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Global Health

Medical tests for poor countries need to be properly field-tested.

Applying modern diagnostic technologies to disease management around the globe could dramatically improve patient care. Unfortunately, many such technologies are not available or not usable in resource-poor settings.

In sub-Saharan Africa, for example, health-care practitioners treating children with severe fevers have to either make an educated guess or use a “shotgun” approach, treating for all potential illnesses from malarial infection to bacterial pneumonia. The inability to arrive at a specific diagnosis not only delays proper therapy but can increase death rates. A recent study has shown that mortality is almost twice as high in patients mistakenly diagnosed as having malaria. Those deaths could be dramatically reduced with a reliable test that can be given at the bedside.

With current advances in low-cost, portable technologies (see “Paper Diagnostic Tests”) and increasing knowledge of the biology of disease, the time is ripe to bring novel diagnostic tools to those who desperately need them. Accurate diagnoses will not only help individual patients but also yield more-precise measurements for public-health and treatment programs.

It is imperative, however, that new diagnostics be developed and tested as early as possible in the settings where they will be used–preferably in collaboration with local researchers and clinicians. Hospitals in the developing world are littered with broken x-ray machines and other donated medical equipment that does not work in humid conditions and has no replacement parts. Most businesses wouldn’t think of releasing a new product without sufficient market research or testing, and the same should be true for field-testing medical devices. Such testing will help avoid two problems that have hobbled earlier efforts: pushing newer technologies when existing or simpler technologies would be as effective, and attempting to apply technologies that work well in the controlled, sterile environment of the laboratory but not in the real world.

Given that different diseases are endemic to specific parts of the world, and that regions differ in genetics, environment, culture, sociopolitical infrastructure, and the biology of particular pathogens, a “one size fits all” approach to diagnostics is rarely appropriate. The steps leading from a promising diagnostic technology to a robust working product must be thoughtfully executed to ensure that the enormous potential of these tests is fulfilled in the places where they can do the most good.

José Miguel Trevejo is a principal scientist at Charles Stark Draper Laboratory.

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