Preferred techniques of hair harvest for medical testing among adult pulmonary TB patients

Background: Antiretroviral hair drug levels are currently being used to monitor adherence to HIV treatment. There is currently a dearth of literature on the preferred technique(s) of hair harvest for medical testing in the context of African multicultural settings. Objective: To explore the preferred techniques(s) of hair harvest for medical testing among TB patients. Methods: We used a descriptive phenomenological approach to conduct interviews for 15 TB patients from the 06th through the 24th of June 2022. Data was organized by N-VIVO version 10 and analysed step by step using a thematic analytical approach. Results: Participants aged <30 years were more knowledgeable, positively perceived, and experienced about the salon-based hair cutting technique compared to those aged≥30 years old. Participants aged ≥30 had experience, flexibility to use, and were knowledgeable in all three techniques, Overall, for all age categories (<30,30-40 and >40 years), majority of the respondents were knowledgeable, flexible and experienced in using all the three techniques. Conclusion: The majority of TB patients were knowledgeable, experienced and flexible about the hair cutting techniques however, efforts are needed to educate the youth that hair for medical testing can be cut by any of the three techniques without changing their cosmetic look.

Discrepancies between clinical diagnoses and autopsy findings: A comparative study conducted in South Africa

The anatomical pathology autopsy serves several purposes, notably as a quality management tool for evaluation of accuracy in clinical diagnosis. Despite its value, for various reasons there has been an international decline in autopsies conducted. In the modern medical era, with all its advances in technology, diagnostic techniques and interventions, there is still a high discrepancy between clinical diagnoses and postmortem findings.Objectives. To establish the discrepancies between clinical diagnoses and postmortem findings in anatomical pathology autopsies.Methods. A retrospective, descriptive study was conducted over the 4-year-period 2014 - 2017. The clinical diagnoses and postmortem findings of cases referred to the Department of Anatomical Pathology at the University of Pretoria, South Africa, were evaluated and compared using the modified Goldman criteria.Results. A total of 288 cases qualified for the study and were evaluated. The gender distribution was 155 (53.8%) male and 133 (48.2%) female, with the majority of cases in the age group 19 - 60 years (mean 36.4). The majority of the cases were referred by internal medicine, followed by paediatrics. The most common cause of death in major missed diagnoses was pulmonary conditions. Of the cases, 115 (39.3%) had a major discrepancy and 62 (21.5%) a minor discrepancy.Conclusion. This study showed that there is still a high discrepancy between clinical diagnoses and postmortem findings, similar to studies conducted globally. The current COVID-19 pandemic may be a driver for revival of the anatomical pathology autopsy, and future studies are recommended to evaluate whether the decline can be reversed

The Togo national proficiency test pilot programme for basic clinical chemistry tests

Background: A national proficiency test (PT) programme is not currently implemented in most low-income countries. However, participation in such PT programmes assists improves test performance and result accuracy.Objective: This study assessed how well 11 government hospital laboratories performed 18 basic clinical chemistry tests and identified areas needing improvement.Methods: A cross-sectional study was carried out by the Division of Laboratories of the Ministry of Health of Togo from 01 July 2016 to 31 December 2016. The test performance was evaluated using panels provided by One World Accuracy, Canada (Vancouver). The Clinical Laboratory Improvement Amendments criteria were used in evaluating the laboratories, and their success rates were compared with the World Health Organization Regional Office for Africa's target of 80%.Results: The overall rate of acceptable results at the laboratories was over 80% for glucose, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyltransferase, alkaline phosphatase and triglycerides tests. The laboratories using fully automated spectrophotometers had an acceptable results rate of 89% (p = 0.001). The overall performance of the laboratories by cycles varied from 71% to 82%.Conclusion: This national PT programme identified the tests, which laboratories must improve their performance (urea, creatinine, uric acid, bilirubin, cholesterol, total protein, calcium, magnesium, phosphorus). It demonstrated the need for the use of routine appropriate internal quality control in all laboratories. The proficiency test programme should be extended to all clinical laboratories and target all biology disciplines

