Utilisation of laboratory services by health workers in a district hospital in Malawi.
OBJECTIVE
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 under-requesting 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.
Africa Centre for Health and Population Studies, University of KwaZulu Natal, Durban, South Africa.
S O
SO
Mepham
S Bertel
SB
Squire
L
L
Chisuwo
J
J
Kandulu
I
I
Bates
D003906:Developing Countries; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data; D006767:Hospitals, District / Q000706:statistics & numerical data*; D006801:Humans; D007755:Laboratories, Hospital / Q000706:statistics & numerical data*; D008288:Malaria / Q000175:diagnosis; D008295:Malawi; D011364:Professional Practice / Q000706:statistics & numerical data; D011446:Prospective Studies; D014376:Tuberculosis / Q000175:diagnosis