Availability of essential diagnostics in ten low-income and middle-income countries: results from national health facility surveys

Harika Yadav; Devanshi Shah; Shahin SayedSusan HortonLee F Schroeder

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Availability of essential diagnostics in ten low-income and middle-income countries: results from national health facility surveys

机译：Availability of essential diagnostics in ten low-income and middle-income countries: results from national health facility surveys

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Background Pathology and laboratory medicine diagnostics and diagnostic imaging are crucial to achieving universal health coverage. We analysed Service Provision Assessments (SPAs) from ten low-income and middle-income countries to benchmark diagnostic availability. Methods Diagnostic availabilities were determined for Bangladesh, Haiti, Malawi, Namibia, Nepal, Kenya, Rwanda, Senegal, Tanzania, and Uganda, with multiple timepoints for Haiti, Kenya, Senegal, and Tanzania. A smaller set of diagnostics were included in the analysis for primary care facilities compared with those expected at hospitals, with 16 evaluated in total. Surveys spanned 2004–18, including 8512 surveyed facilities. Country-specific facility types were mapped to basic primary care, advanced primary care, or hospital tiers. We calculated percentages of facilities offering each diagnostic, accounting for facility weights, stratifying by tier, and for some analyses, region. The tier-level estimate of diagnostic availability was defined as the median of all diagnostic-specific availabilities at each tier, and country-level estimates were the median of all diagnostic-specific availabilities of each of the tiers. Associations of country-level diagnostic availability with country income as well as (within-country) region-level availability with region-specific population densities were determined by multivariable linear regression, controlling for appropriate covariates including tier. Findings Median availability of diagnostics was 19·1 in basic primary care facilities, 49·2 in advanced primary care facilities, and 68·4 in hospitals. Availability varied considerably between diagnostics, ranging from 1·2 (ultrasound) to 76·7 (malaria) in primary care (basic and advanced) and from 6·1 (CT scan) to 91·6 (malaria) in hospitals. Availability also varied between countries, from 14·9 (Bangladesh) to 89·6 (Namibia). Availability correlated positively with log(income) at both primary care tiers but not the hospital tier, and positively with region-specific population density at the basic primary care tier only. Interpretation Major gaps in diagnostic availability exist in many low-income and middle-income countries, particularly in primary care facilities. These results can serve as a benchmark to gauge progress towards implementing guidelines such as the WHO Essential Diagnostics List and Priority Medical Devices initiatives. Funding Bill Melinda Gates Foundation.

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《The Lancet Global Health》 |2021年第11期|1553-1560|共8页
作者
Harika Yadav; Devanshi Shah; Shahin SayedSusan HortonLee F Schroeder;
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Internal Medicine, University of Tennessee College of Medicine;

Dalla Lana School of Public Health, University of Toronto;

Department of Pathology, Aga Khan University Hospital NairobiSchool of Public Health and Health Systems, University of WaterlooDepartment of Pathology, University of Michigan School of Medicine, Ann Arbor;

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Availability of essential diagnostics in ten low-income and middle-income countries: results from national health facility surveys

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