Background: India carries one of the largest burdens of infectious diseases in the world. To estimate this, laboratory confirmation is vital. We estimated the lab capacity and effectiveness in the state of Gujarat for Enteric Fever, Infectious Hepatitis, and Dengue. Methods: We estimated the number of labs in the state through telephonic surveys and physical screening of a representative sample of labs. We created four levels of tests, Level-0 being no test and 3 being the best confirmatory test available in the state. For the profusion of rapid diagnostic test kits (RDTKs), we constructed Effective Diagnostic Scores (EDS) calculated from their sensitivity and specificity at disease prevalences specified in the literature. Tests with EDS > 0.51 were level-2 tests, and EDS < 0.50, level-1 tests. Results: Our analysis showed that there are 4293 labs in the state (1765 public and 2528 private), 7/100,000 population. However, only 2878 labs contributed to a total pooled Effective Lab Diagnostic Score (ELDS) of 6776 in the state. Strikingly, 94% of the lab effectiveness lay in RDTs (level-2 and 1 tests) which are essentially screening tests. Ninety-six percent of the overall lab effectiveness of Gujarat existed in private and only 4% in public labs. Contrarily, the level-3 confirmatory testing effectiveness, through ELISA and culture constituted only 4% of private and 36% of public lab effectiveness. More than half of the private lab effectiveness was located in eight Tier 1 cities. Level-3 confirmatory testing effectiveness was present only in Tier 1 and 2 towns. Hepatitis B testing contributed 34% of the total ELDS, followed by Dengue (30%), Enteric Fever (26%) and Hepatitis A and E (10%). Conclusion: Our study has established that the capacity and effectiveness of the lab network in Gujarat lie predominantly in RDTKs. We need to adapt our systems to capture this data in a manner that will allow us to monitor the burdens of these diseases.
References
[1]
Mentor, V. and Dworkin, M.S. (2006) Clinical Pearl Surveillance of Infectious Diseases Is Information for Action. Virtual Mentor, 8, 223-226.
https://doi.org/10.1001/virtualmentor.2006.8.4.cprl1-0604
http://www.virtualmentor.org
[2]
Perry, H.N., McDonnell, S.M., Alemu, W., Nsubuga, P., Chungong, S., Otten, M.W., et al. (2007) Planning an Integrated Disease Surveillance and Response System: A Matrix of Skills and Activities. BMC Medicine, 5, 24.
https://doi.org/10.1186/1741-7015-5-24
[3]
Cantón, R. (2005) Role of the Microbiology Laboratory in Infectious Disease Surveillance, Alert and Response. Clinical Microbiology and Infection, 11, 3-8.
https://doi.org/10.1111/j.1469-0691.2005.01081.x
[4]
Frieden, T.R., Khabbaz, R.F., Redd, S.C., Bell, B.P., Fenton, K., Schuchat, A., et al. (2011) A CDC Framework for Preventing Infectious Diseases: Sustaining the Essentials and Innovating for the Future. Centers for Disease Control and Prevention. Atlanta.
[5]
Cash, R.A. and Narasimhan, V. (2000) Impediments to Global Surveillance of Infectious Diseases: Consequences of Open Reporting in a Global Economy. Bulletin of the World Health Organization, 78, 1358-1367.
[6]
Hamburg, M.A., Sparling, P.F., Choffnes, E.R. and Mack, A. (2007) Global Infectious Disease Surveillance and Detection: Assessing the Challenges—Finding Solutions. Challenges, 284 p.
[7]
World Health Organization, Department of Communicable Disease Surveillance and Response (2004) WHO Recommended Surveillance Standards. Second Edition, WHO, Geneva.
[8]
National Vector Borne Disease Control Programme (2017) Strategic Plan for Malaria Control in India (2012-17). A Five-Year Strategic Plan. Delhi.
[9]
Singh, N. (2009) Perspective, a New Global Malaria Eradication Strategy: Implications for Malaria Research from an Indian. Transactions of the Royal Society of Tropical Medicine and Hygiene, 103, 1202-1203.
https://doi.org/10.1016/j.trstmh.2009.04.023
[10]
Sharma, V. (1999) Current Scenario of Malaria in India. Parassitologia, 41, 349-353.
[11]
Central TB Division (2012) Welfare M of H and F. TB India 2012 Annual Status Report. New Delhi.
[12]
Rotary and Polio. Rotary International [Internet].
[13]
Child Health Division, Ministry of Health and Family Welfare (2005) Field Guide: Surveillance of Acute Flaccid Paralysis. 3rd Edition, 1-61.
[14]
MOHFW (2010) UNGASS Country Progress Report (CPR India 2010). Delhi.
[15]
NCDC, Ministry of Health G of I. Brief History of IDSP (2009) Integrated Disease Surveillance Programme, Ministry of Health & Family Welfare, Government of India.
[16]
IDSP. Training Manual for State & District Surveillance Officers—Module 5. IDSP, Delhi.
[17]
Iyer, V., Azhar, G.S., Choudhury, N., Dhruwey, V.S., Dacombe, R. and Upadhyay, A. (2014) Infectious Disease Burden in Gujarat (2005-2011): Comparison of Selected Infectious Disease Rates with India. Emerging Health Threats Journal, 7, Article ID: 22838. https://doi.org/10.3402/ehtj.v7.22838
[18]
Veeraraghavan, B., Pragasam, A.K., Bakthavatchalam, Y.D. and Ralph, R. (2018) Typhoid Fever: Issues in Laboratory Detection, Treatment Options Concerns in Management in Developing Countries. Future Science OA, 4, FSO312.
https://doi.org/10.4155/fsoa-2018-0003
[19]
World Health Organization (2012) Handbook for Clinical Management of Dengue. 114 p.