Delays in HIV-1 infant polymerase chain reaction testing may leave children without confirmed diagnoses in the Western Cape province, South Africa

Background: Early diagnosis and confirmation of HIV infection in newborns is crucial for expedited initiation of antiretroviral therapy. Confirmatory testing must be done for all children with a reactive HIV PCR result. There is no comprehensive data on confirmatory testing and HIV PCR test request rejections at National Health Laboratory Service laboratories in South Africa.Objective: This study assessed the metrics of routine infant HIV PCR testing at the Tygerberg Hospital Virology Laboratory, Cape Town, Western Cape, South Africa, including the proportion of rejected test requests, turn-around time (TAT), and rate of confirmatory testing.Methods: We retrospectively reviewed laboratory-based data on all HIV PCR tests performed on children ≤ 24 months old (n = 43346) and data on rejected HIV PCR requests (n = 1479) at the Tygerberg virology laboratory over two years (2017­2019). Data from sample collection to release of results were analysed to assess the TAT and follow-up patterns.Results: The proportion of rejected HIV PCR requests was 3.3%; 83.9% of these were rejected for various pre-analytical reasons. Most of the test results (89.2%) met the required 96-h TAT. Of the reactive initial test results, 53.5% had a follow-up sample tested, of which 93.1% were positive. Of the initial indeterminate results, 74.7% were negative on follow-up testing.Conclusion: A high proportion of HIV PCR requests were rejected for pre-analytical reasons. The high number of initial reactive tests without evidence of follow-up suggests that a shorter TAT is required to allow confirmatory testing before children are discharged.

Drotaverine to shorten the duration of labour in primigravidas: a randomised, double-blind, placebo-controlled trial

Background: Drotaverine, a spasmolytic, has been found to have potential to achieve a reduction in the duration of labor and prevent prolonged labor. Objective: To compare the effects of intravenous drotaverine hydrochloride with placebo for shortening the duration of active phase of labor in primigravida's. Methods: A double-blind, placebo-controlled randomized trial of 246 primigravida's in active phase of labor at term was conducted. They were randomly (1:1 ratio) administered intravenous 2 ml (40mg) of drotaverine hydrochloride or 2 ml of Vitamin B complex as placebo. The primary outcome measure was the duration of active phase of labor. The secondary outcome measures were cervical dilatation rate, oxytocin augmentation rate, incidence of prolonged labor, labor pain scores, mode of delivery, maternal and neonatal outcomes. Results: The mean duration of active phase of labor (hour) was significantly lower in the drotaverine group compared to the control (drotaverine; 6.22 ± 2.41 vs placebo; 8.33 ± 3.56; p <0.001). Also, the cervical dilatation rate (cm/hr) was significantly faster in the drotaverine arm (drotaverine; 1.68 ± 1.02 versus placebo; 1.06 ± 0.53, p <0.001). There was a significantly higher probability of faster delivery among women who were given drotaverine (log-rank test, p < 0.001). The oxytocin augmentation rate, incidence of prolonged labor, labor pain scores, mode of delivery, maternal and neonatal outcomes were not significantly different among the groups. Conclusions: Drotaverine hydrochloride is effective in shortening the duration of active phase of labor without adverse maternal and neonatal outcomes. However, more evidence is needed to explore its role in active phase of labor among primigravid women. Trial registration number: PACTR201810902005232

