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League A, Bangure D, Meyer MJ, Salyer SJ, Wanjohi D, Tebeje YK, Sorrell EM, Standley CJ. Assessing the impact of regional laboratory networks in East and West Africa on national health security capacities. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001962. [PMID: 37224130 DOI: 10.1371/journal.pgph.0001962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 05/01/2023] [Indexed: 05/26/2023]
Abstract
National laboratories are a fundamental capacity for public health, contributing to disease surveillance and outbreak response. The establishment of regional laboratory networks has been posited as a means of improving health security across multiple countries. Our study objective was to assess whether membership in regional laboratory networks in Africa has an effect on national health security capacities and outbreak response. We conducted a literature review to select regional laboratory networks in the Eastern and Western African regions. We examined data from the World Health Organization Joint External Evaluation (JEE) mission reports, the 2018 WHO States Parties Annual Report (SPAR), and the 2019 Global Health Security Index (GHS). We compared the average scores of countries that are members of a regional laboratory network to those that are not. We also assessed country-level diagnostic and testing indicators during the COVID-19 pandemic. We found no significant differences in any of the selected health security metrics for member versus non-member countries of the either the East Africa Public Health Laboratory Networking Project (EAPHLNP) in the Eastern Africa region, nor for the West African Network of Clinical Laboratories (RESAOLAB) in the Western Africa region. No statistically significant differences were observed in COVID-19 testing rates in either region. Small sample sizes and the inherent heterogeneities in governance, health, and other factors between countries within and between regions limited all analyses. These results suggest potential benefit in setting baseline capacity for network inclusion and developing regional metrics for measuring network impact, but also beyond national health security capacities, other effects that may be required to justify continued support for regional laboratory networks.
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Affiliation(s)
- Avery League
- Milken Institute School of Public Health, The George Washington University, Washington, DC, United States of America
| | - Donewell Bangure
- Laboratory Systems and Networks Division, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Mark J Meyer
- Department of Mathematics and Statistics, Georgetown University, Washington, DC, United States of America
- Center for Global Health Science and Security, Georgetown University, Washington, DC, United States of America
| | - Stephanie J Salyer
- Surveillance and Disease Intelligence Networks Division, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Dorcas Wanjohi
- Laboratory Systems and Networks Division, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Yenew Kebede Tebeje
- Laboratory Systems and Networks Division, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Erin M Sorrell
- Center for Global Health Science and Security, Georgetown University, Washington, DC, United States of America
- Department of Microbiology & Immunology, Georgetown University, Washington, DC, United States of America
| | - Claire J Standley
- Center for Global Health Science and Security, Georgetown University, Washington, DC, United States of America
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
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Odhiambo CO, van der Puije B, Maina M, Mekonen T, Diallo S, Datema T, Loembe MM, Kebede Y, Ndlovu N, Ondoa P. Examining 7 years of implementing quality management systems in medical laboratories in sub-Saharan Africa. Trop Med Int Health 2023; 28:126-135. [PMID: 36480459 PMCID: PMC10108081 DOI: 10.1111/tmi.13839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Achievement of ISO15189 accreditation demonstrates competency of a laboratory to conduct testing. Three programmes were developed to facilitate achievement of accreditation in low- and middle-income countries: Strengthening Laboratory Management Towards Accreditation (SLMTA), Stepwise Laboratory Improvement Process Towards Accreditation (SLIPTA) and Laboratory Quality Stepwise Implementation (LQSI). OBJECTIVE To determine the level of accreditation and associated barriers and facilitators among medical laboratories in the WHO-AFRO region by 2020. METHODS A desk review of SLIPTA and SLMTA databases was conducted to identify ISO15189-accredited medical laboratories between January 2013 and December 2020. Data on access to the LQSI tool were extracted from the WHO database. Facility and country characteristics were collected for analysis as possible enablers of accreditation. The chi-square test was used to analyse differences with level of significance set at <0.05. RESULTS A total of 668 laboratories achieved accreditation by 2020 representing a 75% increase from the number in 2013. Accredited laboratories were mainly in South Africa (n = 396; 55%) and Kenya (n = 106; 16%), two countries with national accreditation bodies. About 16.9% (n = 113) of the accredited laboratories were registered for the SLIPTA programme and 26.6% (n = 178) for SLMTA. Approximately 58,217 LQSI users were registered by December 2020. Countries with a higher UHC index for access to HIV care and treatment, higher WHO JEE scores for laboratory networks, a larger number of registered LQSI users, with national laboratory policy/strategic plans and PEPFAR-priority countries were more likely to have an accredited laboratory. Of the 475 laboratories engaged in the SLIPTA programme, 154 attained ≥4 SLIPTA stars (ready to apply for accreditation) and 113 achieved ISO 15189 accreditation, with 96 enrolled into the SLMTA programme. Lower-tier laboratories were less likely to achieve accreditation than higher-tier laboratories (7.7% vs. 30%) (p < 0.001). The probability of achieving ISO 15189 accreditation (19%) was highest during the first 24 months after enrolment into the SLIPTA programme. CONCLUSION To sustainably anchor quality improvement initiatives at facility level, national approaches including access to a national accreditation authority, adoption of national quality standards and regulatory frameworks are required.
