Knowledge, Attitudes, and Behaviour Related to COVID-19 Testing: A Rapid Scoping Review

Bevan, I., Stage Baxter, M., Stagg, H.R., Street, A., 2021

Testing programs for COVID-19 depend on the voluntary actions of members of the public for their success. Understanding people’s knowledge, attitudes, and behavior related to COVID-19 testing is, therefore, key to the design of effective testing programs worldwide. This paper reports on the findings of a rapid scoping review to map the extent, characteristics, and scope of social science research on COVID-19 testing and identifies key themes from the literature. Main findings include the discoveries that people are largely accepting of testing technologies and guidelines and that a sense of social solidarity is a key motivator of testing uptake. The main barriers to accessing and undertaking testing include uncertainty about eligibility and how to access tests, difficulty interpreting symptoms, logistical issues including transport to and from test sites and the discomfort of sample extraction, and concerns about the consequences of a positive result. The review found that existing research was limited in depth and scope. More research employing longitudinal and qualitative methods based in under-resourced settings and examining intersections between testing and experiences of social, political, and economic vulnerability is needed. Last, the findings of this review suggest that testing should be understood as a social process that is inseparable from processes of contact tracing and isolation and is embedded in people’s everyday routines, livelihoods and relationships

Full citation:  

Bevan I, Stage Baxter M, Stagg HR, Street A. Knowledge, Attitudes, and Behavior Related to COVID-19 Testing: A Rapid Scoping Review. Diagnostics. 2021; 11(9):1685.

Acceptability and perceived utility of different diagnostic tests and sample types for trachoma surveillance in the Bijagos Islands, Guinea Bissau

Ramandeep Singh S., Salimato, S., Last, A., Cassama, E., Goncalves, A., Kelly, A.H., Street, A., Harding-Esch, E.M, 2020
Transactions of the Royal Society of Tropical Medicine and Hygiene

Trachoma is the leading infectious cause of blindness worldwide and is nearing elimination as a public health problem in Guinea Bissau. It is imperative that elimination is followed by a successful postvalidation surveillance programme. The aim of this study was to determine the acceptability and perceived utility of different diagnostic tests and sample types that could be used for postvalidation trachoma surveillance in the Bijagos Islands, Guinea Bissau.

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Patient Pathways and Diagnostic Value in Sierra Leone

Bah, F., Vernooij, E., Street, A., 2021
Medicine, Anthropology, Theory

What is the value of a diagnostic test? Most obviously for primary healthcare settings, laboratory tests can inform clinical decision making about treatment and patient management. Their predominant value in this context is therefore medical. But what about when that healthcare setting is chronically under-resourced, healthcare workers (including laboratory workers) are underpaid, and government supply chains fail to deliver basic laboratory supplies? In this contribution to the Field Notes section, we describe a Community Health Centre (CHC) in Sierra Leone where such conditions have given rise to a quasi-private laboratory service within the public health facility. Through detailed ethnographic description of patients’ diagnostic pathways through the facility, we examine and assess the impact on patient care when the medical and economic value of diagnostic tests diverge.

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Infrastructural instability, Value and Laboratory Work in a Public Hospital in Sierra Leone

Vernooij, E., 2021
Medicine, Anthropology, Theory

This research article examines the relationship between infrastructural instability and laboratory work in a public referral hospital in Sierra Leone. Drawing on ethnographic fieldwork conducted inside the hospital’s wards and clinical laboratory, I show how attending to infrastructure and materiality (i.e., laboratory spaces, diagnostic equipment, and supply chains) provides insight into the different kinds of value that laboratory work holds for laboratory technicians, clinicians, hospital administrators, and international donors. Through the case study of a newly arrived non-functioning diagnostic instrument, I reveal the institutional undervaluing of both the laboratory and the improvisation work performed by lab technicians to stabilise unstable equipment. Infrastructural instability in the laboratory enables the generation of new kinds of value, including economic and social value for laboratory technicians themselves, but undermines the clinical value of laboratory tests for clinicians and patients. By discussing the everyday practices, challenges, and meanings of laboratory work in a context of infrastructural instability, I aim to draw attention to the clinical laboratory space as a field site worthy of (more) anthropological inquiry and health systems research and contribute new insights about improvisation, instability, and diagnostic value creation in under-resourced settings.

Responsibility, repair and care in Sierra Leone's health system

Vernooij, E., Koker, F., Street, A., 2021
Social Science and Medicine

Central to the workings of a hospital are the technical and bureaucratic systems that ensure the effective coordination of information and biological materials of patients across time and space. In this paper, which is based on ethnographic research in a public referral hospital in Freetown, Sierra Leone, conducted between October 2018 and September 2019, we adopt a patient pathway approach to examine moments of breakdown and repair in the coordination of patient care. Through the in-depth analysis of a single patient pathway through the hospital, we show how coordination work depends on frequent small acts of intervention and improvisation by multiple people across the pathway, including doctors, managers, nurses, patients and their relatives. We argue that such interventions depend on the individualisation of responsibility for ‘making the system work’ and are best conceptualised as acts of temporary repair and care for the health system itself. Examining how responsibility for the repair of the system is distributed and valued, both within the hospital and in terms of broader structures of health funding and policy, we argue, is essential to developing more sustainable systems for repair.

