title: Assessing Perceived Challenges to Laboratory Testing at a Malawian Referral Hospital.
abstract: Adequate laboratory infrastructure in sub-Saharan Africa is vital for tackling the burden of infectious diseases such as human immunodeficiency virus and acquired immune deficiency syndrome, malaria, and tuberculosis, yet laboratories are ill-integrated into the diagnostic and care delivery process in low-resource settings. Although much of the literature focuses on disease-specific challenges around laboratory testing, we sought to identify horizontal challenges to the laboratory testing process through interviews with clinicians involved in the diagnostic process. Based on 22 interviews with physicians, nurses, clinical officers, medical students, and laboratory technicians, technologists and supervisors, we identified 12 distinct challenges in the areas of staff, materials, workflow, and the blood bank. These challenges underscore the informational challenges that compound more visible resource shortages in the laboratory testing process, which lend themselves to horizontal strengthening efforts around the diagnostic process.
authors.affiliation: Center for Health Informatics for the Underserved, Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania; Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania; School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi; Baobab Health Trust, Lilongwe, Malawi; Department of Laboratory Testing, Kamuzu Central Hospital, Lilongwe, Malawi; Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Lia G
authors.initials: LG
authors.lastname: Petrose
authors.affiliation: Center for Health Informatics for the Underserved, Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania; Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania; School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi; Baobab Health Trust, Lilongwe, Malawi; Department of Laboratory Testing, Kamuzu Central Hospital, Lilongwe, Malawi; Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Arielle M
authors.initials: AM
authors.lastname: Fisher
authors.affiliation: Center for Health Informatics for the Underserved, Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania; Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania; School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi; Baobab Health Trust, Lilongwe, Malawi; Department of Laboratory Testing, Kamuzu Central Hospital, Lilongwe, Malawi; Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Gerald P
authors.initials: GP
authors.lastname: Douglas
authors.affiliation: Center for Health Informatics for the Underserved, Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania; Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania; School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi; Baobab Health Trust, Lilongwe, Malawi; Department of Laboratory Testing, Kamuzu Central Hospital, Lilongwe, Malawi; Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Martha A
authors.initials: MA
authors.lastname: Terry
authors.affiliation: Center for Health Informatics for the Underserved, Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania; Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania; School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi; Baobab Health Trust, Lilongwe, Malawi; Department of Laboratory Testing, Kamuzu Central Hospital, Lilongwe, Malawi; Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Adamson
authors.initials: A
authors.lastname: Muula
authors.affiliation: Center for Health Informatics for the Underserved, Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania; Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania; School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi; Baobab Health Trust, Lilongwe, Malawi; Department of Laboratory Testing, Kamuzu Central Hospital, Lilongwe, Malawi; Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Marlen S
authors.initials: MS
authors.lastname: Chawani
authors.affiliation: Center for Health Informatics for the Underserved, Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania; Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania; School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi; Baobab Health Trust, Lilongwe, Malawi; Department of Laboratory Testing, Kamuzu Central Hospital, Lilongwe, Malawi; Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Henry
authors.initials: H
authors.lastname: Limula
authors.affiliation: Center for Health Informatics for the Underserved, Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania; Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania; School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi; Baobab Health Trust, Lilongwe, Malawi; Department of Laboratory Testing, Kamuzu Central Hospital, Lilongwe, Malawi; Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, Pennsylvania driessen@pitt.edu.
authors.forename: Julia
authors.initials: J
authors.lastname: Driessen
mesh_terms: D001771:Blood Banks; D004469:Economics, Hospital; D006739:Hospital Administration; D006761:Hospitals; D006801:Humans; D007407:Interviews as Topic; D007753:Laboratories / Q000191:economics / Q000592:standards*; D008295:Malawi; D016017:Odds Ratio; D000078329:Workforce