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LABORATORY USE IN GHANA: PHYSICIAN PERCEPTION AND PRACTICE

Clinical diagnosis of infectious diseases in Africa has been associated with increased misdiagnosis and mortality, but when laboratory testing is available, it remains underused. We retrospectively compared infectious diagnoses, test results, anti-microbial use, and patient cost with laboratory and physician surveys at a teaching hospital in Ghana to evaluate the potential barriers to laboratory use and financial impact for patients. Laboratory capacity was high, but physician survey results and objective data indicated a reliance on clinical judgment and empirical therapy. For the study period, 9–15% of malaria diagnoses, 34–43% of urinary tract infections (UTIs), and 62% of meningitis cases were supported by abnormal laboratory results. For the same period, 0.82–2.09 units of antibiotics were consumed per patient day, and patient cost for antibiotics was 4.8–21.6 times that of laboratory testing. Physician perception regarding the value of diagnostic testing is potentially a major barrier to laboratory use, resulting in empiricism, disproportionate anti-microbial administration, and cost to patients.

Received April 6, 2006. Accepted for publication May 15, 2006.

Acknowledgments: We express appreciation to the staffs of the KATH pharmacies, laboratories, and medical records.

Disclosure: C. R. Polage, G. Bedu-Addo, A. Owusu-Ofori, E. Frimpong, W. Lloyd, E. Zurcher, D. Hale, and C. A. Petti have no conflicts of interest or funding sources to declare. C. R. Polage had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

^* Address correspondence to Christopher R. Polage, ARUP Laboratories, Inc., 500 Chipeta Way, Salt Lake City, UT 84108-1221. E-mail: polagec{at}aruplab.com

Authors’ addresses: Christopher R. Polage and Cathy A. Petti, ARUP Laboratories, Inc., 500 Chipeta Way, Salt Lake City, UT 84108-1221, Telephone: 001-801-583-2787 x3205, Fax: 001-801-584-5207, E-mail: polagec{at}aruplab.com and cathy.petti{at}aruplab.com. George Bedu-Addo, Directorate of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana, E-mail: gba{at}africaonline.com.gh. Alex Owusu-Ofori, Diagnostics Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana, E-mail: owusu_ofori{at}yahoo.com. Enoch Frimpong, School of Allied Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana, E-mail: ehfrimps{at}yahoo.co.uk. Weston Lloyd, University of Utah School of Medicine, Salt Lake City, UT, E-mail: Weston.Lloyd{at}hsc.utah.edu. Emily Zurcher, University of Utah School of Medicine, Salt Lake City, UT, E-mail: Emily.Zurcher{at}hsc.utah.edu. DeVon Hale, University of Utah School of Medicine, Salt Lake City, UT E-mail: devon.hale{at}hsc.utah.edu.