26.06.18

Shona Jane Lee » Tracing product pathways from development to scale

From the outset of the course and throughout the week, the centrality of diagnosis to the wider system of care was signposted as a point of departure to explore key issues in delivering care across different settings, from public health emergencies where "accurate and expedient diagnosis impacts every aspect of outbreak response" (Dr Jana Broadhurst), to elimination programmes. "Diagnostics are a cornerstone to directing who needs treatments, and seal the deal for elimination" remarked Dr Cédric Yansouni (who chaired the majority of panels throughout the week). Using devices to ‘rule out’ infections creates further uncertainties for clinicians dealing with syndromic fevers, "our interventions are bearing fruits, but now clinicians have to consider a whole constellation of causes that they may not be equipped to deal with". This raises some important questions regarding diagnostics’ role amidst this constellation, and how devices evolve in an ever-changing ecosystem of global health priorities.

26.06.18

Shona Jane Lee » Developing Diagnostics for Global Health

In June 2018, McGill University's Global Health Programme hosted its 4th annual Summer Institute in Infectious Diseases and Global Health in Montreal, Canada. Shona Jane Lee, an associated researcher with the DiaDev project, attended this year's 5 day course on Global Health Diagnostics. In this mini-series she reports some of the key themes and conversations emerging from the

1.06.18

Rebekah Thompson » Diagnosis where? Testing pigs and humans for T. solium cysticercosis in Uganda

Taenia solium is a zoonotic disease shared between humans and pigs. Humans become infected with T. solium, also known as the pork tapeworm, when they consume undercooked pork infected with porcine cysticercosis. Human cysticercosis develops when humans ingest T. solium eggs. If cysterici travel to the human brain this leads to neurocysticercosis, a leading cause of onset epilepsy in endemic areas (Singhi ‎2011). In an effort to control T. solium, the International Livestock Research Institute (ILRI) have collaborated with the University of Edinburgh, Arista Inc., and Astel Diagnostics to develop a prototype, pen-side lateral flow assay (LFA). The assay has been designed to detect porcine cysticercosis using blood or serum.

1.06.18

Steve Sturdy » Risk and utility in the governance of diagnostic testing: the case of genetic screening, 1960 to the present

Routine collection of blood samples from neonates – often using so-called Guthrie cards (pictured) – began in the 1960s when a number of North American and European countries set up screening programmes for phenylketonuria, a rare single-gene disorder which leads to developmental delays and early death if untreated. Such programmes have since been introduced in many other countries around the world. At the same time, refinements in laboratory technology – especially the development of tandem mass spectrometry from the early 1990s, followed by the inception of increasingly powerful new genomic technologies – have made it possible to detect a growing range of disorders from the same blood samples. These proliferating possibilities have been accompanied by often intense discussion about just what diseases should be included in newborn screening programmes.

1.06.18

Jennifer Palmer » Humanitarian diagnostics for sleeping sickness in Uganda

A key impetus for the invention of a Rapid Diagnostic Test (RDT) for sleeping sickness (also known as human African trypanosomiasis or HAT) was the persuasive advocacy for better ‘field ready tools’ by medical humanitarian agencies such as Médecins Sans Frontières. They were engaged in fighting outbreaks of this disease, which is fatal if untreated, in contexts of weakened health systems and mass displacements during the Central African wars of the 1990s.

1.06.18

Ilana Lowy » Ultrasound as a diagnostic tool in Brazil: celebrating babies, blurring problems

This is a photograph of a publicity for a “street corner” obstetrical ultrasound in Brazil. It proclaims: “ultrasound examinations at low prices.” The advertised “low prices” can be indeed be very low: some clinics charge less than US $10 for an ultrasound examination. The aim such examination is to confirm the existence of a pregnancy, provide reassurance, but above all to tell the pregnant woman what the sex of her future child will be, and produce the “baby’s first photograph.”

1.06.18

Diagnostics without diagnosis: RDTs for sleeping sickness in Uganda

Diagnosing sleeping sickness (also known as human African trypanosomiasis (HAT)) is complicated, requiring the alignment of clinical suspicion with serological, parasitological, and molecular confirmation to determine appropriate treatment. Previously, diagnosis was carried out by mobile lab teams which confirmed cases in village screenings and transported patients for treatment. Since cases have declined however, expensive active screening campaigns have been phased out and replaced with passive, symptom-based algorithms.

1.06.18

Emma Harding-Esch » Diagnosing trachoma for elimination

To certify as having eliminated trachoma, countries submit a dossier to WHO, including showing that the prevalence of TT unknown to the health system is <2 cases per 1000 population aged ≥15 years, and that the prevalence of TF in 1-9 year-olds has fallen below 5%, and that this has been sustained for at least two years, in each formerly endemic district. However, the presence of clinical signs of active trachoma (TF and TI) is poorly correlated with detection of infection, especially after MDA where clinical signs tend to over-estimate prevalence relative to infection. The result is that: 1.) We may be conducting unnecessary rounds of MDA; and 2.) Countries may have eliminated ocular chlamydial infection, but not be able to certify as having eliminated trachoma.

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