Background

Pathology and laboratory medicine diagnostics and diagnostic imaging are crucial to achieving universal health coverage. We analysed Service Provision Assessments (SPAs) from ten low-income and middle-income countries to benchmark diagnostic availability.

Methods

Diagnostic availabilities were determined for Bangladesh, Haiti, Malawi, Namibia, Nepal, Kenya, Rwanda, Senegal, Tanzania, and Uganda, with multiple timepoints for Haiti, Kenya, Senegal, and Tanzania. A smaller set of diagnostics were included in the analysis for primary care facilities compared with those expected at hospitals, with 16 evaluated in total. Surveys spanned 2004–18, including 8512 surveyed facilities. Country-specific facility types were mapped to basic primary care, advanced primary care, or hospital tiers. We calculated percentages of facilities offering each diagnostic, accounting for facility weights, stratifying by tier, and for some analyses, region. The tier-level estimate of diagnostic availability was defined as the median of all diagnostic-specific availabilities at each tier, and country-level estimates were the median of all diagnostic-specific availabilities of each of the tiers. Associations of country-level diagnostic availability with country income as well as (within-country) region-level availability with region-specific population densities were determined by multivariable linear regression, controlling for appropriate covariates including tier.

Findings

Median availability of diagnostics was 19·1% in basic primary care facilities, 49·2% in advanced primary care facilities, and 68·4% in hospitals. Availability varied considerably between diagnostics, ranging from 1·2% (ultrasound) to 76·7% (malaria) in primary care (basic and advanced) and from 6·1% (CT scan) to 91·6% (malaria) in hospitals. Availability also varied between countries, from 14·9% (Bangladesh) to 89·6% (Namibia). Availability correlated positively with log(income) at both primary care tiers but not the hospital tier, and positively with region-specific population density at the basic primary care tier only.

Interpretation

Major gaps in diagnostic availability exist in many low-income and middle-income countries, particularly in primary care facilities. These results can serve as a benchmark to gauge progress towards implementing guidelines such as the WHO Essential Diagnostics List and Priority Medical Devices initiatives.

Funding

Bill & Melinda Gates Foundation.

中文翻译：

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十个低收入和中等收入国家基本诊断的可用性：来自国家卫生机构调查的结果

背景

病理学和实验室医学诊断以及诊断成像对于实现全民健康覆盖至关重要。我们分析了来自 10 个低收入和中等收入国家的服务提供评估 (SPA)，以对诊断可用性进行基准测试。

方法

确定了孟加拉国、海地、马拉维、纳米比亚、尼泊尔、肯尼亚、卢旺达、塞内加尔、坦桑尼亚和乌干达的诊断可用性，海地、肯尼亚、塞内加尔和坦桑尼亚有多个时间点。与医院预期的诊断相比，初级保健机构的分析中包括了较少的诊断，总共评估了 16 项。调查跨越 2004-18 年，包括 8512 个被调查的设施。特定国家的设施类型被映射到基本初级保健、高级初级保健或医院等级。我们计算了提供每种诊断的设施的百分比，考虑了设施权重，按层分层，在某些分析中，还包括区域。诊断可用性的层级估计定义为每一层所有诊断特定可用性的中位数，国家层面的估计是每个层级所有诊断特定可用性的中位数。国家级诊断可用性与国家收入以及（国内）区域级可用性与区域特定人口密度的关联由多变量线性回归确定，控制了适当的协变量，包括层级。

发现

在基本初级保健机构中，诊断的中位数为 19·1%，在高级初级保健机构中为 49·2%，在医院中为 68·4%。诊断之间的可用性差异很大，初级保健（基础和高级）从 1·2%（超声）到 76·7%（疟疾），在初级保健（基础和高级）中从 6·1%（CT 扫描）到 91·6%（疟疾）不等。医院。不同国家的可用性也不同，从 14·9%（孟加拉国）到 89·6%（纳米比亚）。可用性与两个初级保健层的对数（收入）呈正相关，但与医院层无关，并且仅与基本初级保健层的区域特定人口密度呈正相关。

解释

许多低收入和中等收入国家在诊断可用性方面存在重大差距，特别是在初级保健机构中。这些结果可作为衡量指南实施进展的基准，例如世卫组织基本诊断清单和优先医疗器械计划。

资金

比尔和梅琳达盖茨基金会。