Full citation:  

Vernooij, E., Koker, F., & Street, A. (2021). Responsibility, repair and care in Sierra Leone's health system. Social Science & Medicine, 114260.

NTD Diagnostics for Disease Elimination: A Review

Taylor, E.M., 2020

Neglected Tropical Diseases (NTDs) marked out for disease elimination provide a lens through which to explore the changing status of diagnosis in global health. This paper reports on the findings of a scoping review, which set out to explore the main debates around diagnosis for the elimination of NTDs, including the multiple roles diagnostic technologies are being ascribed and the ideal characteristics of tests. It also attempts to summarise the state of diagnosis for three NTDs with elimination goals. The review places special emphasis on point-of-care testing in acknowledgement of the remote and underserved areas where NTDs proliferate. Early NTD campaigns were largely focused on attack phase planning, whereby a similar set of interventions could be transplanted anywhere. Now, with elimination goals in sight, strategies must be tailored to local settings if they are to attain and sustain success. Diagnostic data helps with local adaptation and is increasingly used for programmatic decision-making. The review finds that elimination goals reframe whom diagnosis is for and the myriad roles diagnostics can play. The exigencies of elimination also serve to highlight deficiencies in the current diagnostic arsenal and development pipeline for many NTDs. Moving forward, a guiding framework is needed to drive research and stimulate investment in diagnosis to support NTD goals

Full citation:  

Taylor, E. M. (2020). NTD Diagnostics for Disease Elimination: A Review. Diagnostics, 10(6), 375.

Building diagnostic systems in Sierra Leone: The role of point-of-care devices in laboratory strengthening

Ansumana,R.,Bah,F., Biao,K., Harding,D., Jalloh, M.B., ,Kelly,A.H., Koker,F., Koroma, Z., , Momoh,, M., Rogers, M.H., Rogers, J., Street, A (corresponding author), Vernooij,E., Wurie, I., 2020
African Journal of Laboratory Medicine

On 04 March 2019, a multidisciplinary group of policymakers, biomedical and social scientists and local experts in the field of laboratory medicine convened to discuss the role of point-of-care diagnostic devices in outbreaks and their integration with healthcare infrastructure in Sierra Leone. The meeting was organised by the DiaDev research project, funded by the European Research Council under the Horizon 2020 Framework, which investigates the development of point-of-care diagnostic devices in global health and their role in transforming health systems in resource-constrained settings ( The meeting featured short presentations as well as a panel discussion with Sierra Leonean laboratory scientists and health workers, who shared their first-hand experience using rapid diagnostic tests during the Ebola outbreak. Three key insights from the day are highlighted here as disruptive and constructive contributions to debates about diagnostic futures in Africa.

Full citation:  

doi: 10.4102/ajlm.v9i2.1029

Understanding the Role of the Diagnostic ‘Reflex’ in the Elimination of Human African Trypanosomiasis

Palmer, J.J., Jones, C., Surur, E., Kelly, A., 2020
Tropical Medicine and Infectious Disease

To successfully eliminate human African trypanosomiasis (HAT), healthcare workers (HCWs) must maintain their diagnostic acuity to identify cases as the disease becomes rarer. HAT experts refer to this concept as a ‘reflex’ which incorporates the idea that diagnostic expertise, particularly skills involved in recognising which patients should be tested, comes from embodied knowledge, accrued through practice. We investigated diagnostic pathways in the detection of 32 symptomatic HAT patients in South Sudan and found that this ‘reflex’ was not confined to HCWs. Indeed, lay people suggested patients test for HAT in more than half of cases using similar practices to HCWs, highlighting the importance of the expertise present in disease-affected communities. Three typologies of diagnostic practice characterised patients’ detection: ‘syndromic suspicion’, which closely resembled the idea of an expert diagnostic reflex, as well as ‘pragmatic testing’ and ‘serendipitous detection’, which depended on diagnostic expertise embedded in hospital and lay social structures when HAT-specific suspicion was ambivalent or even absent. As we approach elimination, health systems should embrace both expert and non-expert forms of diagnostic practice that can lead to detection. Supporting multidimensional access to HAT tests will be vital for HCWs and lay people to practice diagnosis and develop their expertise.

Full citation:  

Palmer JJ, Jones C, Surur EI, Kelly AH. Understanding the Role of the Diagnostic ‘Reflex’ in the Elimination of Human African Trypanosomiasis. Tropical Medicine and Infectious Disease. 2020; 5(2):52.

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