In this section, we present the tests performed at the different laboratory levels based on the standard menus, reasons for the lack of tests, specimen and test referral and availability of vital and essential supplies.
Background characteristics
A total of 57 HCIIIs, 18 HCVs, 19 hospital laboratories and 6 regional referral hospital laboratories were assessed. Sixteen of these laboratories were hubs and 84 were non hubs. The laboratories had been in operation for an average of 15 years (Table 2).
Table 1: Levels of Laboratories assessed
Level of Laboratory
|
Frequency (N=100)
|
HC III
|
57
|
HC IV
|
18
|
Hospital
|
19
|
Regional Referral
|
6
|
Hub laboratories
|
16
|
Non Hub laboratories
|
84
|
Tests performed at facility level according to Test menus
Health center III laboratories: Most health center III laboratories can conduct basic urine/stool analysis with a few exceptions due to non-functioning equipment and lack of reagents. All conducted HIV tests, malaria and pregnancy tests. None of the HC III laboratories performed blood grouping, sickle cell screening due to non-functioning equipment, lack of equipment and reagents. Full blood count and basic chemistry tests were grossly lacking due to non-functioning equipment, lack of equipment, reagents and skilled staff (Table 3).
Health center IV laboratories: All the Health center IV laboratories conducted HIV tests, malaria and pregnancy tests. None of the pneumonia and ulcer tests, electrolytes and chemistry tests was performed at Health center IV laboratories due to non-functioning equipment, lack of equipment, reagents and limited staff skills. The majority of the diabetes (83.3%), Hepatitis (76.5%) and CBC (60.0%) tests were referred mainly due to broken down equipment and lack of reagents (Table 3).
Table 2: Tests performed at Health Center IIIs and Health center IV according to test menus
Test Menus
|
HC III 57(%)
|
Reasons for unavailability of tests
|
Bacteriology tests
|
|
|
Stool analysis
|
36 (63.2)
|
*&
|
Urine Analysis
|
48 (84.2)
|
*&
|
AFB (TB screening)
|
40 (70.2)
|
*#&
|
Serology
|
|
|
Syphilis test
|
52 (91.2)
|
*#&
|
HIV test
|
57(100.0)
|
-
|
Pregnancy test
|
57(100.0)
|
-
|
Rapid Blood Sugar
|
44(77.2)
|
&
|
Parasitology
|
|
|
Malaria test
|
57 (100.0)
|
-
|
Hematology
|
|
|
Full blood count
|
5 (8.8)
|
*#&
|
Blood grouping
|
0(0.0)
|
*#&
|
Sickle cell screening test
|
0(0.0)
|
*#&
|
Chemistry test
|
5 (8.8)
|
$*#&
|
Test Menus for HCIV
|
HCIV 18 (%)
|
|
Bacteriology
|
|
|
Stool analysis
|
16 (88.9)
|
&
|
Urine Analysis
|
17 (94.4)
|
#
|
AFB (TB screening)
|
17 (94.4)
|
&
|
Serology
|
|
|
Syphilis test
|
16 (88.9)
|
*#
|
HIV test
|
18(100.0)
|
-
|
Pregnancy test
|
18(100.0)
|
-
|
Rapid Blood Sugar
|
3(16.7)
|
&
|
Parasitology
|
|
|
Malaria test
|
18 (100.0)
|
-
|
Electrolytes
|
0 (0.0)
|
$*#&
|
Hematology
|
|
|
Full blood count
|
6 (33.3)
|
*#&
|
Blood grouping
|
9(50.0)
|
&
|
Sickle cell screening test
|
7(38.9)
|
&
|
Chemistry test
|
1 (5.6)
|
$*#&
|
$-Staff not trained, *-nonfunctioning equipment, #-No equipment, &-No reagents, bold-weak areas
Tests performed at Hospital laboratories
Almost all tests supposed to be conducted at hospital level laboratories, were conducted except for chemistry and electrolytes tests. Majority (52.6%) of laboratories did not conduct electrolytes tests due nonfunctioning equipment, lack of equipment, reagents and skilled staffs. A few laboratories did not conduct chemistry tests (26.3%) due to nonfunctioning equipment and lack of equipment. BAT tests (12.8%), TB tests (16.7%) and Ulcer tests (25.0) were also not available at the time of assessment due to lack of reagents and equipment (Table 4).
Tests performed at Regional Referral hospital laboratories
Almost all tests supposed to be conducted at regional referral laboratories were available at the time of the assessment. However, half of the laboratories did not conduct electrolyte tests due to lack of reagents and equipment. One lab did not conduct full blood count due to lack of reagents (Table 4).
