New health threat as clinicial labs proliferate

The number of medical laboratories is fast catching up with patent medicine stores that can be found everywhere. With increasing demands for clinical diagnosis fuelling the set-up of laboratories, Nigerians are threatened by the level of quackery that has infiltrated the medical laboratory profession, writes ALEXANDER CHIEJINA.

Globally, modern healthcare services rely on accurate laboratory results. While over 75 percent of the indices used in patient management and care emanate from laboratory services, this figure has moved to over 90 percent in developed countries.

However, most indices required by the doctor to attend to patients emanate from medical laboratory results. Where poor laboratory services persist, efficient healthcare delivery system is threatened.

The importance of timeliness, accurate testing and advanced technology in diagnosis of diseases cannot be overemphasised as a tool to saving lives in the health sector. While several patients in Nigeria have faced various complications as a result of inaccurate laboratory testing, some patients have either died or sustained debilitating injuries due to misdiagnosis.

The ordeal of Stella Emmanuel, a young Nigerian woman who experienced the unfortunate incident of misdiagnosis can be said to be an example of how timely and accurate testing can save one’s life from such an ugly situation. Some other Nigerians like her are not as fortunate to live to tell their story.

Sharing her experience with BusinessDay, Stella disclosed that if she had been diagnosed earlier, she woouldn’t have had to undergo any kidney transplant.

According to Stella, “If you live within Nigeria, you will always have strains of malaria in your bloodstream. When I started showing signs of malaria, I was tested and treatment for malaria. After the usual course of treatment, I did not get any better. I was asked to do more testing.” After the second level of testing, which showed that she had typhoid fever, she became worried.

“I found that very strange,” she continued, “because I thought the source of typhoid fever is from the food and water you are getting. I am very particular about where and how I eat. At this point, I started asking myself: what is exactly going on? To cut the long story short, the doctors came to me again, and said: ‘From the result of the test we have done now, it looks like your kidneys are failing.’”

She continued: “I was thinking and asking myself: what point could this have been discovered? Probably that should have been stopped. Eventually, it was true that my kidneys were failing. So, I travelled abroad. And there it was confirmed that both kidneys had actually failed and I had to be on long time kidney dialysis just to stay alive.

“While on dialysis, testing is key and fundamental to success of the dialysis. One needs to know if there is an allergic reaction which underscores the fact that timing and accurate testing is pertinent.”

In today’s Nigeria, it has become a common feature to see physicians telling patients having sensations of fever and headache that they have been diagnosed of malaria and/typhoid fever without laboratory tests been conducted. More often than not, this has led to inaccurate or incomplete diagnosis and consequently, the treatment of a wrong disease, infection or other ailment.

In an interview with BusinessDay, Kehinde Aluko, managing director, Clina-Lancet Laboratories, Nigeria; Aluko said that prompt diagnosis with accurate laboratory test before treatment would eliminate misdiagnosis and improve life expectancy.

With the consequences of wrong diagnosis leading to untimely death of patients, Aluko explained that quality control measures must be put in place in laboratories to ensure that each test is conducted according to set standards.

The managing director described quality assurance as overall programme that ensures that the final results reported by the laboratory are accurate. She noted that the aim of medical tests is to improve the efficacy of diagnostic medicine, compliments the technology deficiency in the tertiary hospitals, avail doctors the opportunity to practice evidence-based medicine (EBM) and bridge the gap between Nigeria and other countries in the area of clinical diagnosis.

“Unfortunately, several laboratories in Nigeria cannot boast of internal quality control which has become the bane of accurate laboratory results. Most laboratories have inadequately trained personnel, poor reagent equipment among others and this has made laboratory results from the country unacceptable abroad.

“For us in Clina-Lancet Laboratories Nigeria with operations in South Africa and 14 other African countries, quality of testing, efficient quality control and quality assurance are what we strive for in order to assist in delivering the best patient care.

“While we offer series of specialised and advanced testing for clinical analysis, staff at Clina-Lancet Laboratories Nigeria undergo periodic training and retraining on pathology and medical lab practice outside Nigeria in order to keep abreast of evolving trends in global clinical space.

“What you see is that lab practice in one part of the country is not the same with another laboratory practice elsewhere, leading to a variance in the outcome of lab results. There is need to put in place standard operating procedure that every lab in the country must follow. There should be regular audits to ensure that standards are maintained and quality control and quality assurance met,” Aluko pointed out.

Critical bottlenecks

The number of medical laboratories is fast catching up with patent medicine stores that can be found everywhere in Nigeria. The increasing demands for sample tests by people seeking answers to ailments have fuelled the increase in laboratories. These clinical laboratories are dotted in attractive diagnostic varieties.

While some labs claim that they have the capacity to test all samples as may be requested by any health facility, some are well branded to offer quality care and others made to suit the environment they are located in.

Laboratories can be set up in any space available like kiosks, shops, room apartment, hospitals or any place as long as there is a roof. With a handful of equipment and reagents, medical laboratory business can hit the ground running. Desperate people seeking solution to health issues are never out of sight.

Anthony Emeribe, registrar, Medical Laboratory Science Council of Nigeria (MLSCN), lamented that a number of laboratories in the country are manned by people who do not have any knowledge of laboratory science.

Emeribe expressed the need to get rid of quackery in the healthcare system as they are not helping the healthcare practitioners due to the poor quality results they issue.

According to Emeribe, “We have levels of practice — the laboratory scientist, the technician and the assistant; but the point is that in most of the health facilities we have, particularly at the state and local government levels, people who are not trained and licensed to perform laboratory services are saddled with these responsibilities. With the advocacy we are now mounting, the healthcare institutions are trying to put square pegs in square holes in giving effective health care delivery.

“Some laboratories even issue results without conducting any test. Some issue results without having the right equipment and reagents because they don’t have the know-how, whereas we have people on the ground that can do the work.

Idris Durojaiye, medical director and consultant pathologist at ClinaLancet Laboratories, identified the dearth in quality control of clinical laboratory practice, difficulty in accessing test centres, inadequate power supply and lack of synergy between labs as factors bedevilling medical lab practice in the country.

Way forward

Durojaiye stated that since laboratory tests are fundamental for accurate diagnosis and treatment of ailments and management of patients, urgent approaches needs to be adopted in addressing misdiagnosis and quackery in view of the hazardous effects they have on the health of Nigerians.

“To ensure reliability of laboratory results, there is need to institutionalise internal and external quality assurance programmes. 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. Furthermore, there is the need to invest in upgrading laboratories to meet world standard,” Durojaiye explained.

There are concerns over the absence of clear policies and guidelines on the management and leadership of facilities, lack of internationally adopted standards that encompass all professionals and lack of accreditation and monitoring system amongst others that have continued to plague the system.

BusinessDay investigation shows that with over 10,000 medical labs in the country, only 3,000 medical labs are registered with MLSCN national database.