1921
Volume 75, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

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.

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References

  1. English M, Esamai F, Wasunna A, Were F, Ogutu B, Wamae A, Snow RW, Peshu N, 2004. Assessment of inpatient paediatric care in first referral level hospitals in 13 districts in Kenya. Lancet 363 : 1948–1953. [Google Scholar]
  2. Amexo M, Tolhurst R, Barnish G, Bates I, 2004. Malaria misdiagnosis: effects on the poor and vulnerable. Lancet 364 : 1896–1898. [Google Scholar]
  3. World Health Organization, 2003. The Africa malaria report. Available at : http://www.afro.who.int/amd_2003/mainreport.pdf. Accessed 22 January 2006.
  4. Kehinde AO, Obaseki FA, Cadmus SI, Bakare RA, 2005. Diagnosis of tuberculosis: Urgent need to strengthen laboratory services. J Natl Med Assoc 97 : 394–396. [Google Scholar]
  5. O’Dempsey TJ, McArdle TF, Laurence BE, Lamont AC, Todd JE, Greenwood BM, 1993. Overlap in the clinical features of pneumonia and malaria in African children. Trans R Soc Trop Med Hyg 87 : 662–665. [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 CJM, 2004. Overdiagnosis of malaria in patients with severe febrile illness in Tanzania: A prospective study. BMJ 329 : 1212. [Google Scholar]
  7. Berkley JA, Mwangi I, Ngetsa CJ, Mwarumba S, Lowe BS, Marsh K, Newton CR, 2001. Diagnosis of acute bacterial meningitis in children at a district hospital in sub-Saharan Africa. Lancet 357 : 1753–1757. [Google Scholar]
  8. Evans JA, Adusei A, Timmann C, May J, Mack D, Agbenyega T, Horstmann RD, Frimpong E, 2004. High mortality of infant bacteraemia clinically indistinguishable from severe malaria. QJM 97 : 591–597. [Google Scholar]
  9. 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 : 377–382. [Google Scholar]
  10. Makani J, Matuja W, Liyombo E, Snow RW, Marsh K, Warrell DA, 2003. Admission diagnosis of cerebral malaria in adults in an endemic area of Tanzania: implications and clinical description. QJM 96 : 355–362. [Google Scholar]
  11. The World Bank Group, 2006. World Development Indicators database. Available at: http://devdata.worldbank.org/data-query/. Accessed 22 January 2006.
  12. Kassu A, Aseffa A, 1999. Laboratory services in health centres within Amhara region, north Ethiopia. East Afr Med J 76 : 239–242. [Google Scholar]
  13. English M, Esamai F, Wasunna A, Were F, Ogutu B, Wamae A, Snow RW, Peshu N, 2004. Delivery of paediatric care at the first-referral level in Kenya. Lancet 364 : 1622–1629. [Google Scholar]
  14. Harries AD, Michongwe J, Nyirenda TE, Kemp JR, Squire SB, Ramsay AR, Godfrey-Faucett P, Salaniponi FM, 2004. Using a bus service for transporting sputum specimens to the Central Reference Laboratory: Effect on the routine TB culture service in Malawi. Int J Tuberc Lung Dis 8 : 204–210. [Google Scholar]
  15. Bates I, Mundy C, Pendame R, Kadewele G, Gilks C, Squire S, 2001. Use of clinical judgement to guide administration of blood transfusions in Malawi. Trans R Soc Trop Med Hyg 95 : 510–512. [Google Scholar]
  16. Narasimhan V, Brown H, Pablos-Mendez A, Adams O, Dussault G, Elzinga G, Nordstrom A, Habte D, Jacobs M, Solimano G, Sewankambo N, Wibulpolprasert S, Evans T, Chen L, 2004. Responding to the global human resources crisis. Lancet 363 : 1469–1472. [Google Scholar]
  17. Barat L, Chipipa J, Kolczak M, Sukwa T, 1999. Does the availability of blood slide microscopy for malaria at health centers improve the management of persons with fever in Zambia? Am J Trop Med Hyg 60 : 1024–1030. [Google Scholar]
  18. Stauffer P, 1999. Making lab tests more accurate: Ghanaian effort offers model process. Impact HIV 1 : 23–24. [Google Scholar]
  19. Bates I, Bekoe V, Asamoa-Adu A, 2004. Improving the accuracy of malaria-related laboratory tests in Ghana. Malar J 3 : 38. [Google Scholar]
  20. Opoku-Okrah C, Rumble R, Bedu-Addo G, Bates I, 2000. Improving microscope quality is a good investment for under-resourced laboratories. Trans R Soc Trop Med Hyg 94 : 582. [Google Scholar]
  21. Berkley JA, Lowe BS, Mwangi I, Williams T, Bauni E, Mwarumba S, Ngetsa C, Slack MP, Njenga S, Hart CA, Maitland K, English M, Marsh K, Scott JA, 2005. Bacteremia among children admitted to a rural hospital in Kenya. N Engl J Med 352 : 39–47. [Google Scholar]
  22. Jonkman A, Chibwe RA, Khoromana CO, Liabunya UL, Chaponda ME, Kandiero GE, Molyneux ME, Taylor TE, 1995. Cost-saving through microscopy-based versus presumptive diagnosis of malaria in adult outpatients in Malawi. Bull World Health Organ 73 : 223–227. [Google Scholar]
  23. Walsh AL, Phiri AJ, Graham SM, Molyneux EM, Molyneux ME, 2000. Bacteremia in febrile Malawian children: clinical and microbiologic features. Pediatr Infect Dis J 19 : 312–318. [Google Scholar]
