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Utilisation of laboratory services by health workers in a district hospital in Malawi

Mepham, S. O., Squire, Bertie ORCID:, Chisuwo, L., Kandulu, J. and Bates, Imelda ORCID: (2009) 'Utilisation of laboratory services by health workers in a district hospital in Malawi'. Journal of Clinical Pathology, Vol 62, Issue 10, pp. 935-938.


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Aims: To identify priorities for improving effective use of laboratory services in a district hospital in Malawi. Methods: A prospective observational study of clinician-patient interactions to analyse laboratory test requesting practices and utilisation of laboratory results. The proportion of tests that was appropriately ordered, processed and ultimately influenced clinical management was used to assess effectiveness of utilisation. Results: 420 clinical consultations between health professionals and patients were observed. 92% of tests were ordered appropriately, 84% were processed by the laboratory and 64% of results influenced patient management. 73-79% of high-volume tests (haemoglobin, microscopy for malaria and tuberculosis) and 32% of low-volume tests influenced management. Conclusions: 25% of commonly requested laboratory tests were not utilised effectively; because of the high volume, interventions to improve their use are likely to be cost effective. Although 68% of low-volume tests were not used efficiently, the cost of providing support for these tests in a resource-poor setting needs to be balanced against their clinical usefulness. In contrast to published information, this study shows significant underrequesting of laboratory tests that were available. Measures to increase appropriate test requests will have implications for clinician education as well as laboratory space, budgets and staffing levels.

Item Type: Article
Additional Information: Export Date: 24 November 2009 Source: Scopus CODEN: JCPAA doi: 10.1136/jcp.2009.069062 Language of Original Document: English Correspondence Address: Bates, I.; Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, United Kingdom; email:
Uncontrolled Keywords: Diagnosis Laboratory Testing Microscopy Malawi
Subjects: QZ Pathology > QZ 4 General works
W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 84 Health services. Delivery of health care
QY Clinical Pathology > QY 4 General works
WB Practice of Medicine > Medical Climatology > WB 710 Diseases of geographic areas
WB Practice of Medicine > Diagnosis > General Diagnosis > WB 141 General works
QY Clinical Pathology > Diagnostic Tests > QY 250 Immunodiagnostic tests
Faculty: Department: Groups (2002 - 2012) > Clinical Group
Groups (2002 - 2012) > Disease Control Strategy Group
Digital Object Identifer (DOI):
Depositing User: Helen Rigby
Date Deposited: 17 Mar 2010 18:09
Last Modified: 13 Nov 2019 11:20


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