African Journal of Laboratory Medicine - latest Issue
Volume 5, Issue 3, 2016
Author Iruka N. OkekeSource: African Journal of Laboratory Medicine 5, pp 1 –8 (2016) http://dx.doi.org/10.4102/ajlm.v5i3.497More Less
Introduction: As crucial as clinical laboratories are to preventing, identifying and managing resistance problems, laboratory scientists are among the most overlooked stakeholders. This review outlines the contributions that diagnostic laboratory systems should make toward all five of the World Health Organization's 2015 strategic objectives for antimicrobial resistance containment.
Laboratory systems in resistance containment: Antimicrobial susceptibility testing and surveillance are central to antibacterial resistance management and control and need to be implemented more commonly and closer to sick patients. However, the scope of tests that promote judicious antimicrobial use extend beyond susceptibility testing. Laboratory tests for pathogens or their associated biomarkers confirm or rule out specific causes of signs and symptoms associated with infection. Laboratory systems also provide critical support to infection control programmes. All of these functions promote rational antimicrobial use and contain the spread of resistance. Routine laboratory data supports the development of vaccines and other technologies that could ease the pressure placed by antimicrobials. Laboratories are also a rich source of information for health professionals, policymakers and the general public about the urgency of the resistance problem and progress in containing it.
Conclusion: Laboratory systems are integral to antimicrobial resistance containment and contributions from African laboratories to addressing resistance need to be enhanced.
The laboratory health system and its response to the Ebola virus disease outbreak in Liberia : lessons from the fieldSource: African Journal of Laboratory Medicine 5, pp 1 –5 (2016) http://dx.doi.org/10.4102/ajlm.v5i3.509More Less
The laboratory system in Liberia has generally been fragmented and uncoordinated. Accordingly, the country's Ministry of Health established the National Reference laboratory to strengthen and sustain laboratory services. However, diagnostic testing services were often limited to clinical tests performed in health facilities, with the functionality of the National Reference Laboratory restricted to performing testing services for a limited number of epidemic-prone diseases. The lack of testing capacity in-country for Lassa fever and other haemorrhagic fevers affected the response of the country's health system during the onset of the Ebola virus disease (EVD) outbreak. Based on the experiences of the EVD outbreak, efforts were initiated to strengthen the laboratory system and infrastructure, enhance human resource capacity, and invest in diagnostic services and public health surveillance to inform admittance,treatment, and discharge decisions. In this article, we briefly describe the pre-EVD laboratory capability in Liberia, and extensively explore the post-EVD strengthening initiatives to enhance capacity, mobilise resources and coordinate disaster response with international partners to rebuild the laboratory infrastructure in the country. Now that the EVD outbreak has ended, additional initiatives are needed to revise the laboratory strategic and operational plan for post-EVD relevance, promote continual human resource capacity, institute accreditation and validation programmes, and coordinate the investment strategy to strengthen and sustain the preparedness of the laboratory sector to mitigate future emerging and re-emerging infectious diseases.
Pre-Ebola virus disease laboratory system and related challenges in Liberia : lessons from the fieldSource: African Journal of Laboratory Medicine 5, pp 1 –5 (2016) http://dx.doi.org/10.4102/ajlm.v5i3.508More Less
Prior to the Ebola virus disease outbreak in Liberia, the laboratory system was duplicative, fragmented and minimally coordinated. The National Reference Laboratory was conceptualised to address the existing challenges by promoting the implementation of effective and sustainable laboratory services in Liberia. However, in a resource-limited environment such as Liberia, progress regarding the rebuilding of the health system can be relatively slow, while efforts to sustain the transient gains remain a key challenge for the Ministry of Health. In this paper, we describe the pre-Ebola virus disease laboratory system in Liberia and its prevailing efforts to address future emerging infectious diseases, as well as current Infectious diseases, all of which are exacerbated by poverty. We conclude that laboratory and diagnostic services in Liberia have encountered numerous challenges regarding its efforts to strengthen the healthcare delivery system. These challenges include limited trained human resource capacity, inadequate infrastructure, and a lack of coordination. As with most countries in sub-Saharan Africa, when comparing urban and rural settings, diagnostic and clinical services are generally skewed toward urban health facilities and private, faith-based health facilities. We recommend that structured policy be directed at these challenges for national institutions to develop guidelines to improve, strengthen and sustain diagnostic and curative laboratory services to effectively address current infectious diseases and prepare for future emerging and re-emerging infectious diseases.
