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He Y, Kouabenan YR, Assoa PH, Puttkammer N, Wagenaar BH, Xiao H, Gloyd S, Hoffman NG, Komena P, Kamelan NPF, Iiams-Hauser C, Pongathie AS, Kouakou A, Flowers J, Abiola N, Kohemun N, Amani JB, Adje-Toure C, Perrone LA. Laboratory Data Timeliness and Completeness Improves Following Implementation of an Electronic Laboratory Information System in Côte d'Ivoire: Quasi-Experimental Study on 21 Clinical Laboratories From 2014 to 2020. JMIR Public Health Surveill 2024; 10:e50407. [PMID: 38506899 PMCID: PMC10993113 DOI: 10.2196/50407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 01/04/2024] [Accepted: 01/23/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND The Ministry of Health in Côte d'Ivoire and the International Training and Education Center for Health at the University of Washington, funded by the United States President's Emergency Plan for AIDS Relief, have been collaborating to develop and implement the Open-Source Enterprise-Level Laboratory Information System (OpenELIS). The system is designed to improve HIV-related laboratory data management and strengthen quality management and capacity at clinical laboratories across the nation. OBJECTIVE This evaluation aimed to quantify the effects of implementing OpenELIS on data quality for laboratory tests related to HIV care and treatment. METHODS This evaluation used a quasi-experimental design to perform an interrupted time-series analysis to estimate the changes in the level and slope of 3 data quality indicators (timeliness, completeness, and validity) after OpenELIS implementation. We collected paper and electronic records on clusters of differentiation 4 (CD4) testing for 48 weeks before OpenELIS adoption until 72 weeks after. Data collection took place at 21 laboratories in 13 health regions that started using OpenELIS between 2014 and 2020. We analyzed the data at the laboratory level. We estimated odds ratios (ORs) by comparing the observed outcomes with modeled counterfactual ones when the laboratories did not adopt OpenELIS. RESULTS There was an immediate 5-fold increase in timeliness (OR 5.27, 95% CI 4.33-6.41; P<.001) and an immediate 3.6-fold increase in completeness (OR 3.59, 95% CI 2.40-5.37; P<.001). These immediate improvements were observed starting after OpenELIS installation and then maintained until 72 weeks after OpenELIS adoption. The weekly improvement in the postimplementation trend of completeness was significant (OR 1.03, 95% CI 1.02-1.05; P<.001). The improvement in validity was not statistically significant (OR 1.34, 95% CI 0.69-2.60; P=.38), but validity did not fall below pre-OpenELIS levels. CONCLUSIONS These results demonstrate the value of electronic laboratory information systems in improving laboratory data quality and supporting evidence-based decision-making in health care. These findings highlight the importance of OpenELIS in Côte d'Ivoire and the potential for adoption in other low- and middle-income countries with similar health systems.
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Affiliation(s)
- Yao He
- Digital Initiatives Group at International Training and Education Center for Health, Department of Global Health, Schools of Public Health and Medicine, University of Washington, Seattle, WA, United States
| | - Yves-Rolland Kouabenan
- International Training and Education Center for Health - Côte d'Ivoire, Abidjan, Cote D'Ivoire
| | - Paul Henri Assoa
- International Training and Education Center for Health - Côte d'Ivoire, Abidjan, Cote D'Ivoire
| | - Nancy Puttkammer
- Digital Initiatives Group at International Training and Education Center for Health, Department of Global Health, Schools of Public Health and Medicine, University of Washington, Seattle, WA, United States
| | - Bradley H Wagenaar
- Department of Global Health, Schools of Public Health and Medicine, University of Washington, Seattle, WA, United States
- Department of Epidemiology, Schools of Public Health and Medicine, University of Washington, Seattle, WA, United States
| | - Hong Xiao
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Stephen Gloyd
- Department of Global Health, Schools of Public Health and Medicine, University of Washington, Seattle, WA, United States
| | - Noah G Hoffman
- Department of Pathology and Laboratory Medicine, University of Washington, Seattle, WA, United States
| | - Pascal Komena
- International Training and Education Center for Health - Côte d'Ivoire, Abidjan, Cote D'Ivoire
