Utilisation of laboratory services by health workers in a district hospital in Malawi

AIMS

To identify priorities for improving effective use of laboratory services in a district hospital in Malawi.

METHODS

A prospective observational study of clinician-patient interactions to analyse laboratory test requesting practices and utilisation of laboratory results. The proportion of tests that was appropriately ordered, processed and ultimately influenced clinical management was used to assess effectiveness of utilisation.

RESULTS

420 clinical consultations between health professionals and patients were observed. 92% of tests were ordered appropriately, 84% were processed by the laboratory and 64% of results influenced patient management. 73-79% of high-volume tests (haemoglobin, microscopy for malaria and tuberculosis) and 32% of low-volume tests influenced management.

CONCLUSIONS

25% of commonly requested laboratory tests were not utilised effectively; because of the high volume, interventions to improve their use are likely to be cost effective. Although 68% of low-volume tests were not used efficiently, the cost of providing support for these tests in a resource-poor setting needs to be balanced against their clinical usefulness. In contrast to published information, this study shows significant under-requesting of laboratory tests that were available. Measures to increase appropriate test requests will have implications for clinician education as well as laboratory space, budgets and staffing levels.

Evaluation and costs of different haemoglobin methods for use in district hospitals in Malawi

AIMS

To evaluate the characteristics of manual haemoglobin methods in use in Malawi and provide evidence for the Ministry of Health in Malawi to enable them to choose a suitable method for district hospitals.

METHODS

Criteria on accuracy, clinical usefulness, user friendliness, speed, training time, and economic costs were determined by local health professionals and used to compare six different manual haemoglobin methods. These were introduced sequentially into use in a district hospital in Malawi alongside the reference method.

RESULTS

HemoCue was the optimal method based on most of the outcome measures but was also the most expensive (0.75 US dollars/test). DHT meter and Jenway colorimeter were the second choice because they were cheaper (0.20-0.35 US dollars/test), but they were not as accurate or user friendly as HemoCue.

CONCLUSIONS

The process for choosing appropriate laboratory methods is complex and very little guidance is available for health managers in poorer countries. This paper describes the development and testing of a practical model for gathering evidence about test efficiency that could be adapted for use in other resource poor settings.