Laboratory use in Ghana: physician perception and practice.

Area of Science:

• Medical Microbiology
• Infectious Diseases
• Health Services Research

Background:

• Clinical diagnosis of infectious diseases in Africa often results in misdiagnosis and mortality.
• Laboratory testing is available but underutilized in many African healthcare settings.
• Empirical therapy and clinical judgment are frequently prioritized over diagnostic testing.

Purpose of the Study:

• To evaluate barriers to laboratory use in infectious disease diagnosis.
• To assess the financial impact of diagnostic practices on patients.
• To compare clinical diagnoses with laboratory findings and antimicrobial use.

Main Methods:

• Retrospective analysis of infectious diagnoses and laboratory test results.
• Physician surveys to assess perceptions and practices regarding diagnostic testing.
• Analysis of antimicrobial consumption and patient costs for laboratory tests versus antibiotics.
• Study conducted at a teaching hospital in Ghana.

Main Results:

• Laboratory capacity was found to be high.
• Physician reliance on clinical judgment and empirical therapy was evident.
• Laboratory results supported only 9-15% of malaria diagnoses, 34-43% of UTIs, and 62% of meningitis cases.
• Antibiotic consumption was high (0.82-2.09 units/patient day).
• Patient costs for antibiotics were 4.8-21.6 times higher than for laboratory testing.

Conclusions:

• Physician perception of diagnostic testing value is a significant barrier to its use.
• Underutilization of laboratory diagnostics contributes to empirical treatment and excessive antimicrobial administration.
• Current practices lead to increased patient financial burden due to high antibiotic costs.