| | | | - Casey Iiams-Hauser
- Digital Initiatives Group at International Training and Education Center for Health, Department of Global Health, Schools of Public Health and Medicine, University of Washington, Seattle, WA, United States
| | - Adama Sanogo Pongathie
- Direction de l'Informatique et de l'Information Sanitaire, Ministry of Health, Public Hygiene and Universal Health Coverage, Abidjan, Cote D'Ivoire
| | - Alain Kouakou
- Direction de l'Informatique et de l'Information Sanitaire, Ministry of Health, Public Hygiene and Universal Health Coverage, Abidjan, Cote D'Ivoire
| | - Jan Flowers
- Digital Initiatives Group at International Training and Education Center for Health, Department of Global Health, Schools of Public Health and Medicine, University of Washington, Seattle, WA, United States
| | - Nadine Abiola
- International Training and Education Center for Health - Côte d'Ivoire, Abidjan, Cote D'Ivoire
| | - Natacha Kohemun
- Laboratory Branch, United States Centers for Disease Control and Prevention, Abidjan, Cote D'Ivoire
| | - Jean-Bernard Amani
- Laboratory Branch, United States Centers for Disease Control and Prevention, Abidjan, Cote D'Ivoire
| | - Christiane Adje-Toure
- Retro-CI Laboratory, United States Centers for Disease Control and Prevention, Abidjan, Cote D'Ivoire
| | - Lucy A Perrone
- Department of Global Health, Schools of Public Health and Medicine, University of Washington, Seattle, WA, United States
- Department of Pathology and Laboratory Medicine, University of British Columbia (UBC), Vancouver, BC, Canada
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Filisa-Kaphamtengo F, Ngoma J, Mukhula V, Matemvu Z, Kapute D, Banda P, Phiri T, Mipando M, Hosseinipour MC, Katundu KGH. Prevalence, patterns and associated risk factors for dyslipidaemia among individuals attending the diabetes clinic at a tertiary hospital in Central Malawi. BMC Cardiovasc Disord 2023; 23:548. [PMID: 37946116 PMCID: PMC10636904 DOI: 10.1186/s12872-023-03589-x] [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] [Received: 08/15/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Dyslipidaemia among individuals with diabetes is a significant modifiable risk factor for atherosclerotic cardiovascular diseases (ASCVDs). ASCVDs are a major cause of mortality and morbidity globally, especially in people with diabetes. In Malawi, limited data exist on the prevalence and biochemical characteristics of diabetic dyslipidaemia. This study investigated the prevalence and biochemical characteristics of dyslipidaemia in individuals attending the diabetes clinic at Kamuzu Central Hospital, the largest tertiary referral hospital in Central Malawi. METHODS Using a cross-sectional design, sociodemographic, medical and anthropometric data were collected from 391 adult participants who were enrolled in the study. Blood samples were analysed for glycosylated haemoglobin (HBA1c) and fasting lipid profiles. The prevalence of dyslipidaemia was calculated, and the biochemical characteristics of the dyslipidaemia were defined. The associations between dyslipidaemia and risk factors such as sociodemographic characteristics, obesity, and HBA1c levels were evaluated using logistic regression analysis. RESULTS Prevalence of dyslipidaemia was observed in 71% of the participants, and elevated low-density lipoprotein cholesterol was the most frequent lipid abnormality among the study participants. None of the participants were receiving any lipid-lowering therapy. On bivariate analysis, dyslipidemia was positively associated with female sex [OR 1.65 (95% CI 1.05- 2.58); p = 0.09], age ≥ 30 years [OR 3.60 (95% CI 1.17-7.68); p = 0.001] and overweight and obesity [OR 2.11 (95% CI 1.33-3.34); p = 0.002]. On multivariate analysis, being overweight or obese was an independent predictor of dyslipidaemia [AOR 1.8;(95% CI 1.15- 3.37); p = 0.04]. CONCLUSION Dyslipidaemia was highly prevalent among individuals with diabetes in this study, and elevated low-density lipoprotein cholesterol was the most frequent lipid abnormality. Overweight and obesity were also highly prevalent and positively predicted dyslipidaemia. This study highlights the importance of appropriately addressing dyslipidaemia, overweight and obesity among individuals with diabetes in Malawi and other similar settings in Africa as one of the significant ways of reducing the risk of ASCVDs among this population.
