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GHP’s First Visit to Malawi Reveals Laboratories in Desperate Condition

When CLSI’s Global Health Partnerships (GHP) traveled to Malawi for the first time in the program’s seven-year history, the staff encountered laboratories that were ill-equipped and technicians who were improperly trained and or lacked the tools to follow basic safety guidelines.

GHP Vice President Karen McClure and Director Fran Ingersoll traveled to the African nation in September as part of the TB CARE II project. Tuberculosis (TB) is a major cause of disease and death in Africa, particularly among people living with HIV/AIDS. Their goals included assessing the transportation networks that carried samples from health centers to district laboratories to the central TB reference laboratory, and examining the internal and external quality improvement system for the district microscopy network.


A lack of adequate supplies was a serious problem at all the Malawi laboratories they visited. Most were running out of some reagents or using expired reagents, and they did not have enough distilled water. Employees either wore laboratory coats improperly, or lacked them entirely. Many laboratories had no soap for hand washing and/or no paper towels for drying. Most also lacked N-95 medical masks, which aid in preventing TB infection. Many facilities either had no ventilation or not enough, and the temperatures in some laboratories were sweltering.

Dr. McClure reported that most of the laboratories they visited had standard operating procedures in place and some also had copies of TB procedures, but there was no evidence that they had been reviewed by laboratory staff or management (with one exception) and many were out of date. Most TB staff said they had not received any training for more than two years. The laboratories were not adequately tracking mislabeled, unlabeled, or rejected TB samples. Microscope objectives were not being cleaned in between examination of samples, and control slides were not being run daily. There were no contracts in place for regular microscope service.

CLSI and the National TB Control Programme in Malawi, along with other TB CARE II partners, will be working with the national TB network to address these concerns.


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