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Tanasiichuk I, Karaman O, Natrus L. Key success factors for the implementation of quality management systems in developing countries. Afr J Lab Med 2023; 12:2058. [PMID: 36756216 PMCID: PMC9900284 DOI: 10.4102/ajlm.v12i1.2058] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 11/17/2022] [Indexed: 02/04/2023] Open
Abstract
Background Despite the tremendous progress made in advancing laboratory medicine in low- and middle-income countries (LMICs), inadequate quality management systems (QMSs) remain a problem and barrier to provision of reliable laboratory services in resource-limited settings. Therefore, it is useful to study the experience of medical laboratories in LMICs that have successfully implemented QMS. Aim This review identified key success factors (KSFs) for medical laboratories in LMICs implementing QMS in accordance with the International Organization for Standardization standard 15189 as a pathway to improving laboratory quality. Methods Applying Preferred Reporting Items for Systematic Reviews procedures, we conducted a targeted search of studies from LMICs published between 2012 and 2022 to identify KSFs. Thirty-two out of 952 references retrieved were considered relevant and included in this review. Grounded theory was used to extract key features of the included studies to derive KSFs. Results Ten KSFs for medical laboratories striving to implement QMS were identified and described. These KSFs were integrated to create a model of success for laboratory QMS implementation. The model consists of three underlying factors, namely preparing for change, resource availability, and effective project management, each comprising three separate KSFs. Institutional commitment was identified as the core of the model and is integral to ensuring the quality of laboratory services. Conclusion Laboratories planning to implement a QMS can benefit from understanding the KSFs demonstrated in this study as this would help them to identify the necessary changes to implement and set realistic expectations about the outcomes of QMS implementation.
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Affiliation(s)
- Iryna Tanasiichuk
- Department of Modern Technologies of Medical Diagnostics and Treatment, Institute of Postgraduate Education, Bogomolets National Medical University, Kyiv, Ukraine
| | - Olha Karaman
- Laboratory of Oncoimmunology and Design of Tumor Vaccines, R.E. Kavetsky Institute of Experimental Pathology, Oncology and Radiobiology, National Academy of Sciences of Ukraine, Kyiv, Ukraine
| | - Larysa Natrus
- Department of Modern Technologies of Medical Diagnostics and Treatment, Institute of Postgraduate Education, Bogomolets National Medical University, Kyiv, Ukraine
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Markby J, Gygax M, Savoy C, Giebens Y, Janjanin S, Machoka F, Mawina JK, Ghanem SMM, Vetter BN. Assessment of laboratory capacity in conflict-affected low-resource settings using two World Health Organization laboratory assessment tools. Clin Chem Lab Med 2023; 61:1015-1024. [PMID: 36704916 DOI: 10.1515/cclm-2022-1203] [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: 11/23/2022] [Accepted: 01/16/2023] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Laboratory diagnostic services are essential to drive evidence-based treatment decisions, manage outbreaks, and provide population-level data. Many low- and middle-income countries (LMICs) lack sufficient diagnostic capacity, often further exacerbated in conflict-affected areas. This project assessed laboratory services in conflict-affected LMICs to understand gaps and opportunities for improving laboratory capacity. METHODS The World Health Organization Laboratory Assessment Tool Facility Questionnaire (WHO Laboratory Tool) and Stepwise Laboratory Improvement Process Towards Accreditation (SLIPTA) checklist were used to assess five laboratories in Eastern Democratic Republic of the Congo (DRC) and five in Gaza, Palestine. Total scores and percentage outcomes by indicator were calculated. RESULTS Average WHO Laboratory Tool score across all facilities was 41% (range 32-50%) in DRC and 78% (range 72-84%) in Gaza. Lowest scoring indicators in DRC were Biorisk management (13%, range 8-21%), Documentation (14%, range 6-21%), and in Gaza, were Facilities (59%, range 46-75%) and Documentation (60%, range 44-76%). Highest scoring indicators in DRC were Facilities (70%, range 45-83%) and Data and Information Management (61%, range 38-80%), and in Gaza were Data Information and Management (96%) and Public Health Function (91%, range 88-94%). In DRC, no laboratory achieved a SLIPTA star rating. In Gaza, two laboratories had a 3-star SLIPTA rating, one had a 2-star rating and two had a 1-star rating. CONCLUSIONS Laboratory systems in conflict-affected LMICs have significant gaps. Implementating improvement strategies in such settings may be especially challenging.