Overview of preparedness and response to COVID-19 in Ghana

The Coronavirus disease 2019 (COVID-19) outbreak in Ghana is part of an ongoing pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). The first two cases of COVID-19 were confirmed in Ghana on 12th March 2020. COVID-19 was consequently declared a Public Health Emergency of National Concern, triggering several response actions, including enhanced surveillance, case detection, case management and contact tracing, closure of borders, suspension of international flights, ban on social gatherings and closure of schools. Preparedness and response plans were activated for implementation at the national, regional, district and community levels. Ghana's Strategic approaches were to limit and stop the importation of cases; detect and contain cases early; expand infrastructure, logistics and capacity to provide quality healthcare for the sick; minimise disruption to social and economic life and increase the domestic capacity of all sectors to deal with existing and future shocks. The health sector strategic frame focused on testing, treatment, and tracking. As of 31st December 2020, a total of 535,168 cases, including 335 deaths (CFR: 0.61%), have been confirmed with 53,928 recoveries and 905 active cases. All the regions have reported cases, with Greater Accra reporting the highest number. The response actions in Ghana have seen highlevel political commitment, appropriate and timely decisions, and a careful balance of public health interventions with economic and socio-cultural dynamics. Efforts are ongoing to intensify non-pharmaceutical interventions, sustain the gains made so far and introduce COVID-19 vaccines to reduce the public health burden of the disease in Ghana

Data management during COVID-19 outbreak response in Ghana: a reference laboratory perspective on key issues and measures

The COVID-19 pandemic caused by SARS-CoV-2 is an important subject for global health. Ghana experienced lowmoderate transmission of the disease when the first case was detected in March 12, 2020 until the middle of July when the number of cases begun to drop. By August 24, 2020, the country's total number of confirmed cases stood at 43,622, with 263 deaths. By the same time, the Noguchi Memorial Institute for Medical Research (NMIMR) of the University of Ghana, the primary testing centre for COVID-19, had tested 285,501 with 28,878 confirmed cases. Due to database gaps, there were initial challenges with timely reporting and feedback to stakeholders during the peak surveillance period. The gaps resulted from mismatches between samples and their accompanying case investigation forms, samples without case investigation forms and vice versa, huge data entry requirements, and delayed test results. However, a revamp in data management procedures, and systems helped to improve the turnaround time for reporting results to all interested parties and partners. Additionally, inconsistencies such as multiple entries and discrepant patient-sample information were resolved by introducing a barcoding electronic capture system. Here, we describe the main challenges with COVID-19 data management and analysis in the laboratory and recommend measures for improvement

Laboratory organisation and management of SARS-CoV-2 infection in Niger, West Africa

Background: As the coronavirus disease 2019 (COVID-19) pandemic unfolds, laboratory services have been identified as key to its containment. This article outlines the laboratory organisation and management and control interventions in Niger.Intervention: The capitol city of Niger, Niamey, adopted a 'National COVID-19 Emergency Preparedness and Response Plan' to strengthen the preparedness of the country for the detection of severe acute respiratory syndrome coronavirus-2. Laboratory training and diagnostic capacity building were supported by existing active clinical and research laboratories for more rapid and practicable responses. The National Reference Laboratory for Respiratory Viruses located at the Centre de Recherche Médicale et Sanitaire was designated as the reference centre for COVID-19 testing. The national plan for COVID-19 testing is being gradually adopted in other regions of the country in response to the rapidly evolving COVID-19 emergency and to ensure a more rapid turn-around time.Lessons learnt:After the decentralisation of COVID-19 testing to other regions of the country, turn-around times were reduced from 48­72 h to 12­24 h. Reducing turn-around times allowed Niger to reduce the length of patients' stays in hospitals and isolation facilities. Shortages in testing capacity must be anticipated and addressed. In an effort to reduce risk of shortages and increase availability of reagents and consumables, Niamey diversified real-time reverse transcriptase­polymerase chain reaction kits for severe acute respiratory syndrome coronavirus-2 detection.Recommendations: Continued investment in training programmes and laboratory strategy is needed in order to strengthen Niger's laboratory capacity against the outbreak

Fine needle aspiration cytology of breast lumps with histopathologic correlation in Owo, Ondo State, Nigeria: a five-year review

