Diagnosis In Africa Research Articles

African Swine Fever Diagnosis in Africa: Challenges and Opportunities.

The global spread of African swine fever (ASF) in recent decades has led to the need for technological advances in sampling and diagnostic techniques. The impetus for these has been the need to enable sampling by lay persons and to obtain at least a preliminary diagnosis in the field for early control measures to be put in place before final laboratory confirmation. In rural Africa, rapid diagnosis is hampered by challenges that include lack of infrastructure as well as human and financial resources. Lack of animal health personnel, access to affordable means to transport field samples to a laboratory, and lack of laboratories with the capacity to make the diagnosis result in severe under-reporting of ASF, especially in endemic areas. This review summarizes the challenges identified in gap analyses relevant to low- and middle-income countries, with a focus on Africa, and explore the opportunities provided by recent research to improve field diagnosis and quality of diagnostic samples used. Sampling techniques include invasive sampling techniques requiring trained personnel and non-invasive sampling requiring minimal training, sampling of decomposed carcass material, and preservation of samples in situations where cold chain maintenance cannot be guaranteed. Availability and efficacy of point-of-care (POC) tests for ASF has improved considerably in recent years and their application, as well as advantages and limitations, are discussed. The adequacy of existing laboratory diagnostic capacity is evaluated and opportunities for networking amongst reference and other laboratories offering diagnostic services are discussed. Maintaining laboratory diagnostic efficiency in the absence of samples during periods of quiescence is another issue that requires attention, and the role of improved laboratory networking is emphasized. Early diagnosis of ASF is key to managing the disease spread. Therefore, the establishment of the Africa Chapter of the Global African Swine Fever Research Alliance (GARA) increases opportunities for collaboration and networking among the veterinary diagnostic laboratories in the region.

Integrated Diagnosis in Africa's Low- and Middle-Income Countries: What Is It, What Works, and for Whom? A Realist Synthesis.

Integrated diagnosis can improve health outcomes and patient experiences through early diagnosis and identification of cases that could otherwise be overlooked. Although existing research highlight the feasibility of integrated diagnosis across various conditions, a significant evidence gap remains regarding its direct impact on patient experiences and health outcomes. This review explores the conceptualizations of integrated diagnosis by different stakeholders along the healthcare pathway and examines the necessary contexts and mechanisms crucial for its effectiveness. This study adopts a realist methodology to explore integrated diagnosis. Using a systematic approach, the research aims to collect, assess, and synthesize existing evidence on integrated diagnosis, guided by a program theory developed through literature review and expert consultations. Primary studies and reviews related to integrated diagnosis, multi-disease testing, or integrated healthcare with a diagnostic focus were sourced from major databases and global health organization websites. The collected evidence was used to construct and refine the evolving theoretical framework. This study identified three models of integrated diagnosis interventions: individual/human resource integration, facility or mobile-based integration, and technology integration. Successful implementation of these models relies on understanding the values and perceptions of both healthcare workers and patients/clients. This research emphasizes a holistic approach that considers all elements within the health system and underscores their interdependence. Using the WHO health systems framework to contextualise factors, the study positions diagnosis as an integral component of the broader health ecosystem. A key finding of the research is the importance of addressing the barriers and facilitators of integrated diagnosis interventions. This includes policy frameworks, diagnostic tools, funding mechanisms, treatment pathways, and human resource issues. Improving patient experiences requires cultivating positive relationships with healthcare workers ensuring elements such as respect, confidentiality, accessibility, and timeliness of services are prioritised. The diverse conceptualisations of integrated diagnosis highlight the importance of clear definitions for each intervention. This clarity is essential for transferring lessons learned, comparing programs, and effectively measuring results. The success of integrated diagnosis is not a one-size-fits-all scenario; decisions regarding the approach, conditions to be integrated, and timing of integration must be guided by local contexts to ensure sustainable outcomes. The review findings suggest that integrated diagnosis may be suitable at the primary care level in LMICs under specific circumstances. Successful implementation hinges on addressing the perspectives of healthcare workers and patients/clients alike, requiring adequate time, resources, and a well-defined intervention model.

