Access to the World Health Organization-recommended essential diagnostics for invasive fungal infections in critical care and cancer patients in Africa: A diagnostic survey

Article Authors: Tafese Beyene Tufa, Felix Bongomin, Akila Fathallah, Ana Luísa S M Cândido, Rola Hashad, Maha Soussi Abdallaoui, Abdelsalam Ahmed Nail, Samuel Adetona Fayemiwo, Richard O S Penney, Emma Orefuwa, David W Denning

Abstract

Background: Invasive fungal infections (IFIs) contribute to significant morbidity and mortality among patients with haemato-oncological conditions, seriously ill hospitalised patients and those in intensive care (ICU). We surveyed for the World Health Organization-recommended essential diagnostic tests for IFIs in these risk groups in Africa.

Methods: The Global Action For Fungal Infections (GAFFI) evaluated the different levels of access to both diagnostics for IFIs for populations in Africa, with the aim of building a comparative dataset and a publicly available interactive map. Data was collected through a validated questionnaire administered to a country leader in relevant topics (i.e., HIV, laboratory coordination) and/or Ministry of Health representatives and followed up with 2 rounds of validation by video calls, and later confirmation by email of findings.

Results: Initial data was collected from 48 African countries covering 99.65 % of the population. Conventional diagnostics such as blood cultures, direct microscopy and histopathology were often used for diagnosis of IFIs in more than half of the facilities. Bronchoscopy was rarely done or not done in 20 countries (population 649 million). In over 40 African countries (population >850 million), Aspergillus antigen testing was never performed in either the public or private sectors. Computed tomography (CT) imaging is routinely used in 27 (56 %) of countries in the public sector and 21 44 %) in the private sector. However, magnetic resonance imaging remains relatively uncommon in most African countries.

Conclusions: There are critical gaps in the availability of essential diagnostics for IFIs in Africa, particularly Aspergillus antigen testing and modern medical imaging modalities. Early diagnosis and commencement of targeted therapy of IFIs are critical for optimal outcomes from complex cancer therapies.

Bibliographical metadata

Journal Journal of Infection and Public Health
Volume 16
Issue No. 10
Pages 1666-1674
DOI https://doi.org/10.1016/j.jiph.2023.08.015
Keywords
Links https://pubmed.ncbi.nlm.nih.gov/37633228/
Related Faculties/Schools
Affiliation

Tafese Beyene Tufa 1Felix Bongomin 2Akila Fathallah 3Ana Luísa S M Cândido 4Rola Hashad 5Maha Soussi Abdallaoui 6Abdelsalam Ahmed Nail 7Samuel Adetona Fayemiwo 8Richard O S Penney 9Emma Orefuwa 9David W Denning 10

1 Hirsch Institute of Tropical Medicine, Asella, Ethiopia; College of Health Sciences, Arsi University, Asella, Ethiopia.
2 Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, P. O. BOX 166, Gulu, Uganda.
3 Department of Parasitology-Mycology, Faculty of Medicine, Sousse, Tunisia.
4 National Institute of Health Research (INIS)-Laboratory of Hematology, Biochemistry and Parasitology of Malaria, Luanda, Angola.
5 Department of Microbiology and Immunology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
6 Parasitology-Mycology Department, University Hospital Centrer of Casablanca & Faculty of Medicine University Hassan II of Casablanca, Morocco.
7 Department of Internal Medicine, Faculty of Medicine & Health Sciences, Omdurman Islamic University, Omdurman, Sudan.
8 Department of Microbiology, Ibadan University Hospital, Ibadan, Nigeria.
9 Global Action For Fungal Infections (GAFFI), Geneva, Switzerland.
10 Global Action For Fungal Infections (GAFFI), Geneva, Switzerland; Manchester Fungal Infection Group, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom. Electronic address: ddenning@manchester.ac.uk.