Stepwise approach for implementation of antimicrobial resistance surveillance in Africa : lessons from the fieldSource: African Journal of Laboratory Medicine 5, pp 1 –7 (2016) http://dx.doi.org/10.4102/ajlm.v5i3.482More Less
Background: Antimicrobial resistance (AMR) has reached an end point, prompting a worldwide scare as no new antibiotics are in the pipeline, particularly for treatment of Gram negative bacteria. To prevent further development and spread of AMR and to inform empirical treatment guidelines, surveillance of AMR is necessary.
Objective: We aim to provide a framework for a stepwise approach toward implementation of laboratory-based surveillance for AMR in African countries.
Methods and Results: Building up a surveillance system is a robust process that begins with a gap analysis in each participating country. This framework provides practical guidance on how to set up surveillance, identify responsibilities and set time lines in sustainable manner for African countries. It addresses sampling strategies, human resources, procurement and maintenance issues for AMR testing at routine clinical and national reference and public health laboratories involved in AMR surveillance. Key issues such as laboratory capacity building, training and continuous education, quality and diagnostic stewardship are discussed in detail.
Discussion: There are several priorities for AMR surveillance that need to be addressed in a comprehensive manner at regional and national levels, whilst keeping in line with current and proposed initiatives for laboratory capacity building, in order for African countries to achieve goals for combatting the real and current threat of AMR.
Practical recommendations for strengthening national and regional laboratory networks in Africa in the Global Health Security era : lessons from the fieldSource: African Journal of Laboratory Medicine 5, pp 1 –10 (2016) http://dx.doi.org/10.4102/ajlm.v5i3.471More Less
The role of national health laboratories in support of public health response has expanded beyond laboratory testing to include a number of other core functions such as emergency response, training and outreach, communications, laboratory-based surveillance and data management. These functions can only be accomplished by an efficient and resilient national laboratory network that includes public health, reference, clinical and other laboratories. It is a primary responsibility of the national health laboratory in the Ministry of Health to develop and maintain the national laboratory network in the country. In this article, we present practical recommendations based on 17 years of network development experience for the development of effective national laboratory networks. These recommendations and examples of current laboratory networks, are provided to facilitate laboratory network development in other states. The development of resilient, integrated laboratory networks will enhance each state's public health system and is critical to the development of a robust national laboratory response network to meet global health security threats.
A framework for the assessment and implementation of diagnostics in outbreak situations : lessons from the fieldAuthor Elliot P. CowanSource: African Journal of Laboratory Medicine 5, pp 1 –6 (2016) http://dx.doi.org/10.4102/ajlm.v5i3.494More Less
Observation: Outbreak situations require in vitro diagnostics (IVDs) to identify those who are infected and to track the infectious agent in the population. However, such IVDs are typically not available and must be developed. In addition, the process of IVD development, assessment,and implementation are very time and resource intensive. Recognising the extraordinary public health need for IVDs in an outbreak situation, streamlined processes are needed to provide tests that meet the standard of a reasonable assurance of safety and effectiveness in the shortest amount of time. These IVDs are designated for outbreak use.
Addressing Issues: This paper presents a pathway to the outbreak use of IVDs that can be considered by countries experiencing an outbreak situation. It takes into account recognition of the outbreak, product development, regulatory evaluation, implementation, and monitoring of the outbreak-use test. Streamlined assessment programmes for emergency-use tests have been established by the US Food and Drug Administration and the World Health Organization. These programmes take into account test requirements for the country in which the outbreak exists. Therefore, countries can consider adopting these tests without the need to conduct expensive and time consuming assessments, such as performance studies. Key responsible parties are identified for each step of the pathway, recognising that transparency and communication among all parties are critical.
