Abstract

Background: Communicable diseases remain the leading cause of illness, deaths and disability in African countries. Even though well-known, efficacious responses are available for the control and prevention of these diseases, each year in Sub-Saharan Africa approximately 12million people die (UNICEF, 2005), and for most individuals the cause of death are largely uninvestigated

Method: A standardized, semi-structured questionnaire was used to collect information from 55 health laboratories (13 public (4 hospital and 9 HC), 35 private (3 diagnostic labs, 10 hospitals, 22 HC) and 7 confessionals (4 hospitals and 3HC)). The collected data was coded and analyzed using a Stastical Package for Social Scientists (SPSS).

Results: staffs who got in-service-training for any specific infectious disease of concern were highest in public health labs at 58.4% and lowest in private labs at 41.6% and those who never trained were highest in private at 56% and lowest in public labs at 44%.; Parasitology and serology scored highest at 51.36%, in the tests performed while mycology scored the lowest at 0.66%., all 55 health facilities laboratories had staining rack, drying rack, microscope slides, lancet, sharp container, and gloves in their laboratories, 18.1%, 34.5%, 9%, 36.4%, and 50.9% of the health facilities had autoclave, Bunsen burner (with gas cylinder), ELISA reader and washer, blood mixer and wire loop with handle in their laboratories, respectively. ). Among the 254 medical laboratory practitionals 38.18% who were head of labs had a BSc in MLS, 21.8% had Diploma and HND in MLS, 5.4% had MPH, 7.27% had MSc and 5.45% had post Doctorate fellows.

Conclusion: Laboratories in private health units are possibly designed for general use and are not purposively prepared to handle disease diagnosis like Ebola outbreaks. There is insufficient training of staff relating to management of disease outbreaks and diagnosis. Nevertheless, this research concludes that health laboratories have more progress to make before disease outbreak preparedness is made satisfactory.

CHAPTER ONE

INTRODUCTION AND LITERATURE REVIEW

1.1. Introduction

Communicable diseases remain the leading cause of illness, deaths and disability in African countries. Even though well-known, efficacious responses are available for the control and prevention of these diseases, each year in sub-Saharan Africa approximately 12 million people die (UNICEF, 2005), and for most individuals the cause of death are largely uninvestigated. These uninvestigated deaths are generally attributed to infectious diseases, mostly commonly HIV infection, malaria, typhoid and tuberculosis, but in the absence of laboratory confirmation, the accuracy of these estimates remain uncertain (WHO, 2004). In fact, a study from Kenya found that bacterial bloodstream infections diagnosed by blood culture were responsible for 26% of deaths among children (Berkley et al., 2005), which suggests that invasive bacterial infections may be an underappreciated cause of death. With >25 million people with HIV disease in this region (UNAIDS, 2004), the burden of infectious diseases is even more patent. Quality laboratory testing is crucial to confirm clinical diagnosis, conduct accurate infectious diseases surveillance, and direct public healthcare policy.

Communicable diseases caused by bacteria, viruses, protozoa, fungi and parasites, make a huge contribution to the burden of disease, disability and death in low and middle-income countries. The emergence of HIV/AIDS as a global pandemic, the resurgence of tuberculosis co-infection with HIV, and the rapid spread of fatal outbreaks of influenza, have also brought communicable diseases back onto the agenda of health services in high-income countries. The six leading groups of infectious diseases (acute respiratory infections, HIV/AIDS, diarrhoeal diseases, tuberculosis, malaria and measles) together cause over 11 million deaths worldwide every year, and blights the lives of tens of millions more who are living with their chronic or recurrent effects. These high-profile diseases are relatively well publicized across the world, and are subject to major research into vaccines and treatments.

Some communicable diseases are easily preventable through simple measures such as vaccination and changes in human behavior (for example, hand washing with soap). However, the transmission of infectious agents will be difficult to reduce to the levels seen in wealthier nations without significant reductions in the proportion of people living in impoverished social circumstances, with poor nutrition that leaves them more vulnerable to infection, without housing that is secure from disease-carrying pests, and without access to clean drinking water, improved sanitation or the safe disposal of house hold waste. Strenuous efforts are being made to address these problems in Africa.

