Informing healthcare operations with integrated pathology, clinical, and epidemiology data: Lessons from a single institution in Kenya during COVID-19 waves.

Allan Njau, Jemimah Kimeu, Jaimini Gohil, David Nganga
Author Information
  1. Allan Njau: Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Nairobi, Kenya.
  2. Jemimah Kimeu: Department of Nursing, Aga Khan University Hospital, Nairobi, Kenya.
  3. Jaimini Gohil: Department of Pharmacy and Therapeutics, Aga Khan University Hospital, Nairobi, Kenya.
  4. David Nganga: Department of Nursing, Aga Khan University Hospital, Nairobi, Kenya.

Abstract

Pathology, clinical care teams, and public health experts often operate in silos. We hypothesized that large data sets from laboratories when integrated with other healthcare data can provide evidence that can be used to optimize planning for healthcare needs, often driven by health-seeking or delivery behavior. From the hospital information system, we extracted raw data from tests performed from 2019 to 2021, prescription drug usage, and admission patterns from pharmacy and nursing departments during the COVID-19 pandemic in Kenya (March 2020 to December 2021). Proportions and rates were calculated. Regression models were created, and a -test for differences between means was applied for monthly or yearly clustered data compared to pre-COVID-19 data. Tests for malaria parasite, , rifampicin resistance, blood group, blood count, and histology showed a statistically significant decrease in 2020, followed by a partial recovery in 2021. This pattern was attributed to restrictions implemented to control the spread of COVID-19. On the contrary, D-dimer, fibrinogen, CRP, and HbA1c showed a statistically significant increase (-value <0.001). This pattern was attributed to increased utilization related to the clinical management of COVID-19. Prescription drug utilization revealed a non-linear relationship to the COVID-19 positivity rate. The results from this study reveal the expected scenario in the event of similar outbreaks. They also reveal the need for increased efforts at diabetes and cancer screening, follow-up of HIV, and tuberculosis patients. To realize a broader healthcare impact, pathology departments in Africa should invest in integrated data analytics, for non-communicable diseases as well.

Keywords

References

  1. Trop Med Infect Dis. 2021 May 10;6(2): [PMID: 34068615]
  2. Nat Rev Immunol. 2021 Aug;21(8):469-470 [PMID: 34168345]
  3. Pan Afr Med J. 2020 Jul 24;35(Suppl 2):122 [PMID: 33282077]
  4. Lancet. 2021 May 01;397(10285):1637-1645 [PMID: 33933206]
  5. S Afr Med J. 2020 Nov 05;110(12):1201-1205 [PMID: 33403966]
  6. CA Cancer J Clin. 2021 May;71(3):209-249 [PMID: 33538338]
  7. Nat Commun. 2021 Oct 26;12(1):6196 [PMID: 34702829]
  8. medRxiv. 2022 Feb 28;: [PMID: 35262086]
  9. Trop Med Int Health. 2021 Jul;26(7):716-719 [PMID: 33733568]
  10. BMJ Glob Health. 2020 Aug;5(8): [PMID: 32819917]
  11. Int J Nurs Stud. 2021 Sep;121:104005 [PMID: 34273806]
  12. Lancet. 2021 Apr 3;397(10281):1265-1275 [PMID: 33773118]
  13. BMC Health Serv Res. 2021 Oct 16;21(1):1105 [PMID: 34654411]
  14. Am J Trop Med Hyg. 2020 Oct;103(4):1630-1634 [PMID: 32815509]
  15. Afr J Med Pract. 1994 Mar-Apr;1(1):5-6 [PMID: 12287810]
  16. N Engl J Med. 2020 Nov 5;383(19):1813-1826 [PMID: 32445440]
  17. Int J Gen Med. 2022 Apr 21;15:4237-4246 [PMID: 35480998]
  18. Lancet Glob Health. 2016 Dec;4(12):e923-e935 [PMID: 27855871]
  19. Intern Med J. 2022 Jan;52(1):42-48 [PMID: 34432345]
  20. Int J Infect Dis. 2021 Jan;102:483-488 [PMID: 33010461]
  21. Ann Clin Microbiol Antimicrob. 2020 May 23;19(1):21 [PMID: 32446305]
  22. Indian J Pathol Microbiol. 2021 Jan-Mar;64(1):1-2 [PMID: 33433400]
  23. ATS Sch. 2020 Oct 23;2(1):13-18 [PMID: 33870319]
  24. Pan Afr Med J. 2021 May 31;39:89 [PMID: 34466191]
  25. JCO Clin Cancer Inform. 2020 Nov;4:1059-1071 [PMID: 33253013]
  26. Int J Health Policy Manag. 2021 Aug 01;10(8):462-464 [PMID: 32654433]
  27. Cochrane Database Syst Rev. 2021 Oct 22;10:CD015025 [PMID: 34679203]
  28. Int J Infect Dis. 2021 Nov;112:25-34 [PMID: 34481966]
  29. AAS Open Res. 2020 Apr 17;3:4 [PMID: 32399515]
  30. N Engl J Med. 2021 Jan 7;384(1):20-30 [PMID: 33332779]

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