A new matrix for scoring the functionality of national laboratory networks in Africa - introducing the LABNET scorecard : lessons from the fieldSource: African Journal of Laboratory Medicine 5, pp 1 –9 (2016) http://dx.doi.org/10.4102/ajlm.v5i3.498More Less
Background: Functional national laboratory networks and systems are indispensable to the achievement of global health security targets according to the International Health Regulations. The lack of indicators to measure the functionality of national laboratory network has limited the efficiency of past and current interventions to enhance laboratory capacity in resource limited- settings.
Scorecard for laboratory networks: We have developed a matrix for the assessment of national laboratory network functionality and progress thereof, with support from the African Society of Laboratory Medicine and the Association of Public Health Laboratories. The laboratory network (LABNET) scorecard was designed to: (1) Measure the status of nine overarching core capabilities of laboratory network required to achieve global health security targets, as recommended by the main normative standards; (2) Complement the World Health Organization joint external evaluation tool for the assessment of health system preparedness to International Health Regulations (2005) by providing detailed information on laboratory systems; and (3) Serve as a clear road map to guide the stepwise implementation of laboratory capability to prevent, detect and act upon infectious threats.
Conclusions: The application of the LABNET scorecard under the coordination of the African Society of Laboratory Medicine and the Association of Public Health Laboratories could contribute to the design, monitoring and evaluation of upcoming Global Health Security Agenda-supported laboratory capacity building programmes in sub Saharan-Africa and other resource-limited settings, and inform the development of national laboratory policies and strategic plans. Endorsement by the World Health Organization Regional Office for Africa is foreseen.
Integrating laboratory networks, surveillance systems and public health institutes in Africa : opinion paperSource: African Journal of Laboratory Medicine 5, pp 1 –4 (2016) http://dx.doi.org/10.4102/ajlm.v5i3.431More Less
The Ebola outbreak in West Africa underlined the urgent need for integration of public health systems, including the establishment of national laboratory networks, surveillance systems, and health research institutions at all levels of service delivery. The integration schema presented here would assist in driving the immediate steps needed for integration of public health systems, particularly laboratory networks, in support of the implementation of International Health Regulations and the Global Health Security Agenda in the African region. Increased funding, political willingness from countries, and coordination through enhanced technical assistance from international partners, are critical in achieving this objective.
Author Isatta WurieSource: African Journal of Laboratory Medicine 5, pp 1 –4 (2016) http://dx.doi.org/10.4102/ajlm.v5i3.549More Less
The impact of the 2013-2016 Ebola virus disease outbreak in the Mano River Union region, which includes Liberia, Sierra Leone and Guinea, is a direct indicator of the acute limitations in national healthcare systems and the critical role played by diagnostic and public health laboratories. Despite having a Central Public Health Reference Laboratory, Sierra Leone lacked the capacity to provide the Biosafety Level 3 laboratory support that is required to effectively direct responses and that could have offset such a prolonged and costly health systems war against the outbreak.
Source: African Journal of Laboratory Medicine 5, pp 1 –2 (2016) http://dx.doi.org/10.4102/ajlm.v5i3.579More Less
The major Ebola outbreak in West Africa in 2014 has brought the world's attention to the critical demands of health systems strengthening in Africa. Global health responses to outbreaks have never before been tested to the extent driven by Ebola; however, many lessons were learned and countries are actively working on bolstering capacity to detect and respond effectively to Ebola and other outbreaks of global health security importance. Laboratory testing played a key role in the response, and a number of key improvements in laboratory capacity have been made since 2014, with support from African and international partners, including the African Society for Laboratory Medicine, the World Health Organization's Regional Office for Africa (WHO AFRO) and the United States Centers for Disease Control and Prevention, among others.