Table 3: Tests Performed at Hospital and Regional Referral hospital laboratories according to testing menus
Test Menus
|
Hospital 19(%)
|
Reasons for unavailability of Tests
|
Bacteriology
|
|
|
Stool analysis
|
19 (100.0)
|
-
|
Urine Analysis
|
19 (100.0)
|
-
|
AFB (TB screening)
|
19 (100.0)
|
-
|
Serology
|
|
|
Syphilis test
|
18 (94.7)
|
#
|
HIV test
|
19 (100.0)
|
-
|
Pregnancy test
|
19 (100.0)
|
-
|
Rapid Blood Sugar
|
19 (100.0)
|
-
|
Parasitology
|
|
|
Malaria test
|
19 (100.0)
|
-
|
Electrolytes
|
9 (47.4)
|
*#$&
|
Hematology
|
|
|
Full blood count
|
16 (84.2)
|
*#
|
Blood grouping
|
18 (94.7)
|
&
|
Sickle cell screening test
|
18 (94.7)
|
&
|
Chemistry test
|
14 (73.7)
|
*#
|
Test Menus
|
RRH 6(%)
|
Reasons for unavailability of Tests
|
Bacteriology
|
|
|
Stool analysis
|
5 (83.3)
|
&
|
Urine Analysis
|
5 (83.3)
|
#
|
AFB (TB screening)
|
6 (100.0)
|
-
|
Serology
|
|
|
Syphilis test
|
5 (83.3)
|
#
|
HIV test
|
6 (100.0)
|
-
|
Pregnancy test
|
6 (100.0)
|
-
|
Rapid Blood Sugar
|
6 (100.0)
|
-
|
Parasitology
|
|
|
Malaria test
|
6 (100.0)
|
-
|
Electrolytes
|
3 (50.0)
|
#&
|
Hematology
|
|
|
Full blood count
|
5 (83.3)
|
&
|
Blood grouping
|
6 (100.0)
|
-
|
Sickle cell screening test
|
6 (100.0)
|
-
|
Chemistry test
|
6(100.0)
|
-
|
$-Staff not trained, *-nonfunctioning equipment, #-No equipment, &-No reagents, bold-weak areas
Tests performed at hub laboratories according to test menus and reasons for non-availability of tests
Almost all tests could be performed at hub laboratories. All the hub laboratories had malaria tests and TB screening. Less than half(43.8%) of the hub laboratories were able to perform electrolytes tests due to lack of equipment, non-functioning equipment and lack of reagents, ¼ of the hub laboratories could not conduct Full blood count due to lack of equipment. A few 3/16 hub laboratories were not able to conduct chemistry tests due to lack of equipment and nonfunctioning equipment (Table 5).
Table 4: Tests available at Hub laboratories according to Test menus
Test Menus
|
N16 (%)
|
Reasons for unavailability of tests
|
Bacteriology
|
|
|
Stool analysis
|
14(87.5)
|
&
|
Urine analysis
|
14(87.5)
|
#&
|
AFB (TB screening)
|
16(100.0)
|
-
|
Serology
|
|
|
Syphilis test
|
14(87.5)
|
#
|
Parasitology
|
|
|
Malaria test
|
16(100.0)
|
-
|
Electrolytes
|
7(43.8)
|
*#&
|
Hematology
|
|
|
Full blood count
|
12(75.0)
|
#
|
Chemistry
|
13(81.2)
|
*#
|
$-Staff not trained, *-nonfunctioning equipment, #-No equipment, &-No reagents, bold-weak areas
Tests and specimen routinely referred
Generally, 48.4% of the laboratories referred specimen for tests that could be performed in the laboratories. This was mainly due to lack of reagents (44.1%) and lack of equipment (39.8%). More than half of laboratories at all levels received referred results more than a week from the time the specimens were referred, with HCIVs having the highest number (68.8%) of laboratories receiving results after a week.
Health center III laboratories: Slightly less than half (42.1%) of the health center III laboratories routinely referred tests for which they are mandated to perform. These included BAT Test (33.3%), diabetes tests (25.0%). The main reason for routine referral of these tests was lack of reagents.
Health center IV laboratories: Half 9/18 (50.0%) of the health center IV laboratories routinely referred specimen for tests that could be carried out in the laboratory. These mainly included TB culture (9/9), CD4 (7/9), Viral load (9/13), chemistry (4/9) and hematology (3/9). The main reasons for referral included lack of reagents (88.8%) and broken equipment (55.6%).
Hospital level laboratories: More than half 11/19 (57.9%) of the general hospital laboratories routinely referred specimen for tests that could be carried out in the laboratory. These mainly included PCR (11/11), Histology (7/11), TB culture (8/11) and Viral load (8/11). The main reasons for referral of tests included lack of reagents (72.7%), broken equipment (72.7%) and lack of staff (9.1%).
Regional referral hospital laboratories: Less than half (2/6) of the regional referral hospital laboratories routinely referred specimen for tests that could be carried out in the laboratory. These were mainly PCR, TB culture and viral load. The main reason for referral of specimens was lack of reagents.
