State of clinical labs undermines medical research in Nigeria

The lack of Level 4 Biosafety labs (BSL-4) and standard research centres where detailed examinations on dangerous and emerging pathogens can be conducted, is making it impossible for Nigeria to partake in scientific research to develop vaccines for existing and emerging ailments, BusinessDay findings have shown.

The non-existence of the modern advanced laboratories has also tamed the country’s effort in making concrete headway in playing any significant role in the global health the scene, despite its huge resources.

Health professionals fear that with most clinical laboratories in the country still far from attaining the WHO African Region (WHO/AFRO) and ISO 15189 accreditation, the outbreak of another deadly virus such as

Ebola could greatly hurt the health sector and the country at large.

Biosafety Level 4 labs are required to experiment on dangerous and exotic agents such as Ebola, which pose a high individual risk of

Aerosol-transmitted laboratory infections and life-threatening disease that are frequently fatal, for which there are no vaccines or treatments.

However, agents with a close or identical antigenic relationship to agents requiring BSL-4 containment are handled at this level until sufficient data are obtained either to confirm continued work at this level, or re-designate the level.

“Though most labs in the country boast of the necessary equipment to detect the Ebola virus and other deadly viruses in a patient, the lack of a Biosafety Level 4 infrastructure in a lab would handicap the ability of such facility to tame the bio-hazardous effect of the virus,” Anthony Emeribe, registrar, Medical Laboratory Science Council of Nigeria (MLSCN) told BusinessDay in an exclusive interview.

Though the Lahor laboratory in Irua, Edo state is currently equipped to diagnose Lassa fever and other less virulent haemorrhagic fevers, Emeribe noted that considering the extreme biohazard risk associated with some deadly viruses, there is a need for testing to be conducted under maximum biological containment conditions.

Supporting this claim, Innocent Ujah, director-general, National Institute of Medical Research (NIMR) argued that though some hospitals such as the Lagos University Teaching Hospital (LUTH), Idi-araba, have the capacity to identify most deadly viruses such as Ebola, there is a need to upgrade the human virology laboratory at NIMR to enable it appropriately conduct research into such diseases.

“We must invest in health research if Nigeria must make any headway in quality healthcare. Right now, some of our staff are on training with the National Response Team on the prevention and control of the disease using internationally designed protocol.

“We are intensifying research on Ebola in Nigeria. We have instituted proactive measures by repositioning the Emergency Preparedness and Response Team and

Research Group for national response, in case there is an outbreak in Nigeria,” Ujah stated.

However, with research on the highly contagious disease only executed  at BSL-4 laboratories which have high-containment facilities to conduct beneficial research, industry watcher are pessimistic of any positive result.

Regrettably, only two BSL-4 facilities are presently in Africa;The National Institute for Communicable Diseases of Special Pathogens Unit in Johanassburg, South Africa and Centre International de Recherches Médicales de Franceville, Gabon.

Out of over 5,000 diagnostic laboratories operating in Nigeria, only two (Pathcare Nigeria Limited laboratories and Lagos University Teaching Hospital Lab) have ISO15189 accreditation for delivery of accurate clinical laboratory while 445 Nigerian Air Force Hospital Laboratory have 5- star ranking under the WHO African Region/ Stepwise Laboratory Management Towards Accreditation (WHO/AFRO SLMTA programme), the first 5-star laboratory in Nigeria.

The WHO AFRO accreditation scheme was initiated by the WHO Regional Office for Africa, in collaboration with the United States Centre for Disease Control, with the aim of establishing a stepwise approach, using a 0- to 5-star scale in the recognition of evolving fulfilment of the ISO 15189 standard, rather than pass-fail grading.

It also encouraged health ministries in African countries to evaluate clinical laboratories and score them according to performance. Based on percentage score, accreditation levels are assigned from one to five stars.

Laboratories that receive five-star ratings are strongly encouraged to transit to the level of a reference laboratories, by acquiring an internationally established accreditation scheme, such as the ISO 15189. Those that fail to achieve an assessment score of at least 55 per cent will not be awarded a star ranking.

A peep into Nigeria’s health sector reveals that the number of clinical labs is growing fast in numbers but leaving much to be desired in quality. Increasing demand for sample tests by people seeking answers to ailments have fuelled the set-up of clinical labs. These labs are dotted in attractive diagnostic varieties.

While some labs claim that they have the capacity to test all samples, as may be requested by any health facility, others are well branded to offer quality care and others still, made to suit the environment they are located in. With a handful of equipment and reagents, medical laboratory business can hit the ground running.

However, desperate people seeking solution to health issues are never out of sight.

“There is a need for patients to take ownership of their bodies and object when doctors do not carry out laboratory tests before treating them. To put an end to patient doubts, there is the need for laboratories to be accredited by recognised bodies to ensure that they meet minimum quality management standards. Pathology supervision is also necessary,” Pamela Ajayi, managing director PathCare  Nigeria explained.

Businessday