Abstract
The good quality laboratory services in developing countries are often limited to major urban centers. As a result, many commercially available high-quality diagnostic tests for infectious diseases are neither accessible nor affordable to patients in the rural areas. Health facilities in rural areas are compromised and this limits the usability and performance of the best medical diagnostic technologies in rural areas as they are designed for air-conditioned laboratories, refrigerated storage of chemicals, a constant supply of calibrators and reagents, stable electrical power, highly trained personnel and rapid transportation of samples. The advent of new technologies have allowed miniaturization and integration of complex functions, which has made it possible for sophisticated diagnostic tools to move out of the developed-world laboratory in the form of a “point of care”(POC) tests. Many diagnostic tests are being developed using these platforms. However, the challenge is to develop diagnostics which are inexpensive, rugged and well suited to the medical and social contexts of the developing world and do not compromise on accuracy and reliability. The already available POC tests which are reliable and affordable, like for HIV infection, malaria, syphilis, and some neglected tropical diseases, and POC tests being developed for other diseases if correctly used and effectively regulated after rigorous evaluation, have the potential to make a difference in clinical management and improve surveillance. In order to use these tests effectively they would need to be supported by technically competent manpower, availability of good-quality reagents, and healthcare providers who value and are able to interpret laboratory results to guide treatment; and a system for timely communication between the laboratory and the healthcare provider. Strengthening the laboratories at the rural level can enable utilization of these diagnostics for improving the diagnosis and management of infectious diseases among children which require prompt treatment and thus, considerably reduce morbidity and mortality among the pediatric age group.
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References
Bryce J, Boschi-Pinto C, Shibuya K, Black RE. WHO estimates of the causes of death in children. Lancet. 2005;365:1147–52.
Epsicom Business Intelligence. The Global Market for Point of Care Diagnostics: Major Players and Key Issues, Vol 1. Publication No. ISBN: 978 1 85822 306 3. Epsicom Business Intelligence, 2007.
Peeling RW, Mabey D. Point of care tests for diagnosing infections in developing world. Clin Microbiol Infect. 2010;16:1062–9.
Sample Registration System (SRS) Office of Registrar General, India 7th July 2011.
Morris SK, Bassani DG, Awasthi S, et al. Diarrhea, pneumonia, and infectious disease mortality in children aged 5 to 14 years in India. PLoS One. 2011;6:e20119.
Jordan JA, Durso MB. Comparison of 16S rRNA gene PCR and BACTEC 9240 for detection of neonatal bacteremia. J Clin Microbiol. 2000;38:2574–8.
Menon PK. Polymerase chain reaction in rapid diagnosis of neonatal sepsis. Indian Pediatr. 2005;42:681–5.
Laforgia N, Coppola B, Carbone R, Grassi A, Mautone A, Iolascon A. Rapid detection of neonatal sepsis using polymerase chain reaction. Acta Paediatr. 1997;86:1097–9.
Shang S, Chen G, Wu Y, Du L, Zhao Z. Rapid diagnosis of bacterial sepsis with PCR amplification and microarray hybridization in 16S rRNA gene. Pediatr Res. 2005;58:143–8.
Jordan JA, Jones-Laughner J, Durso MB. Utility of pyrosequencing in identifying bacteria directly from positive blood culture bottles. J Clin Microbiol. 2009;47:368–72.
Jordan JA, Durso MB, Butchko AR, Jones JG, Brozanski BS. Evaluating the near-term infant for early onset sepsis: Progress and challenges to consider with 16S rDNA polymerase chain reaction testing. J Mol Diagn. 2006;8:357–63.
Das NG, Baruah I, Kamal S, Sarkar PK, Das SC, Santhanam K. An epidemiological and entomological investigation on malaria outbreak at Tamulpur PHC, Assam. Indian J Malariol. 1997;34:164–70.
Prakash A, Mohapatra PK, Bhattacharyya DR, Doloi P, Mahanta J. Changing malaria endemicity–a village based study in Sonitpur, Assam. J Com Dis. 1997;29:175–8.
Dutta P, Khan AM, Mahanta J. Problem of malaria in relation to socio-cultural diversity in some ethnic communities of Assam and Arunachal Pradesh. J Parasitic Dis. 1999;23:101–4.
Shukla RP, Pandey AC, Mathur A. Investigations of malaria outbreak in Rajasthan. Indian J Malariol. 1995;32:119–28.