Objective: To determine the histopathologic correlation of fine needle aspiration cytology FNAC of breast masses seen in the department of histopathology of the Federal Medical Center Owo, Southwestern Nigeria.Design: This is a 5-year retrospective study of breast lumps seen at Department of Histopathology, Federal Medical Centre Owo, a tertiary health care facility in Southwestern Nigeria between January 1 2010 and December 31 2014.Participants: All patients who had Fine Needle Aspiration Cytology of Breast lumps with subsequent histological confirmation over this period were included in the study.Results: In the five years under review (2010-2014), a total of 289 FNAC of breast lumps were done. The aspirates were obtained from 275 (95.2%) females and 14 (4.8%) males. There were 161 cases of FNAC with corresponding tissue for histological correlation giving a biopsy rate of 55.7%. The sensitivity of FNAC in determining the final histologic diagnosis was found to be 99.4% while the specificity was 100%. FNAC was able to determine final histologic diagnosis conclusively in 86.3% of cases.Conclusion: We therefore concluded that FNAC is a reliable diagnostic tool of breast lumps in our centre. Being a fast and cheap diagnostic tool as highlighted by previous studies, we advocate that clinicians should continue to embrace this diagnostic technique in the surgical management of breast lumps

Third-year medical students' and clinical teachers' perceptions of formative assessment feedback in the simulated clinical setting

Background. Clinical skills training in the clinical skills laboratory (CSL) environment forms an important part of the undergraduate medical curriculum. These skills are better demonstrated than described. A lack of direct observation and feedback given to medical students performing these skills has been reported. Without feedback; errors are uncorrected; good performance is not reinforced and clinical competence is minimally achieved. Objectives. To explore the perceptions of 3rd-year medical students and their clinical teachers about formative clinical assessment feedback in the CSL setting.Methods. Questionnaires with open- and closed-ended questions were administered to 3rd-year medical students and their clinical skills teachers. Quantitative data were statistically analysed while qualitative data were thematically analysed. Results. Five clinical teachers and 183 medical students participated. Average scores for the items varied between 1.87 and 5.00 (1: negative to 5: positive). The majority of students reported that feedback informed them of their competence level and learning needs; and motivated them to improve their skills and participation in patient-centred learning activities. Teachers believed that they provided sufficient and balanced feedback. Some students were concerned about the lack of standardised and structured assessment criteria and variation in teacher feedback. No statistical difference (p0.05) was found between the mean item ratings based on demographic and academic background. Conclusion. Most teachers and students were satisfied with the feedback given and received; respectively. Structured and balanced criterion-referenced feedback processes; together with feedback training workshops for staff and students; are recommended to enhance feedback practice quality in the CSL. Limited clinical staff in the CSL was noted as a concern

evaluation de la phase pre-analytique dans quelques laboratoires d'analyses medicales de la ville de Yaounde

Objectifs: Les pratiques pre-analytiques conditionnent la reussite des autres phases du systeme d'assurance qualite par l'obtention de l'echantillon dont l'analyse fournira l'information demandee par le prescripteur. Notre etude avait pour but d'evaluer les pratiques pre-analytiques dans les laboratoires d'analyses medicales de la ville de Yaounde.Methodologie : Une etude transversale descriptive a ete menee aupres des laboratoires d'analyses medicales de la ville de Yaounde. Le questionnaire confectionne a cet effet; a ete rempli par l'enqueteur a travers l'interview avec le responsable du laboratoire enquete et les observations journalieres du deroulement de la phase pre-analytique dans ce dernier. Les reponses aux questions; avec leurs cotations; ont permis de determiner les pratiques pre-analytiques avec leur score d'evaluation . Resultats : Nous avons enquete dans 8 laboratoires d'analyses medicales dont 6 dans le secteur public et 2 dans le secteur prive. Nous avons observe une insuffisance d'informations sur les prescriptions d'analyses; un defaut d'individualisation entre les salles d'accueil et de prelevement majoritairement dans le secteur public ; une absence du manuel de prelevement dans la quasi-totalite de ces laboratoires ; un materiel de transport des echantillons n'assurant pas leur integrite et la securite du personnel implique ; une absence de procedure de reception des echantillons. Les scores d'evaluation obtenus etaient inferieurs a 40 pour le secteur prive

