays and even deaths. CONCLUSIONS The study concluded that the laboratory plays an important role in primary level health facilities, as it is associated with greater utilization and perceived higher quality of services. Lack of a laboratory hampers patient management, disease control and financial risk protection. Expansion of the clinical laboratory system at primary level health facilities should be a properly funded priority of the national health system in Mozambique and similar countries.
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Affiliation(s)
| | - Diederike Geelhoed
- Danish Ministry of Foreign Affairs, Provincial Directorate of Health, Rua de Macondes, Cidade de Tete, Tete Province, Mozambique.
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Shrivastava R, Gadde R, Nkengasong JN. Importance of Public-Private Partnerships: Strengthening Laboratory Medicine Systems and Clinical Practice in Africa. J Infect Dis 2016; 213 Suppl 2:S35-40. [PMID: 27025696 DOI: 10.1093/infdis/jiv574] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
After the launch of the US President's Emergency Plan for AIDS Relief in 2003, it became evident that inadequate laboratory systems and services would severely limit the scale-up of human immunodeficiency virus infection prevention, care, and treatment programs. Thus, the Office of the US Global AIDS Coordinator, Centers for Disease Control and Prevention, and Becton, Dickinson and Company developed a public-private partnership (PPP). Between October 2007 and July 2012, the PPP combined the competencies of the public and private sectors to boost sustainable laboratory systems and develop workforce skills in 4 African countries. Key accomplishments of the initiative include measurable and scalable outcomes to strengthen national capacities to build technical skills, develop sample referral networks, map disease prevalence, support evidence-based health programming, and drive continuous quality improvement in laboratories. This report details lessons learned from our experience and a series of recommendations on how to achieve successful PPPs.
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Affiliation(s)
- Ritu Shrivastava
- International Laboratory Branch, Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Renuka Gadde
- Becton, Dickinson, and Company, Franklin Lakes, New Jersey
| | - John N Nkengasong
- International Laboratory Branch, Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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Dominique JK, Ortiz-Osorno AA, Fitzgibbon J, Gnanashanmugam D, Gilpin C, Tucker T, Peel S, Peter T, Kim P, Smith S. Implementation of HIV and Tuberculosis Diagnostics: The Importance of Context. Clin Infect Dis 2016; 61Suppl 3:S119-25. [PMID: 26409272 DOI: 10.1093/cid/civ552] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Novel diagnostics have been widely applied across human immunodeficiency virus (HIV) and tuberculosis prevention and treatment programs. To achieve the greatest impact, HIV and tuberculosis diagnostic programs must carefully plan and implement within the context of a specific healthcare system and the laboratory capacity. METHODS A workshop was convened in Cape Town in September 2014. Participants included experts from laboratory and clinical practices, officials from ministries of health, and representatives from industry. RESULTS The article summarizes best practices, challenges, and lessons learned from implementation experiences across sub-Saharan Africa for (1) building laboratory programs within the context of a healthcare system; (2) utilizing experience of clinicians and healthcare partners in planning and implementing the right diagnostic; and (3) evaluating the effects of new diagnostics on the healthcare system and on patient health outcomes. CONCLUSIONS The successful implementation of HIV and tuberculosis diagnostics in resource-limited settings relies on careful consideration of each specific context.