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Affiliation(s)
- Florence Filisa-Kaphamtengo
- Kamuzu Central Hospital, Lilongwe, Malawi
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Victoria Mukhula
- Malawi-Liverpool Wellcome Clinical Research Program, Blantyre, Malawi
- Blantyre to Blantyre Research Facility, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | | | - Peter Banda
- Department of Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Tamara Phiri
- Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Mwapatsa Mipando
- Blantyre to Blantyre Research Facility, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Biomedical Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Kondwani G H Katundu
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi.
- Malawi-Liverpool Wellcome Clinical Research Program, Blantyre, Malawi.
- Blantyre to Blantyre Research Facility, Kamuzu University of Health Sciences, Blantyre, Malawi.
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3
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Filisa-Kaphamtengo F, Ngoma J, Mukhula V, Matemvu Z, Kapute D, Banda P, Phiri T, Mipando M, Hosseinipour MC, Katundu KGH. Prevalence, patterns and associated risk factors for dyslipidaemia among individuals attending the diabetes clinic at a tertiary hospital in Central Malawi. RESEARCH SQUARE 2023:rs.3.rs-3262287. [PMID: 37674703 PMCID: PMC10479448 DOI: 10.21203/rs.3.rs-3262287/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Background Dyslipidaemia among individuals with diabetes is a significant modifiable risk factor for atherosclerotic cardiovascular diseases (ASCVDs). ASCVDs are a major cause of mortality and morbidity globally, especially in people with diabetes. In Malawi, limited data exist on the prevalence and biochemical characteristics of diabetic dyslipidaemia. This study investigated the prevalence and biochemical characteristics of dyslipidaemia in individuals attending the diabetes clinic at Kamuzu Central Hospital, the largest tertiary referral hospital in Central Malawi. Methods Using a cross-sectional design, sociodemographic, medical and anthropometric data were collected from 391 adult participants who were enrolled in the study. Blood samples were analysed for glycosylated haemoglobin (HBA1c) and fasting lipid profiles. The prevalence of dyslipidaemia was calculated, and the biochemical characteristics of the dyslipidaemia were defined. The associations between dyslipidaemia and risk factors such as sociodemographic characteristics, obesity, and HBA1c levels were evaluated using logistic regression analysis. Results Prevalence of dyslipidaemia was observed in 71% of the participants, and elevated low-density lipoprotein cholesterol was the most frequent lipid abnormality among the study participants. On bivariate analysis, dyslipidemia was positively associated with female sex [OR 1.65 (95% CI 1.05-2.58); p = 0.09], age ≥ 30 years [OR 3.60 (95% CI 1.17-7.68); p = 0.001] and overweight and obesity [OR 2.11 (95% CI 1.33-3.34); p = 0.002]. On multivariate analysis, being overweight or obese was an independent predictor of dyslipidaemia [AOR 1.8 ;( 95% CI 1.15-3.37); p = 0.04]. Conclusion Dyslipidaemia was highly prevalent among individuals with diabetes in this study, and elevated low-density lipoprotein cholesterol was the most frequent lipid abnormality. Overweight and obesity were also highly prevalent and positively predicted dyslipidaemia. This study highlights the importance of appropriately addressing dyslipidaemia, overweight and obesity among individuals with diabetes in Malawi and other similar settings in Africa as one of the significant ways of reducing the risk of ASCVDs among this population.