Prevalence and types of anemia among people with tuberculosis in Africa: a systematic review and meta-analysis

Globally, tuberculosis (TB) and anemia are public health problems related with high morbidity and mortality. Furthermore, anemia is frequently manifested among people with TB in Africa, prevalence ranging from 25 to 99%. The presence of anemia is associated with an increase in individuals’ susceptibility to TB and poor treatment outcomes. Studies have reported heterogeneous estimate of prevalence of anemia among people with TB in Africa. This review aimed to estimate the prevalence of anemia among newly diagnosed people with TB n Africa. We searched studies in Medline/PubMed, Cochrane library, ScienceDirect, JBI database, the Web of Science, Google Scholar, WorldCat, Open Grey, Scopus, Agency for Healthcare Research and Quality, ProQuest, and African Journals Online that reported the prevalence of anemia at TB diagnosis. Two reviewers performed data extraction with pre-defined inclusion criteria. A random-effects logistic regression model was used to pool the prevalence of anemia and levels of anemia with a 95% confidence interval (CI) in STATA version 14. Heterogeneity and publication biases were explored. A total of 1408 studies were initially identified, and seventeen studies with 4555 people with TB were included in the analysis. The prevalence of anemia among people with TB in Africa was 69% (95% CI 60.57–77.51). The pooled prevalence of anemia of chronic disease was 48% (95% CI 13.31–82.75) and normocytic normochromic anemia was 32% (95% CI 13.74–50.94) while mild anemia was 34% (95% CI 20.44–46.86). Females were more anemic than males at TB diagnosis in Africa (74% vs. 66%). The finding indicates that anemia is a common co-morbidity present among people with TB, especially among females. Mild anemia and normocytic normochromic anemia were more common at TB diagnosis. The finding indicates that anemia is a common co-morbidity present among people with TB in Africa region. Hence, it is recommended to instigate a routine anemia screening at TB diagnosis to improve treatment outcomes.

Abstract A083: Higher incidence of rare ovarian tumors in West Africa

Abstract There is considerable regional variation in the incidences of ovarian cancer (OC); Europe and North America have the highest rate of 10.1 and 8.7 per 100,000 respectively whereas Japan and developing countries present with lowest incidences. Recent studies showed that West and East Africa women have high proportion of non-epithelial ovarian cancer, 30% and 39.5% from West and East Africa women respectively compared to 14%, 12%, 3% and 4.12% from US Born Black, Caribbean Born Black, US Born white and Alberta women, respectively. Africa women with epithelial ovarian cancer (EOC) presented at a lower age group; median age of 52.5 years compared with 59 years and above for the other group of women. The objective of the study was to evaluate a large cohort of OC tumors from West Africa, Nigeria to determine the patients’ demographics, the diagnostic accuracy and the tumor histotypes with the aim at identifying opportunities to improve the OC diagnosis in Africa and long-term goal of reduction in mortality and morbidity associated with the disease condition. This is a multi-centered retrospective study of OC involving 19 tertiary health institutions in West Africa, Nigeria over a period of 3 years (2017-2019). The histological records were accessed with the retrieval of patients’ demographics, original diagnosis and formalin fixed paraffin embedded (FFPE) tissue blocks of the corresponding patients. The FFPEs were sent to the collaborating institution, Division of Gynecological Oncology, Miller School of Medicine, University of Miami, Florida for further diagnostic appraisal. All FFPEs were sectioned, stained with hematoxylin and eosin (H&E) and reviewed by two pathologists. Immunohistochemistry (IHC) was performed on cases in which the morphology features were not diagnostic. A total of 422 FFPE ovarian tissue blocks were reviewed, corresponding to 377 patients. 238 (63.1%) of the cases fulfilled criteria for inclusion such as documentation of original diagnosis, presence of tumor on the slides, and interpretable morphologic features. 95 (39.9%) cases had some changes in their diagnosis. 5 cases (2.1%) had a complete change from malignant tumor to benign or borderline. IHC was required to perform differential diagnosis in 42 (44.2%) while the remaining 55 (56.8%) cases were made after histological secondary review. Epithelial ovarian cancer was 48.3% (115) of cases while non-epithelial ovarian cancer cases were 41 (36.4%) and other malignancies such as sarcoma, metastasis and hematological neoplasm accounted for the remaining 60 (25.2%) with 35 (58.3%) of the cases being metastatic tumors to the ovary. Our findings confirmed that West African women have a lower percentage of EOC compared to East Africa and North America women. We further demonstrated that secondary review of surgical pathology cases in a sub-specialized academic center and the use of ancillary techniques such as IHC may improve the diagnosis accuracy of OC in a low resource country. There would be need to incorporate this into the management of OC in low resource countries. Citation Format: Ayodele Joshua Omotoso. Higher incidence of rare ovarian tumors in West Africa [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A083.