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Affiliation(s)
- Joyelle K Dominique
- Office of Global Research, Office of Science Management and Operations, Office of the Director
| | - Alberto A Ortiz-Osorno
- Clinical Research Implementation Subject Matter Expert, Henry M. Jackson Foundation, Division of AIDS Therapeutic Research Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, US Department of Health and Human Services, Rockville, Maryland
| | - Joseph Fitzgibbon
- Therapeutic Research Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, US Department of Health and Human Services, Rockville, Maryland
| | | | | | - Timothy Tucker
- Strategic Evaluation, Advisory and Development Consulting, Cape Town, South Africa
| | - Sheila Peel
- Diagnostics and Laboratory Monitoring, US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Trevor Peter
- Diagnostics, Clinton Health Access Initiative, Gaborone, Botswana
| | - Peter Kim
- Adolescent and Pediatric Research Branch, Prevention Sciences Program, Division of AIDS
| | - Steven Smith
- Office of Global Affairs, Office of the Secretary, US Department of Health and Human Services, Pretoria, South Africa
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Ndihokubwayo JB, Maruta T, Ndlovu N, Moyo S, Yahaya AA, Coulibaly SO, Kasolo F, Turgeon D, Abrol AP. Implementation of the World Health Organization Regional Office for Africa Stepwise Laboratory Quality Improvement Process Towards Accreditation. Afr J Lab Med 2016; 5:280. [PMID: 28879103 PMCID: PMC5436392 DOI: 10.4102/ajlm.v5i1.280] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 12/03/2015] [Indexed: 11/21/2022] Open
Abstract
Background The increase in disease burden has continued to weigh upon health systems in Africa. The role of the laboratory has become increasingly critical in the improvement of health for diagnosis, management and treatment of diseases. In response, the World Health Organization Regional Office for Africa (WHO AFRO) and its partners created the WHO AFRO Stepwise Laboratory (Quality) Improvement Process Towards Accreditation (SLIPTA) program. SLIPTA implementation process WHO AFRO defined a governance structure with roles and responsibilities for six main stakeholders. Laboratories were evaluated by auditors trained and certified by the African Society for Laboratory Medicine. Laboratory performance was measured using the WHO AFRO SLIPTA scoring checklist and recognition certificates rated with 1–5 stars were issued. Preliminary results By March 2015, 27 of the 47 (57%) WHO AFRO member states had appointed a SLIPTA focal point and 14 Ministers of Health had endorsed SLIPTA as the desired programme for continuous quality improvement. Ninety-eight auditors from 17 African countries, competent in the Portuguese (3), French (12) and English (83) languages, were trained and certified. The mean score for the 159 laboratories audited between May 2013 and March 2015 was 69% (median 70%; SD 11.5; interquartile range 62–77). Of these audited laboratories, 70% achieved 55% compliance or higher (2 or more stars) and 1% scored at least 95% (5 stars). The lowest scoring sections of the WHO AFRO SLIPTA checklist were sections 6 (Internal Audit) and 10 (Corrective Action), which both had mean scores below 50%. Conclusion The WHO AFRO SLIPTA is a process that countries with limited resources can adopt for effective implementation of quality management systems. Political commitment, ownership and investment in continuous quality improvement are integral components of the process.
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Affiliation(s)
| | - Talkmore Maruta
- African Society for Laboratory Medicine, Addis Ababa, Ethiopia
| | - Nqobile Ndlovu
- African Society for Laboratory Medicine, Addis Ababa, Ethiopia
| | - Sikhulile Moyo
- Botswana-Harvard AIDS Institute Partnerships, Gaborone, Botswana
| | - Ali Ahmed Yahaya
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | | | - Francis Kasolo
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - David Turgeon
- United States Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and Tuberculosis, Atlanta, Georgia, United States
| | - Angelii P Abrol
- United States Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and Tuberculosis, Atlanta, Georgia, United States
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Elbireer AM, Jackson JB, Sendagire H, Opio A, Bagenda D, Amukele TK. The good, the bad, and the unknown: quality of clinical laboratories in Kampala, Uganda. PLoS One 2013; 8:e64661. [PMID: 23737993 PMCID: PMC3667826 DOI: 10.1371/journal.pone.0064661] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Accepted: 04/16/2013] [Indexed: 11/18/2022] Open
