Medical Laboratory Services in Africa Deserve More
Adamson S. Muula
0
1
4
5
Fresier C. Maseko
2
3
5
6
0
Department of Epidemiology, University of North Carolina at Chapel Hill
1
Petti CA, Polage CR, Quinn TC, Ronald AR,
Sande MA. Laboratory medicine in Africa: a barrier to effective health care. Clin Infect Dis 2006
; 42:377-8
2
Bates I,
Maitland K. Are laboratory services
3
Malawi College of Health Sciences
, Lilongwe,
Malawi
4
Department of Community Health, University of Malawi College of Medicine
, Blantyre
5
Medical Laboratory Services in Africa Deserve More
6
Ecole de sante Publique,
Universite Libre de Bruxelles
,
Brussels, Belgium
-
To the EditorThe recent review by
Petti et al. [1] and the editorial
commentary by Bates and Maitland [2] are timely
contributions to the literature about the
situation regarding inadequate medical
laboratory services in Africa, as well as
some of reasons behind this situation. The
suggestions by Petti and colleagues about
how laboratory services may be improved
are thought provoking, but evidence from
Africa about where implementation of
programs has achieved success is difficult
to come by. The authors refer several times
to situations in which laboratory services
continue to be less than acceptable.
Interestingly, the British government allocated
950,000 to Malawi in 1998 to improve
medical laboratory services [3]. This
amount of money is equivalent to 40%
of Malawis gross national budget for the
20052006 financial year. Obviously, if
the finances necessary to improve
laboratory services require such amounts of
money, Malawi may not be able to
commit the necessary resources to the
improvement of laboratory services.
We agree with Petti et al. [1] that
overreliance on empirical treatment and
management of syndromes have
contributed to the relegation of laboratory
services in many African countries. In
Malawi, for instance, syndromic management
of sexually transmitted infections,
presumptive treatment of malaria in pregnant
women, and initial treatment of all cases
of fever as if they were due to malaria are
the national standards of practice [4]. We
suggest that all presumptive and empirical
treatment measures be considered
temporary and that etiologic diagnosis and
treatment be the gold standard.
Unfortunately, it is not uncommon for paying
clients to access private antenatal clinics
and to be provided with presumptive
antimalarial therapy as a matter of routine
when laboratory investigations could have
been conducted first.
The lack of continued medical and
professional development as a requirement
for reregistration of health professionals in
some of the developing nations impedes
progress in laboratory services [5]. We also
suggest that, if some physicians trained in
laboratory medicine and pursued that as
a profession, changes may occur. The
usual practice, however, is for
technicianlevel staff to take charge, but in many
cases, these leaders cannot stand up
effectively enough to influence the medical
establishment. The training and recruitment
of biomedical technicians for the
maintenance and repair of laboratory
equipment should also be a matter of priority.
Acknowledgments
Potential conflicts of interest. A.S.M. is the
Lecturer in Community and Public Health at the
Malawi College of Medicine, and F.M. is the Senior
Lecturer in Medical Sciences at the Malawi College
of Health Sciences (MCHS). The MCHS is 1 of
only 2 institutions for the training of laboratory
technicians in Malawi.
To the EditorIn the 1 February 2006
issue of Clinical Infectious Diseases, a
timely article by Petti et al. [1] on the need
for increased investment in laboratory
services in Africa was accompanied by an
excellent editorial commentary by Bates and
Maitland, who called for laboratories and
their advocates to be given a much
louder voice on the international health
care stage [2, p. 384]. Many have become
concerned that laboratory services are the
Achilles heel in global efforts to combat
HIV infection, tuberculosis, and malaria
and the antimicrobial resistance that
accompanies them.
On 910 May 2005, the American
Society of Microbiology (ASM) held a
meeting of experts from the United States and
other countries to engage in a thoughtful
discussion about laboratory infrastructure
needs in underresourced countries to
support infectious disease prevention and
control programs. The meeting focused on
(1) the need to increase the awareness of
the importance of laboratories to the
success of public health programs in
underresourced countries and (2) ways to build
on existing or planned programs that
require a good laboratory system for a
programs success.
(...truncated)