The outcomes of palliative surgical treatment in a context of rising incidence of gastro intestinal cancers in Burkina Faso, Africa

Background and objectivesDigestive cancers are frequent and of late diagnosis in Africa. Palliative surgery therefore plays an important role. Our objective is to describe its indications, techniques and results in primary digestive cancers. MethodsRetrospective, bicentric, descriptive study of palliative surgery for primary digestive cancer, performed in Ouagadougou over the last twelve years. The results were assessed according to the degree of improvement in the patients' quality of life. We divided the patients into four groups according to the improvement of the quality of life after the operation. The results were considered very satisfactory when the symptoms disappeared completely. They were considered satisfactory when the symptoms decreased in intensity. They were unsatisfactory when the symptoms kept the same intensity. They were considered poor when the symptoms persisted with greater intensity. ResultsSix hundred and thirty-nine palliative digestive cancer surgeries were performed. All patients had clinical symptoms deteriorating their quality of life (56.7%) or even a surgical emergency (43.3%). Biliodigestive diversion, gastroentero-anastomosis and colostomy were the palliative procedures performed respectively in 26.6%, 16.9%, and 34.1%. Complications were noted in 11.7%. These were digestive fistulas in 9 cases, retraction and stomal prolapse in 11 cases. The improvement of the quality of life was very satisfactory in 76%. ConclusionsPalliative surgery is widely practiced in digestive cancers. It improves the quality of life. African surgeons should be aware and well-educated to safely perform surgical palliative procedures.

Pathology Training for Cancer Diagnosis in Africa.

In response to requests for training in cancer pathology, two virtual training courses were organized: one in English for participants in Nigeria and another in French for participants in Francophone Africa. Each course had weekly 90-minute sessions covering essential topics in cancer pathology led by global experts. Two research questions were investigated for both courses: (1) did the participants improve their knowledge of the topics covered during the course, and (2) did the course participants appreciate the virtual training format? The Nigeria course enrolled 85 participants from 26 Nigerian states; the Francophone Africa course enrolled 425 participants from 18 African countries. In the pre-post technical assessment, participants increased their scores on average by 3.4% (P > .05) in the Nigeria course and by 13.1% (P < .001) in the Francophone Africa course. On the postcourse survey, 95.8% of Nigerian respondents and 96.1% of Francophone African respondents reported being satisfied or very satisfied with the virtual format. Virtual training is a promising tool to improve cancer diagnosis in Africa, as the experience of the courses illustrates that participants appreciate the virtual format. Continued training is required to reinforce skills and enable participants to appropriately apply new knowledge to their daily practice.

Abstract 40: Pathology Training for Cancer Diagnosis in Africa: Perspectives from Two Virtual Courses

Abstract Purpose: The burden of cancer continues to grow in Africa, yet there are too few trained pathologists to manage the rising number of cancer cases. The shortage of resources in African countries, as well as the travel restrictions resulting from the COVID-19 pandemic, necessitate innovative means of training and supporting pathologists across the continent. In response to requests for training in cancer pathology, two virtual training courses were organized: one conducted in English for participants in Nigeria and another conducted in French for participants across several countries in Francophone Africa. Each course had weekly 90-minute sessions covering essential topics in cancer pathology led by global experts. Methods: Two research questions were investigated for both courses: 1) did the participants improve their knowledge of the topics covered during the course? and 2) did the course participants appreciate the virtual training format? Results: The Nigeria course enrolled 85 participants from 26 Nigerian states, while the Francophone Africa course enrolled 425 participants from 18 African countries. On the post course survey, 95.8% of Nigeria course respondents and 96.1% of Francophone Africa respondents reported being satisfied or very satisfied with the course's virtual format. In the pre-post technical assessment, participants increased their scores on average by 3.4% (p&amp;gt;0.05) in the Nigeria course and by 13.1% (p&amp;lt;0.001) in the Francophone Africa course. Conclusion: Virtual training is a promising tool to improve cancer diagnosis in Africa, as the experience of the two courses illustrates participants appreciate the virtual format. However, continued training and mentorship are required to reinforce new skills and enable the participants to appropriately apply their new knowledge to their daily practice. Citation Format: Daniel Seymour, MPA, Katy Graef, PhD, Yawale Iliyasu, MD, Mohenou Isidore Jean-Marie Diomande, MD, Samuel Jaquet, MD, Melissa Kelly, PhD, Ryan Soles, Dan Milner, MD, MSc, MBA. Pathology Training for Cancer Diagnosis in Africa: Perspectives from Two Virtual Courses [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 40.