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Affiliation(s)
| | - Monika Gygax
- International Committee of the Red Cross, Geneva, Switzerland
| | - Catherine Savoy
- International Committee of the Red Cross, Geneva, Switzerland
| | - Yves Giebens
- International Committee of the Red Cross, Geneva, Switzerland
| | - Sanja Janjanin
- International Committee of the Red Cross, Geneva, Switzerland
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Karamagi HC, Ben Charif A, Ngusbrhan Kidane S, Yohanes T, Kariuki D, Titus M, Batungwanayo C, Seydi ABW, Berhane A, Nzinga J, Njuguna D, Kipruto HK, Andrews Annan E, Droti B. Investments for effective functionality of health systems towards Universal Health Coverage in Africa: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001076. [PMID: 36962623 PMCID: PMC10021830 DOI: 10.1371/journal.pgph.0001076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/24/2022] [Indexed: 11/18/2022]
Abstract
The health challenges in Africa underscore the importance of effectively investing in health systems. Unfortunately, there is no information on systems investments adequate for an effective functional health system. We aimed to address this by conducting a scoping review of existing evidence following the Joanna Briggs Institute Manual for Evidence Synthesis and preregistered with the Open Science Framework (https://osf.io/bvg4z). We included any empirical research describing interventions that contributed to the functionality of health systems in Africa or any low-income or lower-middle-income regions. We searched Web of Science, MEDLINE, Embase, PsycINFO, Cochrane Library, CINAHL, and ERIC from their inception, and hand-searched other relevant sources. We summarized data using a narrative approach involving thematic syntheses and descriptive statistics. We identified 554 unique reports describing 575 interventions, of which 495 reported evidence of effectiveness. Most interventions were undertaken in Africa (80.9%), covered multiple elements of health systems (median: 3), and focused on service delivery (77.4%) and health workforce (65.6%). Effective interventions contributed to improving single (35.6%) or multiple (64.4%) capacities of health systems: access to essential services (75.6%), quality of care (70.5%), demand for essential services (38.6%), or health systems resilience (13.5%). For example, telemedicine models which covered software (technologies) and hardware (health workers) elements were used as a strategy to address issues of access to essential services. We inventoried these effective interventions for improving health systems functionality in Africa. Further analyses could deepen understanding of how such interventions differ in their incorporation of evidence for potential scale across African countries.
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Affiliation(s)
- Humphrey Cyprian Karamagi
- Data Analytics and Knowledge Management, World Health Organization (WHO) Regional Office for Africa, Brazzaville, Republic of Congo
| | | | - Solyana Ngusbrhan Kidane
- Data Analytics and Knowledge Management, World Health Organization (WHO) Regional Office for Africa, Brazzaville, Republic of Congo
| | - Tewelde Yohanes
- Division of Policy and Planning, Ministry of Health, Asmara, Eritrea
| | | | | | | | - Aminata Binetou-Wahebine Seydi
- Data Analytics and Knowledge Management, World Health Organization (WHO) Regional Office for Africa, Brazzaville, Republic of Congo
| | - Araia Berhane
- Conmmunicable Diseases Control Division, Ministry of Health, Asmara, Eritrea
| | - Jacinta Nzinga
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - David Njuguna
- Health Economist, Ministry of Health, Nairobi, Kenya
| | - Hillary Kipchumba Kipruto
- Essential Drugs and Medicines, World Health Organization (WHO) Regional Office for Africa, Brazzaville, Republic of Congo
| | - Edith Andrews Annan
- Essential Drugs and Medicines, World Health Organization (WHO) Regional Office for Africa, Brazzaville, Republic of Congo
| | - Benson Droti
- Health Information Systems, World Health Organization (WHO) Regional Office for Africa, Brazzaville, Congo
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4
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Babyar J. Laboratory science and a glimpse into the future. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2020. [DOI: 10.1080/20479700.2019.1603276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Datema TAM, Oskam L, Broerse JEW, Klatser PR. Review of the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) version 2:2015. Afr J Lab Med 2020; 9:1068. [PMID: 33240798 PMCID: PMC7669969 DOI: 10.4102/ajlm.v9i1.1068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 08/19/2020] [Indexed: 12/05/2022] Open