Murray CK, Gasser RA Jr, Magill AJ, Miller RS. Update on rapid diagnostic testing for malaria. Clin Microbiol Rev. 2008;21:97–110.
Marx A, Pewsner D, Egger M, et al. Meta-analysis: Accuracy of rapid tests for malaria in travelers returning from endemic areas. Ann Intern Med. 2005;142:836–46.
Stauffer WM, Cartwright CP, Olson DA. Diagnostic performance of rapid diagnostic tests versus blood smears for malaria in US clinical practice. Clin Infect Dis. 2009;49:908–13.
Wiseman V, Kim M, Mutabingwa TK, Whitty CJM. Cost-effectiveness study of three antimalarial drug combinations in Tanzania. PLoS Med. 2006;3:e373.
Rafael ME, Taylor T, Magill A, Lim YW, Girosi F, Allan R. Reducing the burden of childhood malaria in Africa: The role of improved diagnostics. Nature. 2006;444:39–48.
Black RE, Cousens S, Johnson HL, et al; Global, regional, and national causes of child mortality in 2008: A systematic analysis. Lancet. 2010;375:1969–87.
World Health Organization. Guidelines on the Integrated Management of Childhood Illness. Geneva: WHO; 2004.
Cutts FT, Zaman SM, Enwere G, et al; Gambian Pneumococcal Vaccine Trial Group. Efficacy of nine-valent pneumococcal conjugate vaccine against pneumonia and invasive pneumococcal disease in The Gambia: Randomised, double-blind, placebo-controlled trial. Lancet. 2005;365:1139–46.
Lee WM, Grindle K, Pappas T, et al. High-throughput, sensitive, and accurate multiplex PCR-microsphere flow cytometry system for large-scale comprehensive detection of respiratory viruses. J Clin Microbiol. 2007;45:2626–34.
Caliendo AM. Multiplex PCR, and emerging technologies for the detection of respiratory pathogens. Clin Infect Dis. 2011;52:S326–30.
Coiras MT, Aguilar JC, Garcia ML, Casas I, Perez-Brena P. Simultaneous detection of fourteen respiratory viruses in clinical specimens by two multiplex reverse transcription nested-PCR assays. J Med Virol. 2004;72:484–95.
Syrmis MW, Whiley DM, Thomas M, et al. A sensitive, specific, and cost-effective multiplex reverse transcriptase-PCR assay for the detection of seven common respiratory viruses in respiratory samples. J Mol Diagn. 2004;6:125–31.
Mahony J, Chong S, Merante F, et al. Development of a respiratory virus panel test for detection of twenty human respiratory viruses by use of multiplex PCR and a fluid microbead-based assay. J Clin Microbiol. 2007;45:2965–70.
Murdoch DR, Laing RT, Mills GD, et al. Evaluation of a rapid immunochromatographic test for detection of Streptococcus pneumoniae antigen in urine samples from adults with community-acquired pneumonia. J Clin Microbiol. 2001;39:3495–8.
Leeming JP, Cartwright K, Morris R, Martin SA, Smith MD; South-West Pneumococcus Study Group. Diagnosis of invasive pneumococcal infection by serotype-specific urinary antigen detection. J Clin Microbiol. 2005;43:4972–6.
van der Meer V, Neven AK, van den Broek PJ, Assendelft WJ. Diagnostic value of C reactive protein in infections of the lower respiratory tract: Systematic review. BMJ. 2005;331:26.
Scott JA, Brooks WA, Peiris JS, Holtzman D, Mulholland EK. Pneumonia research to reduce childhood mortality in the developing world. J Clin Invest. 2008;118:1291–300.
National Commission on Macroeconomics and Health (NCMH). Disease burden in India: Estimations and causal analysis. National Commission on Macroeconomics and Health.
Cruz AT, Starke JR. Clinical manifestations of tuberculosis in children. Pediatr Respir Rev. 2007;8:107–17.
Eamranond P, Jaramillo E. Tuberculosis in children: Reassessing the need for improved diagnosis in global control strategies. Int J Tuberc Lung Dis. 2001;5:594–603.
Swaminathan S, Datta M, Radhamani MP, et al. A profile of bacteriologically confirmed pulmonary tuberculosis in children. Indian Pediatr. 2008;45:743–7.