Current trends in the epidemiology and management of enteric fever in Africa: A literature review

Enteric fever remains a tropical disease of public health significance in Africa, due to its high endemicity and transmission rates, more in sub-Saharan Africa with 7.2 million cases of typhoid fever annually and incidence rate of 762 per 100 000 person-years when compared with Northern Africa with a reported incidence rate of 557 per 100 000 person-years and lower. Recent studies show that almost all regions of sub-Saharan Africa are tending towards high incidence rates, especially Central and Western Africa. Though clinically indistinguishable from paratyphoid fever, typhoid fever causes more morbidity and mortality than paratyphoid fever, with a greater threat to children. Risk factors include consumption of contaminated water, patronizing food vendors and a history of contact with a case or a chronic carrier, amongst others. Environmental factors such as the rainy season, open sewers, contaminated water bodies and areas of low elevation have been implicated. Diagnosis in Africa is challenging due to resource constraints, as many centres still depend on clinical diagnosis and serodiagnosis using Widal test, in an era where more sensitive and specific tests exist. The polymerase chain reaction is one of the most sensitive diagnostic methods, while culture (particularly bone marrow) is considered to be one of the most specific. Quinolones (ciprofloxacin) and third-generation cephalosporins, amongst others, remain potent in the management of enteric fever, with resistance to quinolones gradually on the rise. Poor diagnostics, poor antibiotic stewardship and lack of drug (antibiotic) regulation are contributors to the problem of antibiotic resistance in Africa. Prevention of typhoid fever through vaccination, especially in children is still under investigation, with steady progress being documented. Overall, long term prevention strategies for typhoid fever should be based on improved sources of drinking water, good sanitation and hygiene, food safety and poverty alleviation.

A critical appraisal of COVID-19 as a nosocomial infection: an African perspectives

The pandemic of Coronavirus disease 19 is not abating since the outbreak began in December 2019. Africa is currently experiencing a surge after an initial low incidence and nosocomial infections could be contributing to this. A dominant factor responsible for this is a weak healthcare system because of many years of neglect due to abysmal budgetary allocation to the sector. The testing capacity for COVID-19 diagnosis in Africa is grossly inadequate coupled with a severe shortage of personal protective equipment and inadequate infectious diseases expert. These factors exposed the frontline health workers and patients to the hazard of nosocomial infection with the attendants´ morbidity and mortality. Deliberate efforts need to be made toward reducing nosocomial COVID-19 infection.

Meningitis: a frequently fatal diagnosis in Africa

Meningitis: a frequently fatal diagnosis in Africa

Strategies for Autism Diagnosis and Care in Resource Deprived Settings in Africa: An Overview

Background and Goals: Autism Spectrum Disorders (ASDs) exist in Africa as they do everywhere in the world. Historically they have been under recognized and under studied. The aim of this paper is to review the existing challenges of ASD care and diagnosis in Africa, with a view to describing workable unique strategies deployable within the continent. Methods: We present an overview of the existing medical literature and summarize key findings in relation to the topic of ASD in Africa. First, as a preliminary step, we highlight key findings from previous epidemiological surveys. Second, we undertook a review of relevant available evidence from the various African regions. When the authors were familiar with additional local or regional scientific works, these were also used and referenced. Discussion: There has been a growing awareness of the extent to which ASDs exist and have an impact on affected individuals and their families. There are many barriers to diagnosis and effective interventions. These include lack of trained personnel, stigma and cultural beliefs regarding etiology, disparities in resources between urban and rural areas, and poverty. Nonetheless, partnerships to support research and the development of culturally appropriate interventions can be developed and strengths exist in the communities that can be harnessed to improve care.

Ascitic type of abdominal tuberculosis in a 40 year old female

Disseminated tuberculosis can cause a lot of damage to an individual if there is no early diagnosis In Africa about of patients with abdominal tuberculosis present with ascites and most of these cases are misdiagnosed cases The case in question is of a year old women from one of the rural areas of Zimbabwe who had previously presented with severe coughing but had denied sweating at night and the sputum results were negative on screening After months she presented again at the clinic with a swollen abdomen and the X ray showed flooding of the lungs and difficulty in breathing

Corrigendum.