Hub Laboratories: The majority 10/16 of the hubs routinely referred specimens for tests that are supposed to be carried out in their laboratories. These tests included PCR (9/10), Histology (4/10), TB culture (10/10), chemistry (4/10), CD4 (6/10) and Viral load (10/10). The main reason for specimen referral in the hub laboratories included lack of reagents (66.7%) and nonfunctional equipment (58.3%).
Availability of essential and vital laboratory supplies at different laboratory levels
Overall: HIV testing kits, Malaria rapid tests strips, urine strips, were well stocked at all laboratory levels with over 95% of the laboratories having those supplies. At all levels, there was a general shortage of Igm (tubex), reconstituted laboratory reagents for malaria CBC, TB and opportunistic infections which were found in less than half of the laboratories.
Health center III laboratories: Of the supplies mandated to be available at this level, majority (94.7%) of the HC III laboratories were stocked with HIV testing kits (94.7%), malaria rapid diagnostic tests (92.9%) and about half (50.9%) were stocked with blood glucose test strips. There were critical shortages in the availability of IgM tubex (8.8%), reconstituted laboratory reagents for malaria, CBC, tuberculosis and opportunistic infections (28.5%), chemicals (25.2%), blood grouping anti sera (42.8%) and about 39.8% had glass ware and apparatus (Table 6).
Health center IV laboratories: For the supplies supposed to be available at Health center IV laboratories, all of them had HIV testing kits and malaria rapid test strips. None of the laboratories had CD4 Reagents, EasyCD4 (GUAVA), Sysmex 3-part reagent kit, Cobas C 111 equipment reagents, Cobas c 311 liver profile test kits, reagents for Selectra, and blood collection sets and only 35.3% had been stocked with glassware (Table 7).
Hospital level laboratories: All hospital laboratories were stocked with HIV, malaria and urine test strips. There were critical shortages of CD4 reagents (20.0%), Anti-microbial sensitivity disc kit (20.0%), culture media (16.0%), and coagulation reagents (15.0%) Less than half of the laboratories were stocked with human liver function test kits (48%), Blood grouping anti sera (48%) and blood collection supplies (44.0%) while none of them were stocked with reagents for selectra and biochemistry reflotron reagents (Table 6).
Hub level laboratories: Availability of supplies according to supplies menus at Hub laboratories level could not be assessed due to lack of a supplies list for these hub laboratories.
Table 5: Availability of selected Essential and Vital Supplies according to the menus at the time of assessment
Supplies Menus
|
HC III
|
HC IV
|
Hospitals N=25
|
HIV testing kits
|
54(94.7)
|
17(100.0)
|
25(100.0)
|
Specimen containers
|
42(73.7)
|
13(76.5)
|
20 (79.4)
|
Blood glucose test strips
|
29 (50.9)
|
7(41.2)
|
21(84.0)
|
Brucella abortus Ag
|
*
|
5(29.4)
|
14(56.0)
|
HCG pregnancy test strips
|
45(79.0)
|
12(70.6)
|
24(86.0)
|
IgM (tubex)
|
5 (8.8)
|
1(5.9)
|
1(4.0)
|
Malaria rapid
|
53(92.9)
|
17(100.0)
|
25(100.0)
|
RPR test strips
|
48 (84.2)
|
13(76.5)
|
19(76.0)
|
Treponema
|
15(26.3)
|
6(35.3)
|
15(60.0)
|
Urine test strips
|
51(91.1)
|
16(94.11)
|
25(100.0)
|
Reconstituted lab reagents for malaria, CBC, TB
|
16(28.5)
|
7(41.2)
|
11 (43.3)
|
Tuberculosis reagents kit
|
48(84.2)
|
15(88.2)
|
25 (100.0)
|
Malaria fields stain reagents kit
|
29(48.9)
|
7(41.2)
|
15 (60.0)
|
Gram stain kit
|
32(55.7)
|
12(70.6)
|
24 (95.0)
|
Chemicals
|
18(25.2)
|
5(29.4)
|
16 (62.2)
|
CD4 Reagents
|
*
|
0(0.0)
|
5 (20.0)
|
BD FACS Count reagents
|
*
|
1(5.9)
|
10 (40)
|
CD4 point of care machine
|
*
|
12(70.6)
|
9 (36.0)
|
PointCare Now
|
*
|
2(11.8)
|
1 (4.0)
|
HUMAN liver function test
|
*
|
1(5.9)
|
13(52.0)
|
Blood grouping anti sera
|
24(42.8)
|
12(70.6)
|
16(64.0)
|
Blood collection sets
|
*
|
0(0.0)
|
7(28.0)
|
Blood giving sets
|
*
|
5(29.4)
|
20(80.0)
|
Anti-microbial sensitivity disc kit
|
*
|
*
|
5(20.0)
|
* Supplies not in test menus for that level of health facility