Marais BJ, Pai M. Recent advances in the diagnosis of childhood tuberculosis. Arch Dis Child. 2007;92:446–52.
Marais BJ, Pai M. New approaches and emerging technologies in the diagnosis of childhood tuberculosis. Paediatr Respir Rev. 2007;8:124–33.
Guillerm M, Usdin M, Arkinstall J. Tuberculosis diagnosis and drug sensitivity testing: An overview of the current diagnostic pipeline. Geneva: Me’decins Sans Frontie’res, 2006. http://www.accessmedmsf.org/documents/Diagnostics%20Pipeline%20Report.pdf. Accessed on June 2009.
Lalvani A, Millington KA. T cell-based diagnosis of childhood tuberculosis infection. Curr Opin Infect Dis. 2007;20:264–71.
Bianchi L, Galli L, Moriondo M, et al. Interferon-gamma release assay improves the diagnosis of tuberculosis in children. Pediatr Infect Dis J. 2009;28:510–4.
Minion J, Leung E, Talbot E, Dheda K, Pai M, Menzies D. Diagnosing tuberculosis with urine lipoarabinomannan: Systematic review and meta-analysis. Eur Respir J. 2011; published online June 23. doi:10.1183/09031936.00025711.
Sivagnanam G, Thirumalaikolundusubramanian P, Mohanasundaram J, Raaj AA, Namasivayam K, Rajaram S. A survey on current attitude of practicing physicians upon usage of antimicrobial agents in southern part of India. Med Gen Med. 2004;6:1.
Linder JA, Bates DW, Lee GM, Finkelstein JA. Antibiotic treatment of children with sore throat. JAMA. 2005;294:2315–22.
Dellinger RP, Levy MM, Carlet JM, et al. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and shock. Crit Care Med. 2008;36:296–327.
Smolina I, Miller NS, Frank-Kamenetskii MD. PNA-based microbial pathogen identification and resistance marker detection: An accurate, isothermal rapid assay based on genome-specific features. Artif DNA PNA XNA. 2010;1:76–82.
Panizzi P, Nahrendorf M, Figueiredo JL, et al. In vivo detection of Staphylococcus aureus endocarditis by targeting pathogen-specific prothrombin activation. Nat Med. 2011;17:1142–6.
Petti CA, Polage CR, Quinn TC, Ronald AR, Sande MA. Laboratory medicine in Africa: A barrier to effective health care. Clin Infect Dis. 2006;42:377–82.
Ministry of Health and Family Welfare, Government of India. NRHM: Meeting people’s health needs in partnership with states, the journey so far, 2005-10. New Delhi: MoHFW, GOI; 2010.
World Health Organization. Regulation of in vitro diagnostics: A global perspective. Diagnostics for Tuberculosis: Global Demand and Market Potential. Geneva: TDR/FIND SA; 2006. pp. 194–203.
Peeling RW, Smith PG, Bossuyt PM. A guide for diagnostic evaluations. Nat Rev Microbiol. 2006;4:S2–6.
Reyburn H, Mbakilwa H, Mwangi R, et al. Rapid diagnostic tests compared with malaria microscopy for guiding outpatient treatment of febrile illness in Tanzania: Randomised trial. BMJ. 2007;334:403.
Bell D, Wongsrichanalai C, Barnwell JW. Ensuring quality and access for malaria diagnosis: How can it be achieved? Nat Rev Microbiol. 2006;4:S7–20.
Jan Swasthya Sahayog. Impressions from a rural laboratory. MFC Bull. 2006;316, 317:1–4.
Mabey D, Peeling RW, Ustianowski A, Perkins M. Diagnostics for the developing world. Nat Rev Microbiol. 2004;2:231–40.
World Health Organization. Guidelines for the Treatment of Malaria. Geneva: WHO; 2006.
Determining Cost Effectiveness of Malaria Rapid Diagnostic Tests in Rural Areas with High Prevalence. www.wpro.who.int/sites/rdt
Global Health Innovation Quotient Prize: Point of Care Diagnostics for Differential Diagnosis of Fever in Children, BIO Ventures for Global Health 2011. www.bvgh.org
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Walia, K. Point of Care Investigations in Pediatric Care to Improve Health Care in Rural Areas. Indian J Pediatr 80, 576–584 (2013). https://doi.org/10.1007/s12098-013-1016-9
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DOI: https://doi.org/10.1007/s12098-013-1016-9