  24. Fahey T, Webb E, Montgomery AA, Heyderman RS, 2003. Clinical management of urinary tract infection in women: A prospective cohort study. Fam Pract 20 : 1–6. [Google Scholar]
  25. Lemmen SW, Becker G, Frank U, Daschner FD, 2001. Influence of an infectious disease consulting service on quality and costs of antibiotic prescriptions in a university hospital. Scand J Infect Dis 33 : 219–221. [Google Scholar]
  26. World Health Organization, 2004. The world medicines situation. Available at: http://w3.whosea.org/LinkFiles/Reports_World_Medicines_Situation.pdf. Accessed 22 January 2006.
  27. The United Nations Children’s Fund (UNICEF), 2006. The state of the world’s children. Available at: http://www.unicef.org/sowc06_fullreport.pdf. Accessed 22 January 2006.
  28. Krishna S, Planche T, Agbenyega T, Woodrow C, Agranoff D, Bedu-Addo G, Owusu-Ofori AK, Appiah JA, Ramanathan S, Mansor SM, Navaratnam V, 2001. Bioavailability and preliminary clinical efficacy of intrarectal artesunate in Ghanaian children with moderate malaria. Antimicrob Agents Chemother 45 : 509–516. [Google Scholar]
  29. Krishna S, Nagaraja NV, Planche T, Agbenyega T, Bedu-Addo G, Ansong D, Owusu-Ofori A, Shroads AL, Henderson G, Hutson A, Derendorf H, Stacpoole PW, 2001. Population pharmacokinetics of intramuscular quinine in children with severe malaria. Antimicrob Agents Chemother 45 : 1803–1809. [Google Scholar]
  30. Planche T, Agbenyega T, Bedu-Addo G, Ansong D, Owusu-Ofori A, Micah F, Anakwa C, Asafo-Agyei E, Hutson A, Stacpoole PW, Krishna S, 2003. A prospective comparison of malaria with other severe diseases in African children: Prognosis and optimization of management. Clin Infect Dis 37 : 890–897. [Google Scholar]
  31. Berkley JA, Maitland K, Mwangi I, Ngetsa C, Mwarumba S, Lowe BS, Newton CR, Marsh K, Scott JA, English M, 2005. Use of clinical syndromes to target antibiotic prescribing in seriously ill children in malaria endemic area: observational study. BMJ 330 : 995. [Google Scholar]
  32. English M, Berkley J, Mwangi I, Mohammed S, Ahmed M, Osier F, Muturi N, Ogutu B, Marsh K, Newton CR, 2003. Hypothetical performance of syndrome-based management of acute paediatric admissions of children aged more than 60 days in a Kenyan district hospital. Bull World Health Organ 81 : 166–173. [Google Scholar]
  33. Audu R, Omilabu SA, Peenze I, Steele D, 2002. Viral diarrhoea in young children in two districts in Nigeria. Central Afr J Med 48 : 59–63. [Google Scholar]
  34. Ogunsanya TI, Rotimi VO, Adenuga A, 1994. A study of the aetiological agents of childhood diarrhoea in Lagos, Nigeria. J Med Microbiol 40 : 10–14. [Google Scholar]
  35. Castle M, Wilfert CM, Cate TR, Osterhout S, 1977. Antibiotic use at Duke University Medical Center. JAMA 237 : 2819–2822. [Google Scholar]
  36. Norton EB, Archibald LK, Nwanyanwu OC, Kazembe PN, Dobbie H, Reller LB, Jarvis WR, Jason J, 2004. Clinical predictors of bloodstream infections and mortality in hospitalized Malawian children. Pediatr Infect Dis J 23 : 145–151. [Google Scholar]
  37. Petit PL, Haarlem JV, Poelman M, Haverkamp MC, Wamola IA, 1995. Bacteraemia in patients presenting with fever. East Afr Med J 72 : 116–120. [Google Scholar]
  38. el-Teheawy MM, el-Bokl MA, Abd el-Fattah SA, Sabbour MS, 1988. The pattern of antimicrobial use in general hospitals in Egypt. Chemioterapia 7 : 387–392. [Google Scholar]
  39. Nsutebu EF, Ndumbe PM, Koulla S, 2002. The increase in occurrence of typhoid fever in Cameroon: overdiagnosis due to misuse of the Widal test? Trans R Soc Trop Med Hyg 96 : 64–67. [Google Scholar]
  40. Andre M, Eriksson M, Molstad S, Stalsbylundborg C, Jacobsson A, Odenholt I, 2005. The management of infections in children in general practice in Sweden: a repeated 1-week diagnosis-prescribing study in 5 counties in 2000 and 2002. Scand J Infect Dis 37 : 863–869. [Google Scholar]
  41. Takemura Y, Ishida H, Saitoh H, Kure H, Kakoi H, Ebisawa K, Kure M, 2005. Economic consequence of immediate testing for C-reactive protein and leukocyte count in new outpatients with acute infection. Clin Chim Acta 360 : 114–121. [Google Scholar]
  42. Mazzaglia G, Caputi AP, Rossi A, Bettoncelli G, Stefanini G, Ventriglia G, Nardi R, Brignoli O, Cricelli C, 2003. Exploring patient- and doctor-related variables associated with antibiotic prescribing for respiratory infections in primary care. Eur J Clin Pharmacol 59 : 651–657. [Google Scholar]
  43. Okuonghae HO, Nwankwo MU, Offor EC, 1993. Pattern of bacteraemia in febrile children with sickle cell anaemia. Ann Trop Paediatr 13 : 55–64. [Google Scholar]
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  • Received : 06 Apr 2006
  • Accepted : 15 May 2006

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