The presence and availability of essential diagnostics in Malawian district and central hospitals: A secondary analysis of a nationwide survey of musculoskeletal trauma care capacity

Abstract

Background

Diagnostics are foundational to effective health systems but remain widely unavailable worldwide, especially in low-income coun­tries like Malawi. To achieve health equity in Malawi, it is necessary to assess the availability of essential diagnostics.

Methods

We analysed data collected during a nationwide survey of musculoskeletal trauma care capacity. We analysed the presence, avail­ability, and reasons for unavailability of laboratory testing, vital signs monitoring, electrocardiography, and diagnostic radiology at all 25 district hospitals and 4 central hospitals in Malawi. We used geospatial models to estimate the proportion of the Malawian population with 1-hour and 2-hour access to these resources. Taking 1-hour access to most accurately represent geospatial cov­erage in the Malawian context, a hypothetical intervention was designed whereby diagnostic capacity improvement would be prioritized at selected hospitals to cover at least 75% of Malawians nationwide.

Results

Twelve of 29 hospitals had basic laboratory testing available when needed, covering an estimated 58% of Malawians with 1-hour access and 95% with 2-hour access. Vital signs monitoring was available when needed at 18 hospitals, covering an estimated 74% of Malawians with 1-hour access and 97% with 2-hour access. Six hospitals reported that electrocardiography was available when needed, covering an estimated 49% of Malawians with 1-hour access and 91% with 2-hour access. Four hospitals had x-ray capacity of adequate quality to make accurate diagnoses when needed, covering an estimated 39% of Malawians with 1-hour access and 86% with 2-hour access. Broken machinery, inadequate supplies, and inadequate staff training were common reasons for resource unavailability.

Conclusions

Essential diagnostics were found to be unavailable for many Malawians. By prioritizing capacity improvements for all 4 central hospitals and 11 district hospitals, over three-quarters of Malawians could have 1-hour access to laboratory testing, vital signs monitoring, electrocardiography, and diagnostic x-ray. These capacity improvements are essential to meet the needs of a growing population, especially in the context of the current COVID-19 pandemic.