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Musa K, Okoliegbe I, Abdalaziz T, Aboushady AT, Stelling J, Gould IM. Laboratory Surveillance, Quality Management, and Its Role in Addressing Antimicrobial Resistance in Africa: A Narrative Review. Antibiotics (Basel) 2023; 12:1313. [PMID: 37627733 PMCID: PMC10451735 DOI: 10.3390/antibiotics12081313] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/30/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
AMR is a major public health concern that calls for extensive work and a multidisciplinary team approach. The high prevalence of infectious diseases in African nations leads to widespread antibiotic usage and eventual antimicrobial resistance, which has significant negative effects on people's health, the economy, and society. Additionally, inadequate or nonexistent antimicrobial drug regulations, inappropriate prescription practices, and restrictions on public health prevention initiatives such as immunization, water and sanitation, and sexual health may all contribute to the emergence of AMR. Despite the need for laboratory quality assurance, many African laboratories confront substantial difficulties in implementing efficient quality assurance programs. AMR surveillance in Africa is hampered by a lack of laboratory capacity, insufficient data collection and analysis, and poor stakeholder collaboration. Several initiatives and programs, including the World Health Organization's Global Antimicrobial Resistance and Use Surveillance System (GLASS), the Africa Centres for Disease Control and Prevention (Africa CDC) Antimicrobial Resistance Surveillance Network (AMRSNET), and the Fleming Fund, a UK government initiative aimed at tackling AMR in low- and middle-income countries, have been established to strengthen AMR surveillance in Africa and globally.
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Affiliation(s)
- Khalid Musa
- Department of Medical Microbiology and Virology, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK; (I.O.); (T.A.); (I.M.G.)
- Department of Acute Medicine and Infectious Diseases, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK
| | - Ijeoma Okoliegbe
- Department of Medical Microbiology and Virology, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK; (I.O.); (T.A.); (I.M.G.)
| | - Tassabeeh Abdalaziz
- Department of Medical Microbiology and Virology, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK; (I.O.); (T.A.); (I.M.G.)
- Department of Acute Medicine and Infectious Diseases, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK
| | - Ahmed Taha Aboushady
- Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (A.T.A.); (J.S.)
| | - John Stelling
- Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (A.T.A.); (J.S.)
| | - Ian M. Gould
- Department of Medical Microbiology and Virology, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK; (I.O.); (T.A.); (I.M.G.)
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Fontaine E, Saez C. Capillary blood stability and analytical accuracy of 12 analytes stored in Microtainers®. Pract Lab Med 2023; 36:e00325. [PMID: 37649539 PMCID: PMC10462678 DOI: 10.1016/j.plabm.2023.e00325] [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: 03/21/2023] [Revised: 06/08/2023] [Accepted: 07/03/2023] [Indexed: 09/01/2023] Open
Abstract
Objectives The aim of this study was to determine feasibility of collecting capillary blood by traditional fingerstick and next day analysis after transport in Microtainers® at ambient temperature with no plasma separation. This study is pursuing an acceptable alternative to venipuncture for measuring 12 analytes important for health risk assessment. Design and Methods: Performance standards of a 12-assay chemistry panel were assessed using a set of paralleled serum and capillary microsamples. The panel included Hemoglobin A1c (HbA1c), Total Cholesterol, Triglycerides, HDL-C, Creatinine, Urea Nitrogen (BUN), Uric Acid, alkaline phosphatase (ALP), ALT (GPT), AST (GOT), gamma-glutamyltransferase (GGT), and total protein. Correlation studies were performed using 31 simultaneous venous and capillary blood collections. Analytical bias, correlation, and medical decision points were calculated to determine equivalency of sample type and the impact of transport conditions. Clinical sensitivity, specificity, and predictive values were evaluated at calculated medical decision points for their usability in health screening initiatives. Results Laboratory test results using capillary blood samples stored in Microtainers® under conditions of delayed centrifugation, and mail transport at ambient temperature, showed an acceptable agreement with results obtained using their paired serum samples analyzed using standard methods, except AST. Conclusions Capillary blood samples can be self-collected at remote locations using Microtainers® and transported at ambient temperature for 24 h for successful performance of several medical tests important in large-scale health screenings programs.