Abstract
Background In 2011 the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) was launched, aimed at strengthening the quality and competence of African clinical, public health and reference laboratories. We reviewed the first version of the SLIPTA checklist in 2011. The continued development and publication of a new version of the International Organization for Standardization (ISO) 15189 standard demands a renewed review. Objective This study aimed to determine the suitability of SLIPTA in guiding laboratories towards ISO 15189:2012 compliance and accreditation and provide recommendations for further SLIPTA improvement. Methods The study was conducted between September 2018 and April 2019. Coverage of ISO 15189:2012 by SLIPTA checklist version 2:2015 was determined and the point distribution of the scoring system over the different sections of the SLIPTA checklist was re-investigated. These findings were compared with the review of the first version of the SLIPTA checklist (based on ISO 15189:2007) and with findings published on SLIPTA implementation and roll-out. Results The coverage of ISO 15189 by the SLIPTA checklist has increased, even though ISO 15189:012 is more extensive than ISO 15189:2007. The point distribution is still skewed towards sections related to quality planning rather than quality control and improvement. Although to date 314 laboratories have been assessed, barriers for laboratories to participate in SLIPTA are high. Sustainability of SLIPTA results is insufficiently studied. Conclusion SLIPTA checklist version 2:2015 has improved compared to earlier versions. We recommend increasing accessibility for laboratories to participate and increasing guidance for ISO-based quality management system implementation.
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Affiliation(s)
| | | | - Jacqueline E W Broerse
- Department of Science Communication, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Paul R Klatser
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Croxton T, Agala N, Jonathan E, Balogun O, Ozumba PJ, Onyemata E, Lawal S, Mamven M, Ajayi S, Melikam SE, Owolabi M, Ovbiagele B, Adu D, Ojo A, Beiswanger CM, Abimiku A. H3Africa partnerships to empower clinical research sites to generate high-quality biological samples. Afr J Lab Med 2020; 9:935. [PMID: 32284923 PMCID: PMC7136697 DOI: 10.4102/ajlm.v9i1.935] [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: 12/01/2018] [Accepted: 12/12/2019] [Indexed: 11/23/2022] Open
Abstract
Background The Institute of Human Virology Nigeria (IHVN) – Human Heredity and Health in Africa (H3Africa) Biorepository (I-HAB) seeks to provide high-quality biospecimens for research. This depends on the ability of clinical research sites (CRS) – who provide biospecimens – to operate according to well-established industry standards. Yet, standards are often neglected at CRSs located in Africa. Here, I-HAB reports on its four-pronged approach to empower CRSs to prepare high-quality biospecimens for research. Objectives I-HAB sought (1) to assess a four-pronged approach to improve biobanking practices and sample quality among CRSs, and (2) to build human capacity. Methods I-HAB partnered with two H3Africa principal investigators located in Nigeria and Ghana from August 2013 through to May 2017 to debut its four-pronged approach (needs assessment, training and mentorship, pilot, and continuous quality improvement) to empower CRSs to attain high-quality biospecimens. Results Close collaborations were instrumental in establishing mutually beneficial and lasting relationships. Improvements during the 12 months of engagement with CRSs involved personnel, procedural, and supply upgrades. In total, 51 staff were trained in over 20 topics. During the pilot, CRSs extracted 50 DNA biospecimens from whole blood and performed quality control. The CRSs shipped extracted DNA to I-HAB and I-HAB that comparatively analysed the DNA. Remediation was achieved via recommendations, training, and mentorship. Preanalytical, analytical and post-analytical processes, standard operating procedures, and workflows were systematically developed. Conclusion Partnerships between I-HAB and H3Africa CRSs enabled research sites to produce high-quality biospecimens through needs assessment, training and mentorship, pilot, and continuous monitoring and improvement.
