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Key Words: Quality improvement; Point of care; Test utilization; Volume; Uganda; Africa; Laboratory; Global health
Am J Clin Pathol January 2015;143:50-56
DOI: 10.1309/AJCPCYA54DWZQPQT
ABSTRACT
Objectives: To describe key characteristics (laboratory quality, test volumes, and complexity) of clinical laboratories in Kampala, Uganda (population ~1.7 million).
Methods: Cross-sectional survey using a standard questionnaire to document laboratory type and quality, as well as test menus and volumes. Quality was based on the World Health Organization.Africa Region checklist.
Results: Of the 954 laboratories identified (a density of one laboratory per 1,781 persons), 779 (82%) performed only simple kit tests or light microscope examinations. The 95% (907/954) of laboratories for whom volumes were obtained performed an average aggregate of 13,189 tests daily, for a test utilization rate of around 2 tests per individual per year. Laboratories could be segregated into eight groups based on quality, test volume, and complexity. However, 90% of the testing was performed by just two groups: (1) low-volume (.100 tests daily), low-quality laboratories performing simple tests or (2) high-volume (>100 tests daily), highquality laboratories. Each of these two groups did 45% of the daily testing volume (90% combined).
Conclusions: Clinical laboratory density in Kampala (1/1,781 persons) is high, approaching that in the United States (1/1,347 persons). Low-volume/low-quality and high-volume/high-quality laboratories do 90% of the daily aggregate testing. Quality improvement (QI) schemes for Africa must be appropriate to low-volume laboratories as well as to the large laboratories that have been the focus of previous QI efforts.
Key characteristics of clinical laboratories in sub- Saharan African (SSA) communities, such as the daily test volumes and test complexity, are unknown. This information deficit is a detriment to public health because it undermines the impact of capacity-building and quality improvement efforts. For instance, previous work has demonstrated that the laboratories used by SSA communities are of low quality and clinically unreliable.1-3 In response, many national and international initiatives have been deployed to improve the quality of SSA laboratories.4-7 The Strengthening Laboratory Management Towards Accreditation (SLMTA) program,7 an in-depth, 10-module, 50-hour training delivered over a 6- to 12-month period, is currently the most widespread laboratory quality improvement program in sub-Saharan Africa.7 But while such a long-term, hands-on approach may be effective for consolidated, large laboratory systems, is it appropriate...