[20]
Census of India (2011) Census of India Gujarat Provisional. Gujarat.
[21]
National Health Portal of India (2019) Medical Colleges in Gujarat.
[22]
World Health Organization (2017) Guidelines on Hepatitis B and C Testing. WHO, Geneva, 204 p.
[23]
World Health Organization (2018) WHO Vaccine-Preventable Diseases Surveillance Standards. 1-13.
[24]
Brenner, H. and Gefeller, O. (1997) Variation of Sensitivity, Specificity, Likelihood Ratios and Predictive Values with Disease Prevalence. Statistics in Medicine, 16, 981-991.
https://doi.org/10.1002/(SICI)1097-0258(19970515)16:9<981::AID-SIM510>3.0.CO;2-N
[25]
Leeflang, M.M.G., Rutjes, A.W.S., Reitsma, J.B., Hooft, L. and Bossuyt, P.M.M. (2013) Variation of a Test’s Sensitivity and Specificity with Disease Prevalence. Cmaj, 185, 537-544. https://doi.org/10.1503/cmaj.121286
[26]
Jain, A., Jain, P., Prakash, S., Gupta, S., Singh, K., Shrivastava, S., et al. (2013) Prevalence of Hepatitis A Virus, Hepatitis B Virus, Hepatitis C Virus, Hepatitis D Virus and Hepatitis E Virus as Causes of Acute Viral Hepatitis in North India: A Hospital Based Study. Indian Journal of Medical Microbiology, 31, 261.
https://doi.org/10.4103/0255-0857.115631
[27]
Ministry of Health and Family Welfare (Government of India) (2018) National Health Profile (NHP) of India 2018: Central Bureau of Health Intelligence.
[28]
IHME (2018) GBD Compare, IHME Viz Hub.
[29]
Lalremruata, R., Chadha, S. and Bhalla, P. (2014) Retrospective Audit of the Widal Test for Diagnosis of Typhoid Fever in Pediatric Patients in an Endemic Region. Journal of Clinical and Diagnostic Research, 8, 22-25.
[30]
Llor, C. and Bjerrum, L. (2014) Antimicrobial Resistance: Risk Associated with Antibiotic Overuse and Initiatives to Reduce the Problem. Therapeutic Advances in Drug Safety, 5, 229-241. https://doi.org/10.1177/2042098614554919
[31]
Wasihun, A.G., Wlekidan, L.N., Gebremariam, S.A., Welderufael, A.L., Muthupandian, S., Haile, T.D., et al. (2015) Diagnosis and Treatment of Typhoid Fever and Associated Prevailing Drug Resistance in Northern Ethiopia. International Journal of Infectious Diseases, 35, 96-102. https://doi.org/10.1016/j.ijid.2015.04.014
[32]
Pathlabs, L. (2018) Test Lists and Cost.
[33]
Shepard, D.S., Halasa, Y.A., Tyagi, B.K., Adhish, S.V., Nandan, D., Karthiga, K.S., et al. (2014) Economic and Disease Burden of Dengue Illness in India. The American Journal of Tropical Medicine and Hygiene, 91, 1235-1242.
https://doi.org/10.4269/ajtmh.14-0002
[34]
Planning Commission (Government of India) (2011) Report of the Working Group on Disease Burden for the 12th Five Year Plan: WG-3(1) Communicable Diseases.
World Health Organisation (2019) Rapid Diagnostic Tests.
[37]
Davey, A., Davey, S. and Datta, U. (2008) Perception Regarding Quality of Services in Urban ICDS Blocks in Delhi. Indian Journal of Public Health, 52, 156-158.
[38]
Ochiai, R.L., Acosta, C.J., Danovaro-Holliday, M.C., Baiqing, D., Bhattacharya, S.K., Agtini, M.D., et al. (2008) A Study of Typhoid Fever in Five Asian Countries: Disease Burden and Implications for Controls. Bulletin of the World Health Organization, 86, 260-268. https://doi.org/10.2471/BLT.06.039818
[39]
Keddy, K.H., Sooka, A., Letsoalo, M.E., Hoyland, G., Chaignat, C.L., Morrissey, A.B., et al. (2011) Sensitivity and Specificity of Typhoid Fever Rapid Antibody Tests for Laboratory Diagnosis at Two Sub-Saharan African Sites. Bulletin of the World Health Organization, 89, 640-647. https://doi.org/10.2471/BLT.11.087627
[40]
Patankar, M., Patel, B., Gandhi, V. and Parevee Shah, M.V. (2014) Seroprevalence of Dengue in Gujarat: A Study at a Tertiary Care Hospital. International Journal of Medical Science and Public Health, 3, 16-18.
https://doi.org/10.5455/ijmsph.2013.140920131
[41]
Wang, S.M. and Sekaran, S.D. (2010) Early Diagnosis of Dengue Infection Using a Commercial Dengue Duo Rapid Test Kit for the Detection of NS1, IGM, and IGG. The American Journal of Tropical Medicine and Hygiene, 83, 690-695.
https://doi.org/10.4269/ajtmh.2010.10-0117
[42]
World Health Organisation (2004) Hepatits B Surface Antigen Assays: Operational Characteristics (Phase I). Report 2 (Phase I).