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Affiliation(s)
| | - Cristian Saez
- CoreMedica Laboratories, Inc., Lee's Summit, Missouri, USA
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Abebe DD, Temesgen MM, Abozin AT. Clinicians' satisfaction with laboratory services and associated factors at public health facilities in Northeast Ethiopia. BMC Health Serv Res 2023; 23:475. [PMID: 37170228 PMCID: PMC10173562 DOI: 10.1186/s12913-023-09429-0] [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: 03/18/2022] [Accepted: 04/20/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Satisfaction has become a key measure of quality and an important tool for improvement. Laboratories are increasingly required to regularly assess satisfaction of their customers. This study aimed to assess clinicians' satisfaction with laboratory services and associated factors at public health facilities. METHODS A facility-based cross-sectional study was conducted in Northeast Ethiopia from May to June 2019. Eight hospitals and 24 health centres were first selected using a stratified sampling method, and a total of 224 randomly selected clinicians were included. Satisfaction with multiple aspects of laboratory services was assessed using a self-administered questionnaire, on a rating scale of 1 (very dissatisfied) to 5 points (very satisfied). Laboratory quality assessment was performed using WHO-AFRO's stepwise accreditation checklist. Multivariable logistic regression model was fitted to determine the association between independent variables and clinicians' overall satisfaction level using STATA ver14.1. A p-value < 0.05 was considered significant. RESULTS Overall, 72.8% of the clinicians were satisfied. Lowest mean ratings were obtained for the helpfulness of the laboratory handbook (3.3), provision of STAT/urgent services (3.7), and adequacy of tests provided (3.8). The clinicians' timely receipt of results (AOR = 2.3, 95% CI = 1.1-5.0), notification of panic results (AOR = 2.5, 95% CI = 1.1-5.6), perceived quality/reliability of test results (AOR = 3.1, 95% CI = 1.5-6.3), and the laboratories' rate of concordant malaria microscopy results (AOR = 4.1, 95% CI = 1.8-9.3), were significantly associated with satisfaction. CONCLUSIONS Nearly one-third of clinicians were not satisfied with the laboratory services. Laboratory managers should emphasize the timely communication of STAT/urgent and panic results, and the reliability of test results, to improve users' satisfaction and overall quality of care.
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Affiliation(s)
- Daniel Dagne Abebe
- Amhara Public Health Institute Dessie Branch, Dessie, Amhara region, Ethiopia.
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Nayupe SF, Mbulaje P, Munharo S, Patel P, Lucero-Prisno DE. Medical laboratory practice in Malawi - Current status. Afr J Lab Med 2023; 12:1921. [PMID: 36756214 PMCID: PMC9900340 DOI: 10.4102/ajlm.v12i1.1921] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 09/26/2022] [Indexed: 12/27/2022] Open
Abstract
No abstract available.
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Affiliation(s)
- Symon F. Nayupe
- Laboratory Department, Kamuzu University of Health Sciences Private Clinic, Blantyre, Malawi
| | | | - Steven Munharo
- Montfort Hospital, Chikwawa Diocese, Nchalo, Chikwawa, Malawi
| | - Parth Patel
- Department of Health Systems and Policy, Faculty of Health Systems, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Don E. Lucero-Prisno
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Katundu KGH, Mukhula V, Phiri T, Phiri C, Filisa-Kaphamtengo F, Chipewa P, Chirambo G, Mipando M, Mwandumba HC, Muula AS, Kumwenda J. High prevalence of dyslipidaemia among persons with diabetes mellitus and hypertension at a tertiary hospital in Blantyre, Malawi. BMC Cardiovasc Disord 2022; 22:557. [PMID: 36544081 PMCID: PMC9771776 DOI: 10.1186/s12872-022-03011-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Dyslipidaemia drives the process of atherosclerosis, and hence a significant modifiable risk factor complicating hypertension and diabetes. In Malawi, the prevalence, screening and management of dyslipidaemia among persons with diabetes mellitus