1.2. Statement of the Problem

Although the South West Region has several hospitals and health centers of interdisciplinary research and outreach services, there are major gaps that exist in public and private health laboratories. Although progress has been made in strengthening laboratory capacity to support programs such as poliomyelitis eradication, HIV/AIDS prevention and control, and measles elimination, challenges remain. These include the lack of national policy and strategy for laboratory services, insufficient funding, inadequately trained laboratory staff, weak laboratory infrastructures, old or inadequately serviced equipment, lack of essential reagents and consumables, and limited quality assurance and control protocols. Laboratories are usually given low priority and recognition in most national health delivery systems. Availability and access to quality laboratory services are among the major challenges contributing to delayed or inadequate responses to epidemics, disease control and patient management. The result has been continued reliance on empirical patient care, a practice that not only wastes resources but also contributes to drug resistance. Despite the growing threat from emerging and re-emerging pathogens, very few laboratories have capabilities for diagnosing highly infectious diseases such as viral hemorrhagic fever, severe acute respiratory syndrome, viral illness spread by the bite of infected mosquitoes resembling dengue fever, and the highly pathogenic avian influenza virus, including A/H5N1. Countries often ship specimens to other regions for confirmation, resulting in delayed responses to diagnosis of outbreaks. The establishment of centers of excellence or public health reference laboratories to provide diagnostic services for these highly infectious diseases remains a major challenge for most countries including Cameroon.

Policy makers, clinicians, and the public frequently fail to understand that diagnosis is essential to the prevention and treatment of disease. The quality of laboratory services is important in achieving the national goal of improved health care. Service quality is influenced by the competence of the laboratory service providers who are the practitioners as well as the availability of the recommended working conditions as set by the World Health Organization (WHO, 2016). The quality of service remains a growing concern even as medical diagnostic laboratories are undergoing the process of accreditation for quality services in line with WHO standards.

1.3 Rationale

Laboratory services are an essential and fundamental part of all health systems. Reliable and timely laboratory tests are at the centre of the efficient treatment of patients. Moreover, prevention and management of infectious diseases requires accurate laboratory diagnostic information. Many therapeutic decisions rely heavily on data from health laboratories and, at the time of disease outbreaks or other public health’s events, laboratories are at the very heart of the public health investigation and response mechanisms. Today’s world cannot afford unreliable laboratory results, wasting precious time, precious samples, and too often, previous lives (WHO, 2012). Providing health care in sub-Saharan Africa is a complex problem. Recent reports call for more resources to assist in the prevention and treatment of infectious diseases that affect this population, but policy makers, clinicians, and the public frequently fail to understand that diagnosis is essential to the prevention and treatment of disease. Access to reliable diagnostic testing is severely limited and misdiagnosis commonly occurs.

Understandably, allocation of resources to diagnostic laboratory testing has not been a priority for resource-limited health care systems, but unreliable and inaccurate laboratory diagnostic testing leads to unnecessary expenditures in a region already plagued by resource shortages, promotes the perception that laboratory testing in unhelpful, and compromises patient care.

1.4. Hypothesis

Laboratories in the South West Region of Cameroon should have the capacities to diagnose common communicable diseases in their areas.

1.4.1. General Objective

This study is aim at assessing the capacities of laboratories in the South West Region to diagnose communicable diseases and its effect on public health.

1.4.2.   Specific Objective

1. To determine the capacity of health laboratories in diagnosing infectious diseases by providing timely, accurate and reliable results for infectious disease
2. To determine the status of health laboratories in general laboratory management and good laboratory practices
3. To determine the effects of laboratory diagnosis of infectious diseases on public health

1.4.2 Research Questions

1. Do these laboratories have the capacities of diagnosing infectious diseases by providing timely, accurate and reliable results for infectious disease
2. What is the status of health laboratories in terms of management and good laboratory practices?
3. What is the effect of laboratory diagnose on public health?