Experience of quality management system in a clinical laboratory in Nigeria

Issues: Quality-management systems (QMS) are uncommon in clinical laboratories in Nigeria; and until recently; none of the nation's 5 349 clinical laboratories have been able to attain the certifications necessary to begin the process of attaining international accreditation. Nigeria's Human Virology Laboratory (HVL); however; began implementation of a QMS in 2006; and in 2008 it was determined that the laboratory conformed to the requirements of ISO 9001:2000 (now 2008); making it the first diagnostic laboratory to be certified in Nigeria. The HVL has now applied for the World Health Organization (WHO) accreditation preparedness scheme. The experience of the QMS implementation process and the lessons learned there in are shared here. Description: In 2005; two personnel from the HVL spent time studying quality systems in a certified clinical laboratory in Dakar; Senegal. Following this peer-to-peer technical assistance; several training sessions were undertaken by HVL staff; a baseline assessment was conducted; and processes were established. The HVL has monitored its quality indicators and conducted internal and external audits; these analyses (from 2007 to 2009) are presented herein. Lessons learned: Although there was improvement in the pre-analytical and analytical indicators analysed and although data-entry errors decreased in the post-analytical process; the delay in returning laboratory test results increased significantly. There were several factors identified as causes for this delay and all of these have now been addressed except for an identified need for automation of some high-volume assays (currently being negotiated). Internal and external audits showed a trend of increasing non-conformities which could be the result of personnel simply becoming lax over time. Application for laboratory accreditation; however; could provide the renewed vigour needed to correct these non conformities. Recommendation: This experience shows that sustainability of the QMS at present is a cause for concern. However; the tiered system of accreditation being developed by WHO-Afro may act as a driving force to preserve the spirit of continual improvement

Sensitivity and specificity of typhoid fever rapid antibody tests for laboratory diagnosis at two sub-Saharan African sites

Objective:To evaluate three commercial typhoid rapid antibody tests for Salmonella Typhi antibodies in patients suspected of having typhoid fever in Mpumalanga; South Africa; and Moshi; United Republic of Tanzania. Methods The diagnostic accuracy of Cromotest (semiquantitative slide agglutination and single tube Widal test); TUBEX and Typhidot was assessed against that of blood culture. Performance was modelled for scenarios with pretest probabilities of 5and 50. Findings In total 92 patients enrolled: 53 (57.6) from South Africa and 39 (42.4) from the United Republic of Tanzania. Salmonella Typhi was isolated from the blood of 28 (30.4) patients. The semiquantitative slide agglutination and single-tube Widal tests had positive predictive values (PPVs) of 25.0(95confidence interval; CI: 0.6-80.6) and 20.0(95CI: 2.5-55.6); respectively. The newer typhoid rapid antibody tests had comparable PPVs: TUBEX; 54.1(95CI: 36.9-70.5); Typhidot IgM; 56.7(95CI: 37.4-74.5); and Typhidot IgG; 54.3(95CI: 36.6-71.2). For a pretest probability of 5; PPVs were: TUBEX; 11.0(95CI: 6.6-17.9); Typhidot IgM; 9.1(95CI: 5.8-14.0); and Typhidot IgG; 11.0(6.3-18.4). For a pretest probability of 50; PPVs were: TUBEX; 70.2(95CI: 57.3-80.5); Typhidot IgM; 65.6(95CI: 54.0-75.6); and Typhidot IgG; 70.0(95CI: 56.0-81.1). Conclusion Semiquantitative slide agglutination and single-tube Widal tests performed poorly. TUBEX and Typhidot may be suitable when pretest probability is high and blood cultures are unavailable; but their performance does not justify deployment in routine care settings in sub-Saharan Africa