have not been reported. This study aimed to investigate the prevalence, biochemical characteristics, screening and management practices for dyslipidaemia among persons with diabetes mellitus, hypertension, and diabetes mellitus and hypertension comorbidity at Queen Elizabeth Central hospital in Blantyre, Malawi. METHODS This was a cross-sectional study conducted in 2021. A total of 256 adult participants (diabetes mellitus = 100); hypertension = 100; both conditions = 56) were included. Medical data and anthropometric measurements were recorded. Blood samples were analysed for HbA1C and serum lipids. Associated risk factors for dyslipidaemia were also assessed. RESULTS Dyslipidaemia was prevalent in 58%, 55%, and 70% of participants with diabetes mellitus, hypertension, and both conditions. Low-density lipoprotein cholesterol (LDL-C) dyslipidaemia was the most common in all participant groups. Participants with both diabetes and hypertension had 2.4 times (95% CI 1.2-4.6) increased risk of LDL-C dyslipidaemia than those with diabetes alone (p < 0.02). Being overweight or obese and age over 30 years were risk factors for dyslipidaemia in participants with diabetes mellitus alone (OR 1.3 (95% CI 1.1-1.6), p < 0.04, and OR 2.2 (95% CI 1.2-4.7) (p < 0.01), respectively. Overweight and obesity predicted LDL-C dyslipidaemia in hypertensive patients (OR 3.5 (95% CI 1.2-9.9) p < 0.001). Poorly controlled hypertension and the use of beta-blockers and thiazide diuretics predicted dyslipidaemia among patients with both diabetes mellitus and hypertension (OR 6.50 CI 1.45-29.19; and OR 5.20 CI 1.16-23.36 respectively). None of the participants had a lipogram performed before the study or were on lipid-lowering therapy. CONCLUSIONS Dyslipidaemia with LDL-C derangement was highly prevalent, especially in individuals with both diabetes mellitus and hypertension, and there was absent use of lipid-lowering therapy. Screening and managing dyslipidaemia should be reinforced to reduce the risk of cardiovascular complications in this population at increased risk.
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Affiliation(s)
- Kondwani G H Katundu
- Department of Biomedical Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi.
- Malawi-Liverpool Wellcome Clinical Research Program, Kamuzu University of Health Sciences, Blantyre, Malawi.
| | - Victoria Mukhula
- Malawi-Liverpool Wellcome Clinical Research Program, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Tamara Phiri
- Department of Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Chimota Phiri
- Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | | | - Pascal Chipewa
- Department of Biomedical Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - George Chirambo
- Department of Biomedical Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi
- Blantyre to Blantyre Research Facility, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Mwapatsa Mipando
- Department of Biomedical Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi
- Blantyre to Blantyre Research Facility, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Henry C Mwandumba
- Malawi-Liverpool Wellcome Clinical Research Program, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Adamson S Muula
- Department of Community and Environmental Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Johnstone Kumwenda
- Department of Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
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Fleming KA, Horton S, Wilson ML, Atun R, DeStigter K, Flanigan J, Sayed S, Adam P, Aguilar B, Andronikou S, Boehme C, Cherniak W, Cheung AN, Dahn B, Donoso-Bach L, Douglas T, Garcia P, Hussain S, Iyer HS, Kohli M, Labrique AB, Looi LM, Meara JG, Nkengasong J, Pai M, Pool KL, Ramaiya K, Schroeder L, Shah D, Sullivan R, Tan BS, Walia K. The Lancet Commission on diagnostics: transforming access to diagnostics. Lancet 2021; 398:1997-2050. [PMID: 34626542 PMCID: PMC8494468 DOI: 10.1016/s0140-6736(21)00673-5] [Citation(s) in RCA: 128] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/26/2021] [Accepted: 03/12/2021] [Indexed: 12/30/2022]
Affiliation(s)
| | - Susan Horton
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.