Tropical Medicine & International HealthVolume 23, Issue 4 p. E1-E1 CorrigendumFree Access Corrigendum This article corrects the following: The burden of COPD in Africa: a literature review and prospective survey of the availability of spirometry for COPD diagnosis in Africa Anushka Mehrotra, Akanbi Maxwell Oluwole, Stephen B. Gordon, Volume 14Issue 8Tropical Medicine & International Health pages: 840-848 First Published online: August 11, 2009 First published: 10 April 2018 https://doi.org/10.1111/tmi.13045Citations: 1AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL In [1], the second author's name was incorrect in the original published article. The author name should read as ‘Maxwell Oluwole Akanbi’ not ‘Akanbi Maxwell Oluwole’. The authors apologise for the error. Reference 1Mehrotra A, Oluwole AM, Gordon SB. The burden of COPD in Africa: a literature review and prospective survey of the availability of spirometry for COPD diagnosis in Africa. Trop Med Int Health 2009: 14: 840– 848. Citing Literature Volume23, Issue4April 2018Pages E1-E1 ReferencesRelatedInformation

Field performance of the Determine HBsAg point-of-care test for diagnosis of hepatitis B virus co-infection among HIV patients in Zambia

BackgroundWe evaluated the field performance of a rapid point-of-care (POC) test for hepatitis B surface antigen (HBsAg) that could support decentralization and scale-up of hepatitis B virus (HBV) diagnosis in Africa. ObjectiveTo determine the field performance of the Determine HBsAg POC test for diagnosis of HBV co-infection among HIV patients in Zambia. Study designBetween 2013–2014, we screened HIV-infected adults for HBsAg at two urban clinics in Zambia. A subset were tested with the POC Determine HBsAg (Alere, USA) by finger prick in the clinic and HBsAg serology (Access2Analyzer, Beckman Coulter) at a reference laboratory. If either test was reactive, we determined HBV viral load (VL) and genotype. We described patient demographic and clinical characteristics (including liver fibrosis) and assessed the sensitivity, specificity, positive and negative predictive values (PPV and NPV) of the Determine test. In secondary analyses, we assessed sensitivity among patients with replicating HBV (i.e., VL>20 IU/ml) and with high HBV VL (i.e.,>20,000IU/ml). ResultsAmong 412 participants with both HBsAg tests, median age was 34 years, 51% were women, and median CD4 was 208 cells/mm3. By serology, 66 (16%) were HBsAg-positive. Overall Determine had 87.9% sensitivity, 99.7% specificity, 98.3% PPV, and 97.7% NPV. Six of 8 patients with false negative results had undetectable HBV VL and no evidence of significant liver fibrosis. Test sensitivity was 95.9% among the 51 with replicating HBV and 100% among the 28 with high HBV VL. ConclusionsDetermine HBsAg is a cheaper alternative HBV testing option compared to the gold standard ELISA and has high specificity and good sensitivity in the field among HIV-infected individuals.

Ascitic Type of Abdominal Tuberculosis in a 40 Year Old Female

Disseminated tuberculosis can cause a lot of damage to an individual if there is no early diagnosis In Africa about of patients with abdominal tuberculosis present with ascites and most of these cases are misdiagnosed cases The case in question is of a year old women from one of the rural areas of Zimbabwe who had previously presented with severe coughing but had denied sweating at night and the sputum results were negative on screening After months she presented again at the clinic with a swollen abdomen and the X ray showed flooding of the lungs and difficulty in breathing

Population-Level Impact of Same-Day Microscopy and Xpert MTB/RIF for Tuberculosis Diagnosis in Africa

ObjectiveTo compare the population-level impact of two World Health Organization-endorsed strategies for improving the diagnosis of tuberculosis (TB): same-day microscopy and Xpert MTB/RIF (Cepheid, USA).MethodsWe created a compartmental transmission model of TB in a representative African community, fit to the regional incidence and mortality of TB and HIV. We compared the population-level reduction in TB burden over ten years achievable with implementation over two years of same-day microscopy, Xpert MTB/RIF testing, and the combination of both approaches.FindingsSame-day microscopy averted an estimated 11.0% of TB incidence over ten years (95% uncertainty range, UR: 3.3%–22.5%), and prevented 11.8% of all TB deaths (95% UR: 7.7%–27.1%). Scaling up Xpert MTB/RIF to all centralized laboratories to achieve 75% population coverage had similar impact on incidence (9.3% reduction, 95% UR: 1.9%–21.5%) and greater effect on mortality (23.8% reduction, 95% UR: 8.6%–33.4%). Combining the two strategies (i.e., same-day microscopy plus Xpert MTB/RIF) generated synergistic effects: an 18.7% reduction in incidence (95% UR: 5.6%–39.2%) and 33.1% reduction in TB mortality (95% UR: 18.1%–50.2%). By the end of year ten, combining same-day microscopy and Xpert MTB/RIF could reduce annual TB mortality by 44% relative to the current standard of care.ConclusionScaling up novel diagnostic tests for TB and optimizing existing ones are complementary strategies that, when combined, may have substantial impact on TB epidemics in Africa.

