How accurate diagnosis could reduce mortality in Africa

Medical practitioners in Africa, particularly clinicians, have been urged to increase collaborative diagnostics with laboratory experts or pathologists in the treatment chain as this would boost chances of accurate diagnosis and, thus, reduce mortality rates on the continent. Speaking on the second day of the on-going three-day 13th biannual meeting of the Association of Pathologists of East, Central and Southern Africa (APECSA), yesterday, in Kigali, Prof. Gunturu Revathi, Associate Professor and Consultant Microbiologist, at the Aga Khan University Hospital Nairobi, Kenya, said that lack of emphasis on specific diagnosis (pathology) is one of the major causes of mortality in Africa. Pathology is a discipline of medicine of the study of samples of body fluids, tissues and cells to help the clinician come to the diagnosis. This approach is the ideal clinical standard approach to make sure the patient is managed according to facts or evidence rather than impression in our daily practice. Gunturu noted that there’s been a “recent realisation” across treatment regimens in sub-Saharan Africa that limited laboratory capacity is the “greatest barrier” to effective health care in African countries. “Our health facilities lack emphasis on specific diagnosis (clinical misdiagnosis), which is definitely a big cause of major health complications and death,” Gunturu said, adding, “Increased professionalism in a specific medical discipline, such as pathology, will definitely reduce mortality rates in Africa.” In 2008, a World Health Organisation (WHO) external QA survey showed that, “Few medical laboratories are supervised by pathologists or qualified microbiologists.” Major areas of concern Apart from lack of emphasis on specific diagnosis, pathology in sub-Saharan face challenges relating to; inadequate health care infrastructure; laboratory capability and diagnostic accuracy, according to experts. Guntutu says that there is a perceived concept among clinicians that pathology is “expensive and time consuming”, while other physicians are yet to trust lab results in the treatment chain. “Laboratories are usually given low priority and recognition in most national health delivery systems,” Prof. Emile Rwamasirabo, the Acting CEO of King Faisal Hospital, Kigali, told The New Times. He said that, despite being a “necessary step” towards the confirmation of the diagnosis, the extent of the disease, the prognosis and also the follow-up after treatment, “pathology has severely been undermined.” He noted that limited use of the laboratory approach to medical care is the main factor behind the high antibiotic-resistance. “This is another threat that requires Africa to act when there is still time. I trust that, through APECSA, our pathologists will help the continent find the best way of facing that challenge,” Dr. Rwamasirabo said. Dr Robert Lukande, the president of APECSA, says that, “Without pathology, it is just like a soldier on the frontline randomly shooting without knowledge of where the enemy could be hiding.” According to the World Health Organisation (WHO), 28 out the 38 million annual deaths resulting from non-communicable diseases (NCDs), occur in low to middle income countries. At least 82 per cent of all the NCD deaths are due to 4 types of diseases, including, cardiovascular diseases (17.2 million), cancer (8.2 million), respiratory diseases (4 million), and diabetes (1.5 million). “It is obvious that strong prevention measures of NCDS and managing large numbers of patients with chronic diseases will need more laboratory evidence, and more trained pathologists if we are to apply more cost effective strategies,” Rwamasirabo said. “APECSA, with the support of our governments, is certainly the right think tank to help design the correct vision and strategies.” Dr Fabien Ntaganda says Rwanda has 18 pathologists, of which 3 are foreigners—making them 15 qualified Rwanda pathologists—serving 36 district hospitals, 5 national referral hospitals, among other facilities. “There is a gap for pathologists, but we have several of them undergoing training now. Once they are done with studies, we will have enough who will definitely improve the quality of medical care in our country,” Ntaganda told The New Times. How to address the challenge Gunturu says that to close the imbalance in prioritisation and bring investments in diagnostics to a level that will support cost effective deployment of available treatment regimens in Africa, policy makers as well as the entire chain of physicians need to emphasise importance of laboratory testing, strengthen the existing health care infrastructure, and monitor test quality, among others. “There is also a need to offer laboratory training programmes, increase partnerships between public and private organisations as well as introduction of affordable, rapid diagnostic tests,” she said. APECSA meeting due to end today, is being held under the theme, “Resetting the pathology agenda in sub-Saharan Africa”. editorial@newtimes.co.rw

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How accurate diagnosis could reduce mortality in Africa