Clinical laboratory test prices in Zimbabwe: A case of profiteering?

OBJECTIVE: To compare the prices charged for clinical laboratory tests in Zimbabwean institutions with those of similar institutions abroad. DESIGN: An online analytical cross sectional study was conducted. SETTING: An online survey. SUBJECTS: We did an online survey of clinical laboratories that published prices of the tests offered on their websites. We also extracted price information from documents published by fees regulatory authorities. MAIN OUTCOME MEASURES: Laboratory test prices for independent institutions, Laboratory test prices for State institutions. RESULTS: Overally for all countries, laboratory test prices were lower in state laboratories compared to the independent laboratories. In Zimbabwe, state laboratories generally charged about 50% of the independent laboratory tariff for most tests. However prices from both Zimbabwean institutions were generally much higher than those of the comparison countries (United Kingdom, South Africa, India, United States of America and New Zealand). CONCLUSION: Prices of laboratory tests are indeed higher in Zimbabwean institutions compared to other centres abroad. These higher prices could be attributed to challenges in consumable procurement logistics. We also present measures that could be put in place to reduce the costs and therefore prices.

Investigation of the effect of Stalanev (Stavudine, Lamivudine and Nevirapine) treatment on plasma lactate levels in adults attending Beatrice Road and Wilkins Infectious Diseases Hospital Opportunistic Infections Clinics in Harare, Zimbabwe.

MAIN OBJECTIVE: To evaluate the effect of Stalanev (Stavudine, Lamivudine and Nevirapine) treatment on plasma lactate levels in adults attending Beatrice Road Infectious Diseases Hospital and Wilkins Infectious Diseases Hospital Opportunistic Infections Clinics in Harare. DESIGN: Prospective cohort study carried out between January and May 2011. SETTING: Beatrice Road and Wilkins Infectious Diseases Hospital Opportunistic Infections Clinics in Harare, Zimbabwe. PARTICIPANTS: A convenience sample of 180 ART naive HIV infected adults aged 20-68 years who were about to be initiated on STALANEV were recruited. RESULTS: The mean plasma lactate at baseline was 1.57 mmol/L (SD 0.43). After two months on STALANEV, 25 participants (13.9%) had hyperlactatemia and the mean plasma lactate level was 1.99 mmol/L (SD 0.49). At four months follow up, 98 participants (54%) had hyperlactatemia and the mean plasma lactate level was 2.65 mmol/l (SD 0.55). Mean plasma lactate levels increased significantly from baseline to 2 months follow up and from 2 months follow up to 4 months follow up (p < 0.001). None of the participants developed lactic acidosis (plasma lactate > 3.5) after two months of follow up but 14 (7.8%) developed mild lactic acidosis and three (1.7%) had moderate lactic acidosis after four months on STALANEV. CONCLUSIONS: Our findings are in agreement with those of other studies that reported that treatment with STALANEV leads to hyperlactatemia thereby posing a risk for the development of lactic acidosis in patients. In the absence of alternative regimens, we recommend routine monitoring of plasma lactate levels on all patients on STALANEV in Zimbabwe.

Thyroid function in neonates from goitre prevalent areas in Zimbabwe.

OBJECTIVE: To measure serum thyrotropin (TSH), and free thyroxine concentrations in newborns delivered in areas with differing degrees of iodine deficiency, (prior to the salt iodization programme), and to use these biochemical indices to assess the current status of thyroid function in the group. DESIGN: Cross sectional. SETTING: Chemical Pathology, University of Zimbabwe, Medical School. Radio-immunoassay laboratory, Parirenyatwa Hospital. SUBJECTS: 500 healthy full term newborns, aged two to four days old, weighing not less than 2.5 kg. MAIN OUTCOME MEASURES: Thyroid hormone status of newborns. RESULTS: The mean serum FT4 level was found to be slightly but significantly different between the newborns from Harare region, (low goitre prevalent area), and Wedza district (moderate to severe goitre prevalent area). Although there was a trend in the distribution of TSH to higher values in the moderate to severe goitre prevalent areas, the differences were statistically non significant, p = 0.175. The median TSH value in the newborns was 4 microU/ml. TSH values were below 10 microU/ml in 90%, between 10.1 and 20 microU/ml in 9%, and between 20.1 and 32 microU/ml in 1% of the cases. No sex related differences were observed in either the TSH nor the FT4 values of the newborns. CONCLUSION: This study demonstrates that the iodine supplementation programme has been successful, but further monitoring is necessary to ensure complete supplementation throughout the country and to guard against hyperthyroidism which is known to occur during iodine supplementation programmes.

The Zimbabwe External Quality Assessment Scheme (ZEQAS) in clinical chemistry: results of the pilot programme.

A pilot programme for assessing laboratory performance in clinical chemistry laboratories in Zimbabwe is described (ZEQAS). Twenty four laboratories providing patient care services participated. Eight lyphilised bovine sera were distributed over one year. Consensus values and the spread of interlaboratory agreement were calculated for each of 12 analytes and compared with results previously obtained in a large mature national EQA scheme in the UK (UK NEQAS). For all analytes except phosphate, the mean consensus value obtained in ZEQAS was between 94 and 108 pc of the UK target, although the spread of results in ZEQAS was generally two to threefold greater for individual analytes than in UK NEQAS. It is concluded the ZEQAS consensus values for the analytes surveyed provide a valid target against which individual laboratory performance can be assessed. The wide spread of results from individual laboratories suggests there is considerable scope for improving interlaboratory agreement. This is being addressed by the continuing programme, with increased interaction and production of local specimens.

Effect of quinoline-type antimalarial drugs on the binding of oestradiol-17 beta and progesterone by rabbit and human uterine cytosols.

Rabbit and human uterine cytosol, prepared and tested in phosphate buffer, bound less oestradiol-17 beta or progesterone than cytosol from the same source prepared and tested in Tris-HCl buffer. Dissociation constants were the same in both buffer systems, and the difference in binding was due to a difference in the number of binding sites. Three quinoline-type antimalarial drugs, chloroquine, quinine and mefloquine, and the quinoline derivative, 4-(4'-hydroxy-1'-methylbutylamino)-7-chloroquinoline, increased the steroid binding capacity of phosphate-buffered cytosol to that of Tris-buffered cytosol, the optimal concentration of quinoline derivative being 1.4-1.6 mM. Tris (50 mM) increased the binding capacity of phosphate-buffered cytosol to that of Tris-buffered cytosol. The effects of Tris and quinoline derivatives were not additive. By gel chromatography and sucrose density gradient centrifugation it was shown that the molecular size and sedimentation behaviour of the oestradiol and progesterone receptors were not affected by the quinoline derivatives. Two types of binding site are proposed, one requiring the presence of low molecular weight, basic compounds. The uterine levels of chloroquine attained by normal pharmacological doses of the drug are potentially capable of influencing the binding of oestradiol-17 beta and progesterone in the uterine cytosol.