Clinical pathology laboratories operate with little effective regulatory oversight in West African nation
In Nigeria, patients are complaining about the problems caused by both misdiagnosis and faulty medical laboratory test results. There is also the problem that not all physicians and patients have access to a high quality clinical laboratory.
Nigeria’s news media is giving this situation wide play. Government officials have been forced to acknowledge the poor state of the country’s clinical laboratory testing services. In turn, this has led to great scrutiny of medical laboratory testing in Nigeria.
For the pathology and laboratory medicine profession in developed nations, these widely-publicized issues in Nigeria are consistent with the global trend of standardization in the operation and management of clinical laboratories. Within Nigeria, there is recognition that many misdiagnoses happen because physicians and patients frequently lack access to a reliable and high-quality clinical laboratory.
The negative publicity about these problems is a reminder to pathologists and clinical laboratory managers in developed countries that public trust in the quality of the lab test results can disappear overnight when the news media trumpet problems that contribute to unreliable clinical laboratories and poor quality medical laboratory test results.
New Stories about Problems In Quality of Medical Laboratory Testing
One recent example is a story reported by Business Day Online. It spotlighted the fact that misdiagnosis is commonplace in Nigeria’s healthcare system, often with dire consequences for patients. In the piece, Dr. Ibironke Akinsete, Chairman, PathCare Nigeria, acknowledged the consequences of wrong diagnosis, which have included untimely death of patients.
Pictured at left is Dr. Ibironke Akinsete who is Chairman of PathCare, the first clinical pathology laboratory in Nigeria to earn accreditation to the standards of ISO 15189. To her right is Professor F. A. Olatunji. (photo copyright by MedicinalPlantsinNigeria.com.)
“Unfortunately in Nigeria, 90% of [medical] laboratories cannot boast of internal quality control which has become the bane of accurate laboratory results in Nigeria,” stated Akinsete at a recent medical seminar. “Most laboratories in Nigeria have inadequate trained personnel, poor reagent equipment among others and this has made laboratory results from Nigeria unacceptable abroad.”
Akinete outlined necessary steps to improve this situation. “To improve the laboratory results, there is need to put in place standard operating procedures that everybody must follow,” he explained. “There should be regular audits to ensure that standards are maintained. Pathology supervision is also necessary. To put an end to patient doubts and medical tourism, there is need for laboratories to be accredited by recognised bodies to ensure that they meet minimum quality management standards.”
Akinete has credibility on these issues. Her laboratory organization, PathLab, claims to be the first medical laboratory in West Africa to earn accreditation to ISO-15189.
Similarly, the Vanguard published a story that bannered prompt and accurate lab tests as the panacea for misdiagnosis. It stated that misdiagnosis of life-threatening illnesses has become commonplace in Nigeria.
Vanguard reporter Chioma Obinna wrote: “Only an estimated 300 pathologists are serving 140 million people [in Nigeria]. This is a situation experts say could be a major risk when [pathologists are] overworked. Tired pathologists are more likely to make wrong diagnoses. Even when there are very good quality systems in place to try to prevent these mistakes, in such environments mistakes are much more likely.”
Vanguard also reported that, although clinical laboratories are proliferating across the country, the results produced by many medical laboratories are questionable. It cited obsolete medical laboratory equipment, untrained laboratory staff, and lack of regulation among the causes. But the worst deficiency, it claimed, is government failure to see clinical pathology laboratories as a priority.
Along similar lines, Next.com reported in a story that a virologist has urged Nigeria’s Federal Ministry of Health to establish a Department of Laboratories. “Laboratories should be an integral part of the ministry because of [the] relevance to health services delivery,” stated Alash’le Abimiku, Chief Technical Advisor, Clinical Laboratory Services, Institute of Human Virology (IHV), Nigeria.
She had additional recommendations on how to improve the quality of medical laboratories in her nation. “They should have a department that is focused on [medical] laboratory infrastructure in Nigeria, they should have very firm policies that must be adhered to,” declared Abimiku. “If anybody wants to put up a laboratory, there must be a licensing system where only individuals that are licensed can operate. But most importantly they must be monitored. The ministry must provide a structure within the national framework that steers towards a national reference laboratory.”
Dark Daily considers it notable that the media in Nigeria are willing to put the spotlight on the common problems of misdiagnoses and poor quality medical laboratory test results. It demonstrates how the expectations of consumers—even in developing countries—are pushing the bar of quality every higher.
Further, many pathologists and clinical laboratory managers, particularly in the United States, know about the strengthening bonds between high quality clinical laboratory organizations in certain Sub-Saharan nations and the laboratory medicine profession in North America and Europe. This is directly related to the efforts of PEPFAR and similar initiatives to build a high quality clinical laboratory service to support better disease detection and patient care, particular for HIV/AIDS. Dark Daily will cover details of this effort in an upcoming Dark Daily e-briefing.
