Date of Award

11-8-2022

Degree Type

Thesis

Degree Name

Master of Health Policy and Management

First Advisor

Dr Amna Rehana Siddqui

Second Advisor

Dr Muhammad Asim

Department

Community Health Sciences

Abstract

Background: Effective treatment require proper diagnosis. As nature of diseases became complex, physicians’ dependency upon correct laboratory diagnosis for providing right treatment has also heightened. Inadequate availability and access to laboratory diagnostic services is a contributory factor for poor health outcomes in low-middle income countries. Three global health issues, achieving universal health coverage (UHC), antimicrobial resistant (AMR) and global health security, has strong linkage with good availability of diagnostic facilities. COVID 19 pandemic has further highlighted the need of quality diagnostic services. WHO in-vitro model Essential diagnostic test list (EDL) has emphasized upon the importance of essential laboratory diagnostic facilities. EDL is a catalogue of tests for communicable (CD) and non-communicable disease (NCD) which suggests evidence-based recommendations to support countries in choosing the diagnostic tests according to their disease burden for national essential in-vitro diagnostic test (NEDL). This study was designed with the purpose to assess the availability of essential diagnostic tests for communicable diseases in public hospital laboratories of Karachi and to explore challenges in availability of diagnostic tests in these hospitals.
Methods: This was explanatory sequential mixed method study design conducted through crosssectional survey and descriptive qualitative exploratory design conducted from September to October 2022 with active data collection in 14 public hospital laboratories of Karachi through purposive sampling. Quantitative data were collected for availability of 9 assays of general diagnostic tests and 39 disease specific assays for 13 communicable diseases. In-depth interviews (IDIs) were conducted to evaluate the challenges for availability of essential diagnostic tests from 9 key informants who were technologist, pathologist, and laboratory administrator.
Study Findings: staining was available in six of nine hospitals and culture and sensitivity in four out of nine hospitals. Blood sugar was available in all hospitals where as HbA1C was done in five of the nine hospitals. CBC was available in all hospitals, whereas differential cell count was available in four of the nine hospitals. Urine microscopy was available in eight of the nine hospitals. These are basic routine tests and lack of either equipment or technical staff is disturbing and worrisome Only screening tests for Hepatitis B (HBs antigen), Hepatitis C antibody and HIV antibody were available in majority of participant laboratories. Despite the high rates of dengue and malaria cases occuring at the time of data collection, diagnostic kits were not available in two centers. TB culture and sensitivity was mostly referred to National TB control program centers. COVID-19 PCR were available only in laboratories of tertiary care centers. The availability of diagnostic tests for measle, rubella, influenza virus, human papilloma virus, aspergillosis, streptococcus pharyngitis and sexually transmitted infections was next to nothing. The challenges for non-availability of diagnostic tests identified through IDIs were secondary to bureaucratic obstacles, inadequate human resource, inefficient bio-medical support, negligible clinician-laboratory liaison.
Conclusion and policy implication: The diagnostic tests for CD were mainly available for malaria, dengue. For HBV, HVC and HIV screening test were available in all laboratories. Culture and susceptibility testing of clinical specimens for common pathogens and procalcitonin were not available. Tests for sexually transmitted infections were not available in any health facilities. This study has provided a platform to assess the availability of IVDs according to WHO EDL for both CD and NCD in public and private hospital laboratories across country would facilitate in the development national essential diagnostic list (NEDL). Diagnostic services / facilities need to reflect the given disease burden of a setting, policies to be formulated per level of care, filling the gaps in availability of EDL tests from primary to tertiary care.

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1

Last Page

69

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