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. 2023 Apr 11;9(2):00397-2022.
doi: 10.1183/23120541.00397-2022. eCollection 2023 Mar.

Diagnostic options for pulmonary fungal diseases in Africa

Martha F Mushi  1   2 , Sherif M Zaki  3   2 , Richard O S Penney  4 , Sanata Bamba  5 , Marius Paulin Ngouanom Kuate  6 , Eric L Kasamba  7 , Fructueux M Amona  8   9 , Sara Werkneh  4 , Buntung Ceesay  10 , Bakary Dibba  10 , Bright Ocansey  11   12 , Ousmane Sy  13 , Mohammed Yahaya  14 , Darlinda Jiba  15 , Tom Boyles  16   17 , Sixbert I Mkumbaye  18 , Richard Kwizera  19 , Elopy Sibanda  20 , David Koffi  21 , Yolande Sissinto Savi De Tove  22 , Emma Orefuwa  4   23 , David W Denning  4   11   23
Affiliations

Diagnostic options for pulmonary fungal diseases in Africa

Martha F Mushi et al. ERJ Open Res. .

Abstract

Background: Fungal lung diseases are global in distribution and require specific tests for diagnosis. We report a survey of diagnostic service provision in Africa.

Methods: A written questionnaire was followed by a video conference call with each respondent(s) and external validation. To disseminate the questionnaire, a snowball sample was used.

Results: Data were successfully collected from 50 of 51 African countries with populations >1 million. The questionnaire was completed by respondents affiliated with 72 health facilities. Of these 72 respondents, 33 (45.8%) reported data for the whole country while others reported data for a specific region/province within their country. In the public sector, chest X-ray and computed tomography are performed often in 49 countries (98%) and occasionally in 37 countries (74%), and less often in the private sector. Bronchoscopy and spirometry were done often in 28 countries (56%) and occasionally in 18 countries (36%) in the tertiary health facilities of public sector. The most conducted laboratory diagnostic assay was fungal culture (often or occasionally) in 29 countries (58%). In collaboration with the Africa Centre for Disease Control and Prevention, regional webinars and individual country profiles provided further data validation.

Conclusion: This survey has found a huge disparity of diagnostic test capability across the African continent. Some good examples of good diagnostic provision and very high-quality care were seen, but this was unusual. The unavailability of essential testing such as spirometry was noted, which has a high impact in the diagnosis of lung diseases. It is important for countries to implement tests based on the World Health Organization Essential Diagnostics List.

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Conflict of interest statement

Conflict of interest: All authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
a) Provision of chest X-ray in different setting, using a hierarchical approach: seven countries (e.g. Ethiopia) only use chest X-ray at central teaching hospitals, 33 countries (e.g. Benin) use chest X-rays at these hospitals and at district hospitals, and 10 countries (e.g. Ghana) provide chest X-rays at these facilities and in community clinics. b) Access to regularly reporting radiologist. CAR: Central African Republic; DRC: Democratic Republic of the Congo.
FIGURE 2
FIGURE 2
a) Provision of spirometry. b) Frequency of bronchoscopy in tertiary health facilities. CAR: Central African Republic; DRC: Democratic Republic of the Congo.
FIGURE 3
FIGURE 3
Biosafety level 3 (BSL-3) laboratories.
See this image and copyright information in PMC

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