—Pamela Scherer McLeod
Related Information:
Misdiagnosis, common feature in health institutions
Prompt and accurate lab tests panacea to misdiagnosis
Healthcare In Africa: New hospitals in Africa provide quality healthcare
African disease labs to get health check
Medical labs in Nigeria will soon be ranked by category, says EMERIBE
Institute of Human Virology, Nigeria (IHVn) Honors Dr. Alash’le Abimiku
Virologist Wants Ministry of Health to Establish Department of Laboratories
THE DARK REPORT: PEPFAR news from January 2009
While there may be few labs that do not produce good and reliable lab results, it is not always fair to generalize that all results produced by labs in Nigeria are bad.Many professionals that work in public and private hospital laboratories in Nigeria are well trained and qualified. We are not oblivious that some do employ staff who do not have any basic training in medical laboratory operation, thus the multiplicity of errors from such labs. It is a well know and evidenced based statement that many lab errors are always due to poor systems and not necessarily humans. How many labs in Nigeria private and public have quality systems in place?. How many are enrolled for EQA programs?. The Chief Executives who are often medical doctors most times see this as a huge cost and do not even encourage their hospital labs to enroll for such programs. This is very bad! How then does a lab assess her performance? To fill this gap, the efforts of the Medical Laboratory Science Council of Nigeria (MLSCN) in collaboration with African Society of Laboratory Medicine, (ASLM) Centre for Disease Control (CDC) and many other international agencies in strengthening the lab in Nigeria using the WHO/AFRO, Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) and Strengthening Laboratory Management Toward Accreditation (SLMTA) approach should be appreciated. This information is available on public domain and any person interested in knowing more can check for the authenticity of the information. The Council also introduced some form of in-country QA checks and results among registered labs have been encouraging. The challenge here is that there is no cooperation among operators in the system. Some people think that since they are not involved in the process, nothing should work and they do anything to discredit the efforts of others. Laboratory politics in Nigeria should be set aside and all hands should be on deck to collaborate with government agency saddled with the responsibility to improve the laboratory systems. It will benefit all, improve research and quality of health. Publication such as this should also be balanced with evidence based statements to avoid bias.
Hi,
Would like to thanks as….The above given piece of article is very informative.
I want know how much is the scope of improvising the quality Assurance in the existing lab as I have recently joined in Lagos.
I need more information on how to get the proficiency testing done in Lagos as there is only one ISO lab and the instruments and the methodology would be likely different.
I also want to know how to start with the External Quality control here……..
Awaiting your valuable reply…
Thanks!
Dr.Gurpreet Malik
i think people like nuh andrew yashim should go and read ascp handbook on professionals in the lab… and know that customarily a pathologist heads the lab…. it is rather unfortunate that in a counry like nigeria that medical technologists think of usurping the pathologist to the extent of being in denial of the role of the pathologist. this is pure delusion…. if nigeria’s healthcare and lab is to move forward then we should emulate what other countries like us.uk,canada, australia, germany are doing… empower the pathologists and set up an accreditation body…. note most of the problems in the lab are caused by the phds among the lab scientists and executed by their foot soldiers the medical technologists/lab scientists….
It is quite unfortunate for this publication in relation to misdiagnosis being reported within the medical laboratories in Nigeria. However, would want to include it is time we stop laying blames rather HOW can we make things better. Say for instance there are so many trained Nigerians in the medical laboratory profession outside the country that would rather remain abroad than to return to Nigeria and practice. At the moment I am undertaking my training portfolio to become registered biomedical scientist within the area of haematology and transfusion. I have experience good quality laboratory management. If we are to address the root cause is for us who are in the medical laboratory profession to come together and address the issues on ground. hopefully somehow changes could be done. Give you a scenario say we purchase a new analyser for complete blood counts it is mandatory that people are sent for training in order to have a feel of how the equipment/analyser operates (which is validation procedure) does the instrument/analyser gives the recommended results. As being said in the publication there should be a regulatory bodies to oversee all the laboratory procedures in the country in such doing we all(the laboratories)in the country will be producing the same result and for those not within the reference range set the regulatory bodies will have a set standard on dealing with it. Like in UK there is the Clinical Pathology Accreditation (CPA) they regulate all medical laboratories in the UK, assessing every aspect of the medical laboratory. I know it may like diving into the deep blue sea but I tell you, just the bible says ‘write the vision’ so doing we are working towards a plan. I beg if in any way this could be address I am ready to take part in this new vision so that patient (or other service users) could rely and trust our judgement when it comes to laboratory test results.
Thank youy
It is true that there are some few problems with some laboratory result from some few laboratory in nigeria but such laboratories are the ones pathologist clime to be supervising. The socalled pathcare laboratory which the climed to be the first pathologist acriditate do not produce any good result.all the result the poduce is below our standard in national hospital abuja, I mean what Iam saying without apology.
The only way the laboratory standard can be improve in nigeria is let the socalled pathologist go and manage there clinics and let the medical laboratory scientist manage the laboratories. Let us stop running away from the truth and do the right thing. That is the only way to resolve the problem. It is not posible for the pathology to take glory on what he do not know how the result was generated because he is not trainned as amedical laboratory scientist neigther did he have a practising license to practice as a medical laboratory scientist..The medical laboratory scientist is the only professional tha is licence to practice that,therefore must take the glory because he/she produce the result.