ArticleJournal of global health2026
Diagnostic completeness: the missing link in antimicrobial stewardship in low- and middle-income countries.
Article in Journal of global health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Antimicrobial resistance (AMR) is accelerating in low- and middle-income countries, yet antibiotic prescribing decisions are often made without diagnostic certainty. Diagnostic completeness - the systematic commitment to obtaining a confirmed diagnosis before initiating treatment - is an overlooked upstream component of antimicrobial stewardship. Without this pre-treatment commitment, downstream antimicrobial management efforts risk being bypassed because diagnostic testing is never ordered. Here, we distinguish diagnostic completeness from diagnostic stewardship: the former concerns whether a diagnosis is pursued before treatment, whereas the latter concerns whether the appropriate diagnostic test is used. Behavioural alerts, hub-and-spoke diagnostics, and incentive redesign are three practical pathways that could strengthen diagnostic completeness in primary care, although each faces well-documented implementation barriers requiring context-specific adaptation. We also address patient-level constraints, equity implications, health system heterogeneity, and empirical therapy in emergency contexts. Diagnostic completeness is a necessity; closing the diagnostic gap will not solve AMR alone, yet without it, stewardship will not suffice.
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