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Affiliation(s)
- Talishiea Croxton
- Institute of Human Virology Nigeria, Abuja, Nigeria.,Institute of Human Virology, University of Maryland, Baltimore, Maryland, United States
| | - Ndidi Agala
- Institute of Human Virology Nigeria, Abuja, Nigeria
| | | | | | | | | | - Shefiya Lawal
- Department of Internal Medicine, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Manmak Mamven
- Department of Internal Medicine, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Samuel Ajayi
- Department of Medicine, University of Abuja Teaching Hospital, Abuja, Nigeria
| | | | - Mayowa Owolabi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bruce Ovbiagele
- Department of Neurology, University of Ghana Medical School, Accra, Ghana
| | - Dwomoa Adu
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Akinlolu Ojo
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Christine M Beiswanger
- Coriell Institute for Medical Research, Camden, New Jersey.,Independent Contractor, Philadelphia, Pennsylvania, United States
| | - Alash'le Abimiku
- Institute of Human Virology Nigeria, Abuja, Nigeria.,Institute of Human Virology, University of Maryland, Baltimore, Maryland, United States
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Adewoyin A, Ogbenna AA, Harteveld CL. Laboratory quality systems in clinical laboratory practice in Lagos, Nigeria (West Africa): Associated problems and prospects. Int J Lab Hematol 2019; 41:e130-e133. [DOI: 10.1111/ijlh.13038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 04/05/2019] [Accepted: 04/06/2019] [Indexed: 11/29/2022]
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Emperador DM, Yimer SA, Mazzola LT, Norheim G, Kelly-Cirino C. Diagnostic applications for Lassa fever in limited-resource settings. BMJ Glob Health 2019; 4:e001119. [PMID: 30899576 PMCID: PMC6407552 DOI: 10.1136/bmjgh-2018-001119] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 11/03/2022] Open
Abstract
Lassa fever, caused by arenavirus Lassa virus (LASV), is an acute viral haemorrhagic disease that affects up to an estimated 300 000 individuals and causes up to 5000 deaths per year in West Africa. Currently available LASV diagnostic methods are difficult to operationalise in low-resource health centres and may be less sensitive to detecting all known or emerging LASV strains. To prioritise diagnostic development for LASV, we assessed the diagnostic applications for case detection, clinical management, surveillance, outbreak response, and therapeutic and vaccine development at various healthcare levels. Diagnostic development should prioritise point-of-care and near-patient diagnostics, especially those with the ability to detect all lineages of LASV, as they would allow for rapid detection in resource-limited health facilities closer to the patient.
