Use of laboratory test results in patient management by clinicians in Malawi

Background: Malawi has a high burden of infectious disease. The expansion of programmes targeting these diseases requires a strong laboratory infrastructure to support both diagnosis and treatment.Objectives: To assess the use of laboratory test results in patient management and to determine the requirements for improving laboratory services. Methods: A cross-sectional study was conducted in 2012 to survey practising clinicians.Two hospitals were purposively selected for observations of clinicians ordering laboratory tests. Twelve management-level key informants were interviewed. Descriptive statistics were conducted. Results: A total of 242 clinicians were identified and 216 (89%) were interviewed. Of these; 189 (87%) reported doubting laboratory test results at some point. Clinicians most often doubted the quality of haematology (67%); followed by malaria (53%) and CD4 (22%) test results. A total of 151 (70%) clinicians reported using laboratory tests results in patient management. Use of laboratory test results at all times in patient management varied by the type of health facility (P 0.001). Ninety-one percent of clinicians reported that laboratories required infrastructure improvement. During 97 observations of clinicians' use of laboratory test results; 80 tests were ordered; and 73 (91%) of these were used in patient management. Key informants reported that the quality of laboratory services was good and useful; but that services were often unavailable. Conclusion: Gaps in the public laboratory system were evident. Key recommendations to enhance the use of laboratory test results in patient management were to strengthen the supply chain; reduce turn-around times; improve the test menu and improve the laboratory infrastructure

Determinants of postnatal care use in Kenya

Pregnancy related complications may result in maternal deaths post delivery especially in developing countries. Skilled deliveries and postnatal care (PNC) use in Kenya is low. The objective of this study was to identify the determinants of PNC use. Kenya Demographic and Health Survey (2008-09 KDHS) women's data were analyzed. Overall data from 3;970 women were analyzed. Results indicate that 47 percent of the women received PNC services. Factors associated with PNC use are mothers' age at delivery of the last child; 4+ ANC visits; urban residence; and skilled delivery. However; lack of education and unskilled delivery were associated with low use of PNC services (p 0.05). In conclusion; the use of PNC services is low at 47 percent although the main determinants for PNC use are amenable to intervention. Strengthening of maternal health services throughout the continuum of care and promoting the use of high quality services by pregnant women is recommended