Abstract
Background Clinical laboratories are crucial in addressing the high rates of communicable and non-communicable diseases seen in sub-Saharan Africa (SSA). However, the most basic information, such as the number and quality of clinical laboratories in SSA, is not available. The objective of this study was to create a practical method for obtaining this information in SSA towns and cities using an initial survey in Kampala, Uganda. Methods Kampala city was divided into 5 partially-overlapping regions. Each region was assigned to 2–3 surveyors who identified and surveyed laboratories in their respective regions; in person and on foot. A modified version of the World Health Organization - African Region (WHO/AFRO) Laboratory Strengthening Checklist was used to obtain baseline measures of quality for all clinical laboratories within Kampala city. The surveyors also measured other attributes of each laboratory, such as their affiliation (government, private etc), designation (national hospital, district hospital, standalone etc), staff numbers, and type of staff. Results The survey team identified and surveyed 954 laboratories in Kampala city. 96% of laboratories were private. Only 45 (5%) of the laboratories met or surpassed the lowest quality standards defined by the WHO/AFRO-derived laboratory strengthening tool (1-star). These 45 higher-quality laboratories were, on average, larger and had a higher number of laboratory-specific staff (technologists, phlebotomists etc) than the other 909 laboratories. 688 (72%) of the 954 laboratories were not registered with the Ministry of Health (MoH). Conclusions This comprehensive evaluation of the number, scope, and quality of clinical laboratories in Kampala is the first published survey of its kind in sub-Saharan Africa. The survey findings demonstrated that laboratories in Kampala that had qualified personnel and those that had higher testing volumes, tended to be of higher-quality.
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Affiliation(s)
- Ali M Elbireer
- Makerere University-Johns Hopkins University Clinical Core Laboratory at Infectious Diseases Institute, Kampala Uganda.
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Manabe YC, Wang Y, Elbireer A, Auerbach B, Castelnuovo B. Evaluation of portable point-of-care CD4 counter with high sensitivity for detecting patients eligible for antiretroviral therapy. PLoS One 2012; 7:e34319. [PMID: 22536323 PMCID: PMC3334961 DOI: 10.1371/journal.pone.0034319] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 02/28/2012] [Indexed: 11/30/2022] Open
Abstract
Background Accurate, inexpensive point-of-care CD4+ T cell testing technologies are needed that can deliver CD4+ T cell results at lower level health centers or community outreach voluntary counseling and testing. We sought to evaluate a point-of-care CD4+ T cell counter, the Pima CD4 Test System, a portable, battery-operated bench-top instrument that is designed to use finger stick blood samples suitable for field use in conjunction with rapid HIV testing. Methods Duplicate measurements were performed on both capillary and venous samples using Pima CD4 analyzers, compared to the BD FACSCalibur (reference method). The mean bias was estimated by paired Student's t-test. Bland Altman plots were used to assess agreement. Results 206 participants were enrolled with a median CD4 count of 396 (range; 18–1500). The finger stick PIMA had a mean bias of −66.3 cells/µL (95%CI −83.4−49.2, P<0.001) compared to the FACSCalibur; the bias was smaller at lower CD4 counts (0–250 cells/µL) with a mean bias of −10.8 (95%CI −27.3−+5.6, P = 0.198), and much greater at higher CD4 cell counts (>500 cells/µL) with a mean bias of −120.6 (95%CI −162.8, −78.4, P<0.001). The sensitivity (95%CI) of the Pima CD4 analyzer was 96.3% (79.1–99.8%) for a <250 cells/ul cut-off with a negative predictive value of 99.2% (95.1–99.9%). Conclusions The Pima CD4 finger stick test is an easy-to-use, portable, relatively fast device to test CD4+ T cell counts in the field. Issues of negatively-biased CD4 cell counts especially at higher absolute numbers will limit its utility for longitudinal immunologic response to ART. The high sensitivity and negative predictive value of the test makes it an attractive option for field use to identify patients eligible for ART, thus potentially reducing delays in linkage to care and ART initiation.
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Affiliation(s)
- Yukari C Manabe
- Infectious Diseases Institute, Makerere College of Health Sciences, Kampala, Uganda.
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