Prince, a three-year-old boy, is brought to the emergency room in Monrovia, Liberia, with fever and a decreased level of consciousness. He is critically ill. He is treated for malaria.
Time is the only way to tell if this was the right treatment choice — but time may not be on his side. An astute nurse asks a visiting doctor if she can borrow a blood glucose monitor and nails the diagnosis: Type 1 diabetes, requiring urgent administration of insulin to save the boy’s life.
While Prince was lucky to get a correct diagnosis on time, blood glucose monitors are rarely available in resource-limited clinics in sub-Saharan Africa.
Situations like this occur daily in low-resource settings: A sick patient, a clinical suspicion, but no confirmatory testing. As a result, many patients are misdiagnosed, receive unnecessary or harmful treatments, or die.
Thankfully, blood glucose measurement — an important laboratory test — just made it onto the first edition of the WHO Essential Diagnostics List (EDL).
This new list is a great step forward in making the most crucial diagnostic tests available globally.
However, future editions of this list will need to cover an even broader range of tests.
Beyond the ‘Big Three’
The WHO EDL, published on May 16, 2018, is a first step towards addressing the “diagnostics desert” that health-care providers and patients alike still face in many resource-limited settings.
WHO and its expert committee carefully put together a priority list of essential “in vitro” (laboratory-based) diagnostics to guide governments and health-care stakeholders on what tests to make available. The aim was to address the highest priority health-care needs.
Like its 40-year-old WHO sibling, the Essential Medicines List, this list promises to have a big impact on the availability of laboratory-based diagnostics globally, and on the quality of health-care delivery and population health.
WHO and its expert committee should be applauded for this essential accomplishment, including the effort to look beyond the traditional “Big Three” infections (TB, HIV and malaria).
While the list still has an obvious focus on infectious diseases, the consideration of essential non-communicable diseases (NCD) diagnostics is timely, if not overdue.
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