| | | | - Rifat Atun
- Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | | | | | | | - Bertha Aguilar
- Médicos e Investigadores de la Lucha Contra el Cáncer de Mama, Mexico City, Mexico
| | - Savvas Andronikou
- Perelman School of Medicine, University of Pennsylvania Philadelphia, Philadelphia, PA, USA
| | | | - William Cherniak
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Annie Ny Cheung
- The University of Hong Kong, Hong Kong Special Administrative Region, China
| | | | - Lluis Donoso-Bach
- Department of Medical Imaging, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | | | | | - Sarwat Hussain
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Hari S Iyer
- Dana Farber Cancer Institute, Boston, MA, USA
| | - Mikashmi Kohli
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Alain B Labrique
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - John Nkengasong
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Madhukar Pai
- School of Population and Global Health, McGill University, Montreal, QC, Canada
| | | | | | - Lee Schroeder
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Devanshi Shah
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | | | | | - Kamini Walia
- Indian Council of Medical Research, Delhi, India
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Chimhini G, Olaru ID, Fitzgerald F, Chisenga M, Ferreyra C, Malou N, Piton J, Chimhuya S, Yeung S, De S, Mujuru HA, Kranzer K. Evaluation of a Novel Culture System for Rapid Pathogen Identification and Detection of Cephalosporin Resistance in Neonatal Gram-negative Sepsis at a Tertiary Referral Unit in Harare, Zimbabwe. Pediatr Infect Dis J 2021; 40:785-791. [PMID: 33941744 PMCID: PMC8677569 DOI: 10.1097/inf.0000000000003155] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Neonatal sepsis accounts for a large proportion of neonatal deaths in sub-Saharan Africa. The lack of access to diagnostic testing and excessively long turnaround times to result contributes to delays in sepsis identification and initiation of appropriate treatment. This study aims to evaluate the novel InTrays COLOREX Screen and extended-spectrum beta-lactamase for rapid identification of bacterial pathogens causing sepsis and detection of resistance. METHODS Neonates with suspected sepsis admitted to the Harare Central Hospital were prospectively enrolled. One blood culture was collected and incubated using the BacT/ALERT automated system. Positive blood cultures with potential pathogens identified by Gram stain were inoculated on the InTray COLOREX Screen and extended-spectrum beta-lactamase culture plates. RESULTS A total of 216 neonates with suspected sepsis were recruited. Pathogens were isolated from blood cultures in 56 (25.9%) neonates of which 54 were Klebsiella pneumoniae. All K. pneumoniae were resistant to ceftriaxone and 53 (98%) were resistant to gentamicin. Sensitivity and specificity for ceftriaxone-resistant K. pneumoniae detection using InTrays were 100%. InTrays results were interpretable as early as 5-10 hours (median 7 hours, interquartile range 7-7) post blood culture positivity enabling rapid identification and notification of result and leading to a 60% reduction in time to result from blood culture collection. CONCLUSIONS This study shows that the implementation of a novel culture method was feasible and reduced turnaround times for results by 60% compared with standard microbiologic techniques. An impact on patient outcomes and cost-effectiveness of this method needs to be demonstrated.
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Affiliation(s)
- Gwendoline Chimhini
- Child and Adolescent Health Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe
| | - Ioana Diana Olaru
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Felicity Fitzgerald
- Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | | | - Cecilia Ferreyra
- FIND (Foundation for Innovative New Diagnostics), Geneva, Switzerland
| | - Nada Malou
- FIND (Foundation for Innovative New Diagnostics), Geneva, Switzerland
| | - Jeremie Piton
- FIND (Foundation for Innovative New Diagnostics), Geneva, Switzerland
| | - Simbarashe Chimhuya
- Child and Adolescent Health Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe
| | - Shunmay Yeung
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Paediatric Infectious Disease, St Mary’s Imperial College Hospital
| | - Surjo De
- Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Hilda A. Mujuru
- Child and Adolescent Health Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe
| | - Katharina Kranzer
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Division of Infectious and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany
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11
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Mtonga TM, Choonara FE, Espino JU, Kachaje C, Kapundi K, Mengezi TE, Mumba SL, Douglas GP. Design and implementation of a clinical laboratory information system in a low-resource setting. Afr J Lab Med 2019; 8:841. [PMID: 31745456 PMCID: PMC6852617 DOI: 10.4102/ajlm.v8i1.841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 06/28/2019] [Indexed: 11/07/2022] Open
Abstract
Background Reducing laboratory errors presents a significant opportunity for both cost reduction and healthcare quality improvement. This is particularly true in low-resource settings where laboratory errors are further exacerbated by poor infrastructure and shortages in a trained workforce. Informatics interventions can be used to address some of the sources of laboratory errors. Objectives This article describes the development process for a clinical laboratory information system (LIS) that leverages informatics interventions to address problems in the laboratory testing process at a hospital in a low-resource setting. Methods We designed interventions using informatics methods for previously identified problems in the laboratory testing process at a clinical laboratory in a low-resource setting. First, we reviewed a pre-existing LIS functionality assessment toolkit and consulted with laboratory personnel. This provided requirements that were developed into a LIS with interventions designed to address the problems that had been identified. We piloted the LIS at the Kamuzu Central Hospital in Lilongwe, Malawi. Results We implemented a series of informatics interventions in the form of a LIS to address sources of laboratory errors and support the entire laboratory testing process. Custom hardware was built to support the ordering of laboratory tests and review of laboratory test results. Conclusion Our experience highlights the potential of using informatics interventions to address systemic problems in the laboratory testing process in low-resource settings. Implementing these interventions may require innovation of new hardware to address various contextual issues. We strongly encourage thorough testing of such innovations to reduce the risk of failure when implemented.