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Affiliation(s)
| | | | - Michael Maina
- African Society for Laboratory Medicine, Addis Ababa, Ethiopia
| | - Teferi Mekonen
- African Society for Laboratory Medicine, Addis Ababa, Ethiopia
| | - Samba Diallo
- African Society for Laboratory Medicine, Addis Ababa, Ethiopia.,Laboratory Division, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | | | - Marguerite M Loembe
- African Society for Laboratory Medicine, Addis Ababa, Ethiopia.,Laboratory Division, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Yenew Kebede
- Laboratory Division, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Nqobile Ndlovu
- African Society for Laboratory Medicine, Addis Ababa, Ethiopia
| | - Pascale Ondoa
- African Society for Laboratory Medicine, Addis Ababa, Ethiopia.,Amsterdam Institute for Global Health and Development, Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands
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Marinucci F, Dhein J. The time to address diagnostic needs in universal health coverage is now: Leveraging the scale up of national testing capacity for HIV viral load and SARS-CoV-2. Afr J Lab Med 2022; 11:1685. [PMID: 35811749 PMCID: PMC9257892 DOI: 10.4102/ajlm.v11i1.1685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 03/01/2022] [Indexed: 11/25/2022] Open
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Vounba P, Loul S, Tamadea LF, Siawaya JFD. Microbiology laboratories involved in disease and antimicrobial resistance surveillance: Strengths and challenges of the central African states. Afr J Lab Med 2022; 11:1570. [PMID: 35402201 PMCID: PMC8991180 DOI: 10.4102/ajlm.v11i1.1570] [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: 02/27/2021] [Accepted: 01/10/2022] [Indexed: 11/06/2022] Open
Abstract
Laboratory systems have been largely neglected on the margins of health systems in Africa. However, since the 2000s, many African countries have benefited from massive investments to strengthen laboratory capacities through projects fighting priority diseases (HIV/AIDS, tuberculosis, malaria). This review examined the laboratory capacities of the Economic Community of Central African States (ECCAS). Online research using specific terms was carried out. Studies published between 2000 and 2021 on the role of the laboratory in disease and antimicrobial resistance surveillance in the 11 ECCAS countries were considered. The number of human and animal health laboratories meeting international standards was very low in the sub-region. There were only seven International Organization for Standardization (ISO) 15189-accredited human health laboratories, with five in Cameroon and two in Rwanda. There were five high biosafety level (BSL) laboratories (one BSL3 laboratory each in Cameroon, the Central African Republic, Democratic Republic of Congo and the Republic of Congo, and one BSL4 laboratory in Gabon) and three ISO 17025-accredited laboratories in the ECCAS sub-region. Only six countries currently have whole-genome sequencing devices, which is insufficient for a sub-region as large and populous as ECCAS. Yet, a plethora of pathogens, particularly haemorrhagic viruses, are endemic in these countries. The need for laboratory capacity strengthening following a One Health approach is imperative. Since emerging and re-emerging zoonotic infectious diseases are projected to triple in frequency over the next 50 years and given the inextricable link between human and animal health, actors in the two health sectors must collaborate to preserve world health.
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Affiliation(s)
- Passoret Vounba
- Economic Community of Central African States (ECCAS) Commission/Fourth phase of the Regional Disease Surveillance Systems Enhancement Project (REDISSE IV), Libreville, Gabon
| | - Severin Loul
- Economic Community of Central African States (ECCAS) Commission/Fourth phase of the Regional Disease Surveillance Systems Enhancement Project (REDISSE IV), Libreville, Gabon
| | - Ludovic F Tamadea
- Economic Community of Central African States (ECCAS) Commission/Fourth phase of the Regional Disease Surveillance Systems Enhancement Project (REDISSE IV), Libreville, Gabon
| | - Joël F D Siawaya
- Department of Laboratory Services, CHU Mère-Enfant Fondation Jeanne EBORI, Libreville, Gabon.,Regional Integrated Surveillance and Laboratory Network (RISLNET) for Central Africa, Libreville, Gabon
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Howlett WP. Rapidly progressive dementia: limitations in Africa. Pract Neurol 2022; 22:342-343. [DOI: 10.1136/practneurol-2022-003385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2022] [Indexed: 11/04/2022]
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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: 131] [Impact Index Per Article: 43.7] [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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Bringing Data Analytics to the Design of Optimized Diagnostic Networks in Low- and Middle-Income Countries: Process, Terms and Definitions. Diagnostics (Basel) 2020; 11:diagnostics11010022. [PMID: 33374315 PMCID: PMC7823670 DOI: 10.3390/diagnostics11010022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/19/2020] [Accepted: 12/21/2020] [Indexed: 11/29/2022] Open
Abstract
Diagnostics services are an essential component of healthcare systems, advancing universal health coverage and ensuring global health security, but are often unavailable or under-resourced in low- and middle-income (LMIC) countries. Typically, diagnostics are delivered at various tiers of the laboratory network based on population needs, and resource and infrastructure constraints. A diagnostic network additionally incorporates screening and includes point-of-care testing that may occur outside of a laboratory in the community and clinic settings; it also emphasizes the importance of supportive network elements, including specimen referral systems, as being critical for the functioning of the diagnostic network. To date, design and planning of diagnostic networks in LMICs has largely been driven by infectious diseases such as TB and HIV, relying on manual methods and expert consensus, with a limited application of data analytics. Recently, there have been efforts to improve diagnostic network planning, including diagnostic network optimization (DNO). The DNO process involves the collection, mapping, and spatial analysis of baseline data; selection and development of scenarios to model and optimize; and lastly, implementing changes and measuring impact. This review outlines the goals of DNO and steps in the process, and provides clarity on commonly used terms.
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Fongwen N, Boeras D, Peeling RW, Amukele T. Connected diagnostics systems: The future of disease control in Africa. Afr J Lab Med 2020; 9:1365. [PMID: 33392059 PMCID: PMC7756953 DOI: 10.4102/ajlm.v9i2.1365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Noah Fongwen
- International Diagnostics Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Debi Boeras
- Global Health Impact Group, Atlanta, Georgia, United States
| | - Rosanna W. Peeling
- International Diagnostics Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Timothy Amukele
- Department of Pathology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
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