Development & Use of Modern Diagnostic Technology in Low & Mid-Income Settings

Samir K Saha of the Department of Microbiology, Dhaka Shishu Hospital in Dhaka, Bangladesh began by saying that Bangladesh is a country of 144 million people with an exceedingly low per capita income (Figure 2.1and 2.2). Although there is a major, sophisticated “state of the art” international centre for medical research located in Bangladesh, (the International Centre for Diarrheal Research - ICDDR,B), none of the community hospitals have microbiology diagnostic laboratories.

 

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Dr. Saha explained that, globally, child mortality rates are high in regions (Figure 2.3) without diagnostic laboratory facilities (Figure 2.4).

Infectious diseases are major causes of death for children in Bangladesh (Figure 2.5)

 

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Dr. Saha described the need for and difficulties in establishing a functioning, comprehensive, microbiologic diagnostic laboratory in a resource-poor country. He pointed out that the problems in establishing such a facility initially related to communication between clinicians and laboratory programs. He described the need for accurate and open discussion between health authorities and those providing services and said this was especially important in utilizing funds and acquiring equipment.

 

Dr. Saha outlined the problems associated with diagnostic microbiology facilities not being available. In addition to their vital role in helping diagnose acute disease they also shed light on problems that exist in a community. An example of this is that although vaccines are available for the prevention of Hemophilus influenzae b and Pneumococcal infections, they were not being used in Bangladesh because the incidence of these infections was not known. Once diagnostic facilities were available it became evident that these are major problems in Bangladesh where the vaccines are needed most.

 

Dr. Saha described the importance of accurate bacterial diagnosis of infections in children with the need to determine both the responsible bacteria as well as antibiotic sensitivity.

 

Dr. Saha’s laboratory had very simple beginnings in a relatively primitive setting. As the laboratory expanded, new techniques, including molecular diagnostic studies, were developed. These have been of great value in diagnosing bacterial causes of infections in cases requiring antibiotic therapy. They have also been important in helping to recognize antibiotic resistance.

 

Through developing techniques, practicing open communication, and by rapidly providing much needed service, Dr. Saha was able to establish the laboratory and secure continuing local and international funding for diagnostic and research programs. He has now developed a highly sophisticated microbiology laboratory which provides diagnostic service to a major children’s hospital and participates internationally in collaborative research. In addition to many publications, recently BBC prepared and televised a documentary on Hib, based on the work of Dr. Saha’s lab. These data are influential and the Government of Bangladesh has decided to introduce the Hib vaccine in the national program from 2008.