title: The operation, quality and costs of a district hospital laboratory service in Malawi.
abstract: Laboratory services are run down in many low-income countries, severely constraining their input to patient care and disease surveillance. There are few data about the quality and cost of individual components of the laboratory service in poorer countries, yet this information is essential if optimal use is to be made of scarce resources. Staff time, range of tests, workload, and safety procedures were monitored over 12 months (1997-98) in a typical district hospital laboratory in Malawi. Data were collected to calculate the total economic cost of these services. Of the 31203 tests performed, 84% were to support blood transfusion and diagnosis of malaria and tuberculosis (TB). Test quality was reasonable for malaria and TB microscopy and blood transfusion, but poor for haemoglobin estimation. The cost per test ranged from US dollars 0.35 for haemoglobin to US dollars 11.7 per unit of blood issued and the total annual cost of the laboratory service was US dollars 32618. Blood transfusion and microscopy for malaria and TB comprised the majority of tests. Ensuring that these tests are of the highest quality will therefore have the most impact in reducing wastage of laboratory resources. Inadequate quality of haemoglobin estimations is a particular problem. The findings of this study are likely to be relevant to other low-income countries with similar disease burdens.
authors.affiliation: The Malawi Essential Medical Laboratory Services Project at Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: C J F
authors.initials: CJ
authors.lastname: Mundy
authors.forename: I
authors.initials: I
authors.lastname: Bates
authors.forename: W
authors.initials: W
authors.lastname: Nkhoma
authors.forename: K
authors.initials: K
authors.lastname: Floyd
authors.forename: G
authors.initials: G
authors.lastname: Kadewele
authors.forename: M
authors.initials: M
authors.lastname: Ngwira
authors.forename: A
authors.initials: A
authors.lastname: Khuwi
authors.forename: S B
authors.initials: SB
authors.lastname: Squire
authors.forename: C F
authors.initials: CF
authors.lastname: Gilks
mesh_terms: D006302:Health Services Research; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006767:Hospitals, District / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D007755:Laboratories, Hospital / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D008288:Malaria / Q000175:diagnosis; D008295:Malawi; D011787:Quality of Health Care; D014376:Tuberculosis / Q000175:diagnosis; D016526:Workload