Doctors' Use of Laboratory Tests in the Diagnosis and Treatment of Patients

The provincial health budgets in South Africa are under enormous pressure and; annually; budgets are exceeded by most hospitals and clinics. Laboratory tests requested by clinicians are contributing to the problem of over-expenditure. The aim of this study was to determine from patients' files whether doctors were using laboratory tests prudently during their treatment of patients in the outpatient department (OPD) of the National District Hospital in Bloemfontein. A descriptive study was carried out using all the files of patients who visited the OPD in a three-month period (1 July to 30 September 2005) for whom laboratory tests were requested by the attending physician. The majority (31.3) of patients for whom laboratory tests were requested presented to the OPD with cardiovascular complaints or diagnoses; followed by endocrine (27.8) and musculoskeletal (16.3) complaints or diagnoses. Between one and three tests were requested for most patients; i.e. 33and 15; respectively. The most frequently requested tests were erythrocyte sedimentation rate (8.1); urea and electrolytes (7.7); urine microscopy; culture and sensitivity (6.4); cholesterol (6.1); full blood count (5.7) and thyroid profile (TSH 4.6; T4 2.6and thyroid functions 2.3). In 70.4of cases; results were documented and; in 59.1; the physician's management plans indicated the incorporation of laboratory test results into the patient's treatment regimen. Our findings indicated inappropriate documentation and application of test results. Interventions to improve physician behaviour include education; guidelines; feedback; leadership and redesign of requisition forms

A Synopsis of Current Malaria Diagnosis Trends

Malaria has remained a major cause of morbidity and mortality in the under developed and developing countries of the tropical and sub-tropical regions of the world. Globally 3.3 billion people live in areas where malaria exists; affecting 300-500 million people annually and it is estimated to be killing approximately 1-3 million people each year and 90of these mortalities occur in African children especially in sub Saharan Africa. Currently; although several control methods are beginning to result in downward trends in incidence in some countries; the gross number of malaria cases is still on the increase due to several factors including poor and ineffective diagnosis. Prompt and effective diagnosis is essential for the management and control of malaria. Over the years evidence has shown that traditional methods for diagnosing malaria remain problematic with a number of limitations. In this synoptic review an update of malaria diagnosis is presented and discussed highlighting the limitations and difficulties of both clinical (symptoms/ clinical signs-based) and laboratory (parasite-based) diagnosis of malaria. Enhancement of accurate malaria diagnosis is now more imperative than ever not only in the background of the current new era of malaria treatment with relatively expensive artemisinin-based combination therapies (ACTs); but more so in the heightened global campaign to effectively control; manage and possibly eradicate malaria from the face of the globe

Quality of HIV laboratory testing in Tanzania: a situation analysis

Tanzania is scaling up prevention; treatment; care and support of individuals affected with HIV. There is therefore a need for high quality and reliable HIV infection testing and AIDS staging. The objective of this study was to assess laboratories capacities of services in terms of HIV testing and quality control. A baseline survey was conducted from December 2004 to February 2005 in 12 laboratories which were conveniently selected to represent all the zones of Tanzania. The questionnaires comprised of questions on laboratory particulars; internal and external quality control for HIV testing and quality control of reagents. Source and level of customer satisfaction of HIV test kits supply was established. Of 12 laboratories; nine used rapid tests for screening and two used rapid tests for diagnosis. In the 12 laboratories; four used double ELISA and five used single ELISA and three did not use ELISA. Confirmatory tests observed were Western Blot in three laboratories; DNA PCR in two laboratories; CD4 counting in seven laboratories; and viral load in two laboratories. Although all laboratories conducted quality control (QC) of the HIV kits; only two laboratories had Standard Operating Procedures (SOPs). Internal and external quality control (EQC) was done at varied proportions with the highest frequency of 55.6(5/9) for tnternal quality control (IQC) for rapid tests and EQC for ELISA; and the lowest frequency of 14.3(1/ 7) for IQC for CD4 counting. None of the nine laboratories which conducted QC for reagents used for rapid tests and none of the five which performed IQC and EQC had SOPs. HIV kits were mainly procured by the Medical Store Department and most of laboratories were not satisfied with the delay in procurement procedures. Most of the laboratories used rapid tests only; while some used both rapid tests and ELISA method for HIV testing. In conclusion; the survey revealed inadequacy in Good Laboratory Practice and poor laboratory quality control process for HIV testing reagents; internal and external quality control

