ArticleThe Lancet. Global health2021
Availability of essential diagnostics in ten low-income and middle-income countries: results from national health facility surveys.
Article in The Lancet. Global health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 153 papers, 5 of them syntheses that pooled it.
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Who cites it
153 citing papers in PubMed, 5 syntheses or guidelines pooled it, 237 citations in OpenAlex.
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- Human West Nile virus infection: a meta-analysis of recent global data (2019-24).Journal of global health · 2025Pooled it
- Systematic review and meta-analysis of the diagnostic value of four biomarkers in detecting neonatal sepsis in low- and middle-income countries.BMJ paediatrics open · 2023Pooled it
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- A fully integrated sample-to-answer diagnostic platform enables rapid quantification of post-transplant infection at the point-of-care.Nature communications · 2026Article
- Evaluating the nationwide availability of essential diagnostics for tuberculosis toward achieving a TB-free India.Microbiology spectrum · 2026Article
- Global Trends in Antimicrobial Resistance-Related Mortality fromTropical medicine and infectious disease · 2026Article
- Incidence and risk factors for stillbirth in Kenya, Mozambique and the Gambia: the PRECISE cohort study.The Lancet regional health. Africa · 2026Article
- Predicting Failure at Initiation of High-Flow Nasal Oxygen in Patients With COVID-19: Literature Review, Development and Internal Validation of a Prediction Model.Respirology (Carlton, Vic.) · 2026Observational
- Laboratory test availability and user fees in routine HIV care: a global analysis in 42 countries.Health affairs scholar · 2026Article
- Global disparities in the recognition, diagnosis, and management of seizures or epilepsy of autoimmune etiology.Epilepsia open · 2026Article
- Health-system barriers and missed opportunities in cardiovascular care in Sierra Leone: a scoping review.Communications medicine · 2026Article
- Article
- Managing public-private partnerships for health diagnostics: challenges and strategies.Health policy and planning · 2026Article
- Assessments of the in vitro diagnostic kits landscape and availability from selected hospitals and health-related facilities in Addis Ababa, Ethiopia.BMC health services research · 2026Article
- Global patterns of pertussis incidence and vaccination strategies: implications of divergent surveillance data.NPJ vaccines · 2026Article
- Access barriers to in vitro diagnostics in Cambodia, Indonesia, Lao PDR, and the Philippines: programmatic lessons from NEDL field missions.Tropical medicine and health · 2026Article
93 more citing papers are in PubMed but not listed here.
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Authors and funding
5 authors at 5 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPathology and laboratory medicine diagnostics and diagnostic imaging are crucial to achieving universal health coverage. We analysed Service Provision Assessments (SPAs) from ten low-income and middle-income countries to benchmark diagnostic availability.
methodsDiagnostic availabilities were determined for Bangladesh, Haiti, Malawi, Namibia, Nepal, Kenya, Rwanda, Senegal, Tanzania, and Uganda, with multiple timepoints for Haiti, Kenya, Senegal, and Tanzania. A smaller set of diagnostics were included in the analysis for primary care facilities compared with those expected at hospitals, with 16 evaluated in total. Surveys spanned 2004-18, including 8512 surveyed facilities. Country-specific facility types were mapped to basic primary care, advanced primary care, or hospital tiers. We calculated percentages of facilities offering each diagnostic, accounting for facility weights, stratifying by tier, and for some analyses, region. The tier-level estimate of diagnostic availability was defined as the median of all diagnostic-specific availabilities at each tier, and country-level estimates were the median of all diagnostic-specific availabilities of each of the tiers. Associations of country-level diagnostic availability with country income as well as (within-country) region-level availability with region-specific population densities were determined by multivariable linear regression, controlling for appropriate covariates including tier.
findingsMedian availability of diagnostics was 19·1% in basic primary care facilities, 49·2% in advanced primary care facilities, and 68·4% in hospitals. Availability varied considerably between diagnostics, ranging from 1·2% (ultrasound) to 76·7% (malaria) in primary care (basic and advanced) and from 6·1% (CT scan) to 91·6% (malaria) in hospitals. Availability also varied between countries, from 14·9% (Bangladesh) to 89·6% (Namibia). Availability correlated positively with log(income) at both primary care tiers but not the hospital tier, and positively with region-specific population density at the basic primary care tier only.
interpretationMajor gaps in diagnostic availability exist in many low-income and middle-income countries, particularly in primary care facilities. These results can serve as a benchmark to gauge progress towards implementing guidelines such as the WHO Essential Diagnostics List and Priority Medical Devices initiatives.
fundingBill & Melinda Gates Foundation.
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