X-linked adrenal hypoplasia congenita: a novel DAX1 missense mutation and challenges for clinical diagnosis in Africa

Adrenal hypoplasia congenita (AHC) is a rare disease. The X-linked form of AHC is caused by deletions or mutations in DAX1 gene and has a variable clinical presentation. To date, no data on X-linked AHC in central Africa are available. Here, we report a Congolese pedigree with several cases of unexplained deaths of male infants. A careful analysis of the pedigree of this family lead to the recognition of an X-linked inheritance pattern, with subsequent confirmation in a female heterozygous carrier of a DAX1 missense mutation c.1274G>T, (p.Arg425Ile).The diagnosis of this condition remains challenging in a developing country, since the manifestations of AHC overlap with those of the much more frequently occurring infections; darkening of the skin is difficult to evaluate and there is a lack of access to routine endocrinological testing. The diagnosis was eventually made based on the family pedigree, evoking an X-linked inheritance pattern. This illustrates the necessity for medical and clinical genetics to be part of the curriculum of medical school in developing countries.

The burden of COPD in Africa: a literature review and prospective survey of the availability of spirometry for COPD diagnosis in Africa

To ascertain the known burden of chronic obstructive pulmonary disease (COPD) in Africa and of spirometry use to indicate the possibility of further unpublished data becoming shortly available. Literature review. Screening of 132 articles yielded 22 relevant articles, of which only six used spirometry based data. A total of 106 physicians in 34 countries were contacted and only 23 reported satisfactory use and availability of spirometry. Current estimates of COPD burden in Africa are based on an unreliably small dataset. Acquisition of further data will require substantial investment in lung function equipment and training.

UK-based real-time lymphoproliferative disorder diagnostic service to improve the management of patients in Ghana

The objective of the study was to evaluate the feasibility of a UK-based real-time service to improve the diagnosis and management of lymphoproliferative disorders (LPDs) in Ghana. Adult patients reporting to hospital with a suspected LPD, during a 1 year period, were prospectively enrolled. Bone marrow and/or lymph node biopsies were posted to the Haematology Malignancy Diagnostic Service (HMDS), Leeds, UK and underwent morphological analysis and immunophenotyping. Results were returned by e-mail. The initial diagnoses made in Ghana were compared with the final HMDS diagnoses to assess the contribution of the HMDS diagnosis to management decisions. The study was conducted at the two teaching hospitals in Ghana—Komfo Anokye, Kumasi and Korle Bu, Accra. Participants comprised 150 adult patients (≥12 years old), 79 women, median age 46 years. Bone marrow and lymph node biopsy samples from all adults presenting with features suggestive of a LPD, at the two teaching hospitals in Ghana, over 1 year were posted to a UK LPD diagnostic centre, where immunophenotyping was performed by immunohistochemistry. Molecular analysis was performed where indicated. Diagnostic classifications were made according to international criteria. Final diagnosis was compared to the initial Ghanaian diagnosis to evaluate discrepancies; implications for alterations in treatment decisions were evaluated. Median time between taking samples and receiving e-mail results in Ghana was 15 days. Concordance between initial and final diagnoses was 32% (48 of 150). The HMDS diagnosis would have changed management in 31% (46 of 150) of patients. It is feasible to provide a UK-based service for LPD diagnosis in Africa using postal services and e-mail. This study confirmed findings from wealthy countries that a specialised haematopathology service can improve LPD diagnosis. This model of Ghana–UK collaboration provides a platform on which to build local capacity to operate an international quality diagnostic service for LPDs.

Out with the old, in with the new: the utility of rapid diagnostic tests for malaria diagnosis in Africa

After many years of development, rapid diagnostic tests (RDTs) for malaria are now being rolled out in many African countries to support the introduction of artemisinin-based combination therapies (ACT). RDTs create new opportunities both for improved care and as research tools, but it is important that the research agenda continues to address the many challenges, both operational and technical, that still need to be met. Here we review what is known and what new evidence is needed to maximise the utility of RDTs in Africa.