Volume 94, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Adequate laboratory infrastructure in sub-Saharan Africa is vital for tackling the burden of infectious diseases such as human immunodeficiency virus and acquired immune deficiency syndrome, malaria, and tuberculosis, yet laboratories are ill-integrated into the diagnostic and care delivery process in low-resource settings. Although much of the literature focuses on disease-specific challenges around laboratory testing, we sought to identify horizontal challenges to the laboratory testing process through interviews with clinicians involved in the diagnostic process. Based on 22 interviews with physicians, nurses, clinical officers, medical students, and laboratory technicians, technologists and supervisors, we identified 12 distinct challenges in the areas of staff, materials, workflow, and the blood bank. These challenges underscore the informational challenges that compound more visible resource shortages in the laboratory testing process, which lend themselves to horizontal strengthening efforts around the diagnostic process.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Petti CA, Polage CR, Quinn TC, Ronald AR, Sande MA, , 2006. Laboratory medicine in Africa: a barrier to effective health care. Clin Infect Dis 42: 377382.[Crossref] [Google Scholar]
  2. Birx D, de Souza M, Nkengasong JN, , 2009. Laboratory challenges in the scaling up of HIV, TB, and malaria programs: the interaction of health and laboratory systems, clinical research, and service delivery. Am J Clin Pathol 131: 849851.[Crossref] [Google Scholar]
  3. Nankabirwa J, Zurovac D, Njogu JN, Rwakimari JB, Counihan H, Snow RW, Tibenderana JK, , 2009. Malaria misdiagnosis in Uganda—implications for policy change. Malar J 8: 66.[Crossref] [Google Scholar]
  4. Wilson D, Howell V, Toppozini C, Dong K, Clark M, Hurtado R, , 2011. Against all odds: diagnosing tuberculosis in South Africa. J Infect Dis 204 (Suppl 4): S1102S1109.[Crossref] [Google Scholar]
  5. Polage CR, Bedu-Addo G, Owusu-Ofori A, Frimpong E, Lloyd W, Zurcher E, Hale D, Petti CA, , 2006. Laboratory use in Ghana: physician perception and practice. Am J Trop Med Hyg 75: 526531. [Google Scholar]
  6. Reyburn H, Mbatia R, Drakeley C, Carneiro I, Mwakasungula E, Mwerinde O, Saganda K, Shao J, Kitua A, Olomi R, Greenwood BM, Whitty CJ, , 2004. Overdiagnosis of malaria in patients with severe febrile illness in Tanzania: a prospective study. BMJ 329: 1212.[Crossref] [Google Scholar]
  7. Hawkins RC, , 2007. Laboratory turnaround time. Clin Biochem Rev 28: 179. [Google Scholar]
  8. Plebani M, Lippi G, , 2011. Closing the brain-to-brain loop in laboratory testing. Clin Chem Lab Med 49: 11311133. [Google Scholar]
  9. Manor PG, , 1999. Turnaround times in the laboratory: a review of the literature. Clin Lab Sci 12: 85. [Google Scholar]
  10. Ssekabira U, Bukirwa H, Hopkins H, Namagembe A, Weaver MR, Sebuyira LM, Quick L, Staedke S, Yeka A, Kiggundu M, Schneider G, McAdam K, Wabwire-Mangen F, Dorsey G, , 2008. Improved malaria case management after integrated team-based training of health care workers in Uganda. Am J Trop Med Hyg 79: 826833. [Google Scholar]
  11. Kiggundu M, Nsobya SL, Kamya MR, Filler S, Nasr S, Dorsey G, Yeka A, , 2011. Evaluation of a comprehensive refresher training program in malaria microscopy covering four districts of Uganda. Am J Trop Med Hyg 84: 820824.[Crossref] [Google Scholar]
  12. Gwer S, Newton CR, Berkley JA, , 2007. Over-diagnosis and co-morbidity of severe malaria in African children: a guide for clinicians. Am J Trop Med Hyg 77 (Suppl): 613. [Google Scholar]
  13. Nicastri E, Bevilacqua N, Schepisi MS, Paglia MG, Meschi S, Ame SM, Mohamed JA, Mangi S, Fumakule R, Di Caro A, Capobianchi MR, Kitua A, Molteni F, Racalbuto V, Ippolito G, , 2009. Accuracy of malaria diagnosis by microscopy, rapid diagnostic test, and PCR methods and evidence of antimalarial overprescription in non-severe febrile patients in two Tanzanian hospitals. Am J Trop Med Hyg 80: 712717. [Google Scholar]
  14. Driessen J, Cioffi M, Alide N, Landis-Lewis Z, Gamadzi G, Gadabu OJ, Douglas G, , 2013. Modeling return on investment for an electronic medical record system in Lilongwe, Malawi. J Am Med Inform Assoc 20: 743748.[Crossref] [Google Scholar]
  15. Driessen J, Limula H, Gadabu OJ, Gamadzi G, Chitandale E, Ben-Smith A, Alide N, Douglas G, , 2015. Informatics solutions for bridging the gap between clinical and laboratory services in a low-resource setting. Afr J Lab Med 4: 17.[Crossref] [Google Scholar]
  16. Crabtree BF, Miller WL, , 1999. Doing Qualitative Research. Thousand Oaks, CA: Sage Publications. [Google Scholar]

Data & Media loading...

  • Received : 30 Nov 2015
  • Accepted : 26 Feb 2016
  • Published online : 01 Jun 2016

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error