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