Comparison of the performance of SD bioline syphilis 3.0 assay with the RPR test for the syphilis screening in Dar Es Salaam, Tanzania

Background:World Health Organization in 2003 launched Sexually Transmitted Diseases Diagnostics Initiative (SDI) with mission to promote the development; evaluation and application of sexually transmitted infection diagnostic tests including syphilis screening appropriate for use in primary health care settings in developing countries.Objective: To evaluate the performance of SD BIOLINE Syphilis 3.0 test (Standard Diagnostics Inc.; South Korea) using routine serum samples from blood donors; antenatal clinic attendees and out patients.Settings: Mwananyamala and Amana District Hospitals; and Muhimbili University College of Health Sciences; Department of Microbiology and Immunology; Dar es Salaam; TanzaniaMethods: A total of 498 serum samples were initially tested on both SD BIOLINE Syphilis 3.0 and rapid plasma reagin (RPR) tests and were then confirmed on Treponema pallidum hemaagglutination (TPHA) test.Results: The overall seroprevalence of syphilis was 5.6(28/498) on TPHA; 8.2(41/498) on SD BIOLINE Syphilis 3.0 and 9.8(49/498) on RPR tests. The SD BIOLINE test had higher sensitivity (79vs. 68) and specificity (96vs. 94) compared to RPR test.Conclusion: The overall sensitivity (79) of SD BIOLINE syphilis 3.0 test found is low whereas specificity (96) found is similar compared to the previous evaluation but higher compared to the sensitivity (68) and specificity (94) of the currently used RPR test. SD BIOLINE syphilis 3.0 test offers better sensitivity; specificity and test efficiency than the currently used RPR test.Recommendation: The SD BIOLINE syphilis 3.0 test offers better sensitivity; specificity; test efficiency and operational characteristics than the currently used RPR test and may be adopted for use in syphilis screening in our settings

Treatment of malaria restricted to laboratory confirmed cases: a prospective cohort study in Ugandan children

Background: Presumptive treatment of malaria in febrile children is widely advocated in Africa. This may occur in the absence of diagnostic testing or even when diagnostic testing is performed but fails to detect malaria parasites. Such over-treatment of malaria has been tolerated in the era of inexpensive and safe monotherapy. However; with the introduction of new artemisinin-based combination therapy (ACT); presumptive treatment becomes economically and clinically less acceptable. Methods: The risks and benefits of only treating children with microscopy confirmed malaria using a prospective cohort design were investigated. A representative sample of 601 children between one and 10 years of age were recruited from a census population in Kampala; Uganda and were followed for all of their health care needs in a study clinic. Standard microscopy was performed each time a child presented with a new episode of fever and antimalarial therapy given only if the blood smear was positive. Results: Of 5;895 visits for new medical problems 40were for febrile illnesses. Of the 2;359 episodes of new febrile illnesses; blood smears were initially reported as negative in 1;608 (68) and no antimalarial therapy was given. Six of these initially negative smears were reported to be positive following quality control reading of all blood smears: four of these patients were subsequently diagnosed with uncomplicated malaria and two cleared their parasites without antimalarial treatment. Of the 1;602 new febrile illnesses in which the final blood smear reading was classified as negative; only 13 episodes (0.8) were diagnosed with malaria in the subsequent 7 days. All 13 of these episodes of malaria were uncomplicated and were successfully treated.Conclusions: In this urban setting; malaria was responsible for only 32of febrile episodes. Withholding antimalarial therapy in febrile children with negative blood smears was safe and saved over 1;600 antimalarial treatments in 601 children over an 18-month period. In the era of expensive ACT; directing resources towards improving diagnostic and treatment practices may provide a cost-effective measure for promoting rational use of antimalarial therapy