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Affiliation(s)
- Timothy M Mtonga
- Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | | | - Jeremy U Espino
- Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | | | | | | | | | - Gerald P Douglas
- Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
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Ombelet S, Barbé B, Affolabi D, Ronat JB, Lompo P, Lunguya O, Jacobs J, Hardy L. Best Practices of Blood Cultures in Low- and Middle-Income Countries. Front Med (Lausanne) 2019; 6:131. [PMID: 31275940 PMCID: PMC6591475 DOI: 10.3389/fmed.2019.00131] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/29/2019] [Indexed: 12/25/2022] Open
Abstract
Bloodstream infections (BSI) have a substantial impact on morbidity and mortality worldwide. Despite scarcity of data from many low- and middle-income countries (LMICs), there is increasing awareness of the importance of BSI in these countries. For example, it is estimated that the global mortality of non-typhoidal Salmonella bloodstream infection in children under 5 already exceeds that of malaria. Reliable and accurate diagnosis of these infections is therefore of utmost importance. Blood cultures are the reference method for diagnosis of BSI. LMICs face many challenges when implementing blood cultures, due to financial, logistical, and infrastructure-related constraints. This review aims to provide an overview of the state-of-the-art of sampling and processing of blood cultures, with emphasis on its use in LMICs. Laboratory processing of blood cultures is relatively straightforward and can be done without the need for expensive and complicated equipment. Automates for incubation and growth monitoring have become the standard in high-income countries (HICs), but they are still too expensive and not sufficiently robust for imminent implementation in most LMICs. Therefore, this review focuses on "manual" methods of blood culture, not involving automated equipment. In manual blood cultures, a bottle consisting of a broth medium supporting bacterial growth is incubated in a normal incubator and inspected daily for signs of growth. The collection of blood for blood culture is a crucial step in the process, as the sensitivity of blood cultures depends on the volume sampled; furthermore, contamination of the blood culture (accidental inoculation of environmental and skin bacteria) can be avoided by appropriate antisepsis. In this review, we give recommendations regarding appropriate blood culture sampling and processing in LMICs. We present feasible methods to detect and speed up growth and discuss some challenges in implementing blood cultures in LMICs, such as the biosafety aspects, supply chain and waste management.
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Affiliation(s)
- Sien Ombelet
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Microbiology and Immunology, KULeuven, Leuven, Belgium
| | - Barbara Barbé
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Dissou Affolabi
- Centre National Hospitalier Universitaire-Hubert Koutoucou Maga, Cotonou, Benin
| | | | - Palpouguini Lompo
- Clinical Research Unit of Nanoro, Institut de Recherche en Science de la Santé, Nanoro, Burkina Faso
| | - Octavie Lunguya
- National Institute for Biomedical Research, Kinshasa, Democratic Republic of the Congo.,Department of Medical Biology, Cliniques Universitaires, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Microbiology and Immunology, KULeuven, Leuven, Belgium
| | - Liselotte Hardy
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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