Global Health Technologies
Lisa Mtui (she/her/hers)
Student
University of Toronto
Toronto, Ontario, Canada
Sara Ahmad
Student
University of Toronto, United States
Philip Asare
Professor
University of Toronto, United States
Nirmal Ravi
Chief Innovation Officer
EHA Clinics, United States
The goal of this work is to investigate technology and automation opportunities to increase diagnostic facilities' capacity in global health settings. Bacterial pathogens contribute to 1 out of 8 global deaths, highlighting the significant burden on global health (Ikuta et al., 2022). Peripheral blood smear (PBS) microscopy is a crucial tool in global health disease diagnosis, enabling the accurate detection and identification of blood-borne pathogens and abnormalities (Adewoyin & Nwogoh, 2014) such as malaria, tuberculosis, and cholera.These tests are traditionally conducted by specialized pathologists or lab technicians who examine the blood cells on the slide (American Society of Hematology, n.d.). The current method of acquiring blood smear images is time-consuming, leading to longer turnaround times for diagnosis. A PBS typically requires 10-20 minutes for preparation and assessment by a technician (Adewoyin & Nwogoh, 2014). For malaria cases, an efficient workflow allows reading of 30-40 slides per day (World Health Organization, 2016). A gap remains between the potential of health systems and their actual performance. For example, In many African countries there is a shortage of laboratory technicians and resources (Ridderhof et al., 2007); hence, given that lab technicians are trained with a diverse set of skills beyond microscopy (McMinn et al., 1975), dedicating substantial time to microscopy tasks reduces their overall capacity and limits the reach of their health system. Our work creates a human-technology model to examine how automation and technology infusion can increase capacity at various points in the technician's workflow and the overall health system.
Our approach centers around developing a human-technology model that considers the technician's workflow, capacity, and the overall health system capacity. By gaining insights into the frequency and distribution of these diseases, we emphasize the critical role of microscopy in effective detection and management. The development of our human-technology model involves understanding the burden of disease and identifying the specific automation requirements, such as objective lens, field of view, and light settings.
To support our study, we conducted a comprehensive review of 15 highly infectious global health diseases and their diagnostic tools (Figure 1) and associated technical requirements, utilizing reputable sources such as peer-reviewed literature or reports from respected national or international relevant organizations (e.g. public health organizations and associations related to training and regulation of the lab technician profession). For the peer-reviewed literature searches, we used academic literature indexing tools such as Scopus, Pubmed, and Google Scholar. The diseases included meningitis, strep throat (Group A Streptococcus), nocardiosis, Helicobacter pylori, E. coli, relapsing fevers, malaria, tuberculosis, schistosomiasis, tinea capitis, syphilis, Klebsiella pneumoniae, leptospirosis, Lyme disease, cholera, and Salmonella (Ikuta et al., 2022).
Results
We discovered that approximately one-third of the diseases rely on microscopy as the gold standard for diagnosis, followed by PCR tests. Notably, microscopy has high diagnostic capacity, but current utilization has limited returns. However, the current utilization of microscopy in healthcare systems provides limited returns. Typically, a skilled lab technician can process 30-40 slides in 6 hours (World Health Organization, 2016). By reducing the time required for slide processing and assessment, we can effectively increase the overall capacity of the healthcare system. To model the workflow of clinicians, we estimated time spent on microscopy daily to understand how the amount of microscopy time affects overall diagnostic capacity, which was 93.1%. PCR outperforms microscopy in time efficiency (2.5 mins/sample vs. 16 mins 45s/sample) (Morgan et al., 1998). PCR leverages cost-effective bulk processing and reduced hands-on time, significantly increasing overall diagnostic capacity, and addressing microscopy limitations (Figure 2). To dig deeper into opportunities for automation and to reduce time spent on microscopy while maintaining or improving current output we developed a qualitative queuing model to examine two different potential workflows: one where stages of microscopy are performed in sequence by the same person or machine (which is the current situation) (Figure 3) and one where stages are performed in parallel (Figure 4). The parallel workflow requires some automation but also presents an opportunity to improve diagnostic capacity.
Discussion
The proposed framework aims to enhance parasitic blood infection diagnosis in global health settings, addressing challenges of skilled lab technician shortages and turnaround times Integrating technology and automation can enhance technicians' capabilities, streamline the workflow, and increase overall capacity and efficiency. Training lab technicians is essential to fully utilize the framework's potential. Technology acts as a multiplier, improving diagnostic efficiency and management in resource-constrained environments. Successful implementation saves lives in resource-constrained environments.
Conclusion
Our study emphasizes the critical need for devices that seamlessly integrate into the established microscopy workflow in global health settings. Introducing such devices enhances efficiency, accuracy, and throughput in diagnosing parasitic blood infections, improving healthcare outcomes in resource-constrained environments
References