Are laboratory services coming of age in sub-Saharan Africa?

Received 18 October 2005; accepted 19 October 2005; electronically published 20 December 2005. Reprints or correspondence: Dr. Kathryn Maitland, The Centre for Geographic Medicine Research, Coast, Kenya Medical Research Institute, PO Box 230, Kilifi, Kenya ([email protected]). Clinical Infectious Diseases 2006; 42:383–4 2005 by the Infectious Diseases Society of America. All rights reserved. 1058-4838/2006/4203-0013$15.00 In this issue of Clinical Infectious Diseases, Petti and colleagues [1] highlight the need for increased investment in laboratory services to avoid compromising patient care. Health care professionals are waking up to the realization that the development of new drugs and treatment strategies has far outstripped the ability of health care systems to deliver them to individuals who need them. The decision has been made by leading global health care funders that cost should not be a deterrent to providing effective treatment, even in the poorest countries. As a result, there are major drives to rapidly increase availability of antiretroviraldrugsand antimalarial combination therapies. A similar and potentially stronger argument for prioritizing effectiveness over cost pertains to the provision of accurate frontline diagnostic services. Yet, as Petti and colleagues [1] illustrate, there is widespread use of “empiricism without laboratorysupportfordiagnosingdisease” in sub-Saharan Africa, which would not be tolerated in resource-plenty countries. What can be done to redress the imbalance and bring investments in diagnostics to a level that will support costeffective deployment of available treatment regimens in sub-Saharan Africa? Let us consider how this might be achieved by exploring opportunities within the major areas of concern discussed by Petti et al. [1]: clinical misdiagnosis, inadequate health care infrastructure, and laboratory capability and diagnostic accuracy. Almost none of these opportunities can be realized by laboratory services in isolation; they depend on close partnerships between technical and clinical professionals and local and national health care managers.