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Affiliation(s)
- Devy M Emperador
- Foundation for Innovative New Diagnostics (FIND), Emerging Threats Programme, Geneva, Switzerland
| | - Solomon A Yimer
- Department of Vaccine Science, Coalition for Epidemic Preparedness Innovation (CEPI), Oslo, Norway
| | - Laura T Mazzola
- Foundation for Innovative New Diagnostics (FIND), Emerging Threats Programme, Geneva, Switzerland
| | - Gunnstein Norheim
- Department of Vaccine Science, Coalition for Epidemic Preparedness Innovation (CEPI), Oslo, Norway
| | - Cassandra Kelly-Cirino
- Foundation for Innovative New Diagnostics (FIND), Emerging Threats Programme, Geneva, Switzerland
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Saut AM, Berssaneti FT, Moreno MC. Evaluating the impact of accreditation on Brazilian healthcare organizations: A quantitative study. Int J Qual Health Care 2018; 29:713-721. [PMID: 28992152 DOI: 10.1093/intqhc/mzx094] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 07/04/2017] [Indexed: 01/25/2023] Open
Abstract
Objective The aim of this study was to evaluate the impact of accreditation programs on Brazilian healthcare organizations. Design A web-based questionnaire survey was undertaken between February and May 2016. Setting Healthcare organizations from the Federal District and from 18 Brazilian states. Participants The quality managers of 141 Brazilian healthcare organizations were the main respondents of the study. Intervention The questionnaire was applied to not accredited and accredited organizations. Main Outcome Measures The main outcome measures were patient safety activities, quality management activities, planning activities-policies and strategies, patient involvement, involvement of professionals in the quality programs, monitoring of patient safety goals, organizational impact and financial impacts. Results The study identified 13 organizational impacts of accreditation. There was evidence of a significant and moderate correlation between the status of accreditation and patient safety activities, quality management activities, planning activities-policies and strategies, and involvement of professionals in the quality programs. The correlation between accreditation status and patient involvement was significant but weak, suggesting that this issue should be treated with a specific policy. The impact of accreditation on the financial results was not confirmed as relevant; however, the need for investment in the planning stage was validated. Conclusions The impact of accreditation is mainly related to internal processes, culture, training, institutional image and competitive differentiation.
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Affiliation(s)
- Ana Maria Saut
- Department of Production Engineering, University of São Paulo (USP), Polytechnic School, Av. Prof. Almeida Prado, Trav 2, 128 São Paulo, SP 05508-900, Brazil
| | - Fernando Tobal Berssaneti
- Department of Production Engineering, University of São Paulo (USP), Polytechnic School, Av. Prof. Almeida Prado, Trav 2, 128 São Paulo, SP 05508-900, Brazil
| | - Maria Carolina Moreno
- Guarulhos Municipal Heatlh Department, Rua Íris, 300 Guarulhos, SP 07051-080, Brazil
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Jegede F, Mbah HA, Dakata A, Gwarzo DH, Abdulrahman SA, Kuliya-Gwarzo A. Evaluating laboratory request forms submitted to haematology and blood transfusion departments at a hospital in Northwest Nigeria. Afr J Lab Med 2016; 5:381. [PMID: 28879111 PMCID: PMC5436401 DOI: 10.4102/ajlm.v5i1.381] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 02/04/2016] [Indexed: 11/10/2022] Open
Abstract
Background The laboratory request form (LRF) is a communication link between laboratories, requesting physicians and users of laboratory services. Inadequate information or errors arising from the process of filling out LRFs can significantly impact the quality of laboratory results and, ultimately, patient outcomes. Objective We assessed routinely-submitted LRFs to determine the degree of correctness, completeness and consistency. Methods LRFs submitted to the Department of Haematology (DH) and Blood Transfusion Services (BTS) of Aminu Kano Teaching Hospital in Kano, Nigeria, between October 2014 and December 2014, were evaluated for completion of all items on the forms. Performance in four quality indicator domains, including patient identifiers, test request details, laboratory details and physician details, was derived as a composite percentage. Results Of the 2084 LRFs evaluated, 999 were from DH and 1085 from BTS. Overall, LRF completeness was 89.5% for DH and 81.2% for BTS. Information on patient name, patient location and laboratory number were 100% complete for DH, whereas only patient name was 100% complete for BTS. Incomplete information was mostly encountered on BTS forms for physician’s signature (60.8%) and signature of laboratory receiver (63.5%). None of the DH and only 9.4% of BTS LRFs met all quality indicator indices. Conclusion The level of completion of LRFs from these two departments was suboptimal. This underscores the need to review and redesign the LRF, improve on training and communication between laboratory and clinical staff and review specimen rejection practices.
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Affiliation(s)
- Feyisayo Jegede
- Family Health International 360 (FHI360), Department of Laboratory Services, Abuja, Nigeria
| | - Henry A Mbah
- LabTrail Global, Smyrna, Delaware, United States
| | - Ado Dakata
- Department of Haematology, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Dalhatu H Gwarzo
- Department of Haematology, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Aisha Kuliya-Gwarzo
- Department of Haematology, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
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