Experts call for regional policy consideration on Tuberculosis laboratory diagnosis, treatment of Malaria and Antibiotics use
East African countries are likely to adopt changes in Tuberculosis laboratory diagnosis and treatment of Malaria and Antibiotics use for diarrhea diseases following findings of a four year regional research project in the three diseases.
The findings presented at the 10th East Africa Public Health Laboratory Networking Project (EAPHLNP) Regional Project Steering Committee and Joint Stakeholders meeting at Arusha, Tanzania on June 23rd, 2017 makes key recommendations with significant policy implications in public health care for the five regional countries of Burundi, Rwanda, Uganda, Kenya and hosts, Tanzania. For instance, on TB laboratory diagnosis, the study presented by the Operational Research arm of EAPHLNP lead by Dr. Willie Githui from the Kenya Medical Research Institute (KEMRI) calls for complimentary use of GeneXpert (Xpert MTB/RIF) and Microscopy.
Dr. Githui is the regional chairperson of the Operational Research (OR) team and Principal Investigator (PI) for the TB study. “While regional countries are adopting the use of the GeneXpert as the ideal tool of TB detection due to significantly higher sensitivity than microscopy and incremental benefit in smear negative specimens, the LED-FM microscopy has a significantly higher specificity than GeneXpert,” said Dr. Githui, during the presentation of result findings at Gold Crest Hotel in Arusha.
She further indicated that despite the lower sensitivity than GeneXpert, LED-FM microscopy has better likelihood of detecting culture positive which is a confirmation method to TB disease. The researchers therefore recommends that the LED-FM microscopy should complement the GeneXpert technology especially in regions with inadequate capacity including infrastructure, human resource and high workload in order to improve quality of TB diagnostic service.
On malaria, based on country and regional results on current WHO-recommended first-line treatment, it was established that there is reduced efficacy of the Artemisinin-based combination therapy (ACT), however, this reduction was not significantly different between the ArtemetherLumefantrine (AL) and Dihydroartemisinin (DP).
The study therefore recommends that DP which is a second line drug due to previous efficiency above the expected WHO recommended levels, should be adopted as a first line drug. However, of concern to researchers on the malaria picture is the need for establishing strong monitoring systems for efficacy and resistance of ACTs in all countries.
In the area of Enterics which mainly examined bacterial-caused diarrhea that are commonly treated by antibiotics, the study that mainly sampled Kenya presents a worrisome picture of widespread antimicrobial resistance in pathogenic E.coli, Shigellaspp and Salmonellaspp.
Dr. Githui and the research team therefore recommend the strengthening the laboratory capabilities in detection of bacterial pathogens and drugs antibiotic susceptibility testing at the national level. “This will enable the establishment of acceptable threshold for antibiotic resistance in Kenya to inform policy on use of antibiotics according to WHO standards,” the study concludes.
The researchers therefore recommend the establishing national and surveillance monitoring system against commonly circulating and emerging enteric pathogens and antimicrobial resistance.