Laboratory Diagnostic Capacity for Acute Febrile Illness, Afghanistan

Afghanistan’s public health system is developing following decades of war and little investment. Anecdotally, infectious disease has a major impact on childhood morbidity and mortality, but confirmed data is limited due to a lack of laboratory diagnostic capacity. The Afghan Ministry of Public Health and National Public Health Institute (MoPH/ANPHI) and the US Naval Medical Research Unit (NAMRU-3) have jointly undertaken a surveillance study of acute febrile illness (AFI/ADI) and diarrhea to identify the number of hospital admissions caused by AFI and identify the spectrum of infectious agents causing AFI. This project aimed to improve laboratory diagnostic capabilities in order to determine the antimicrobial resistance patterns of Salmonella enterica serovar Typhi, V. cholera, enterohemorrhagic E. coli, non-typhoid Salmonella, Shigella, and Brucella isolates and to describe the epidemiological characteristics and associated risk factors of AFI. To accomplish these goals, seven hospital laboratories in Kandahar, Helmand, Urozgan and Kabul Provinces underwent extensive renovations and received modernized lab equipment including ELISA, PCR and biosafety cabinets. Key personnel from each received training at the CPHL and at NAMRU-3 in Egypt on advanced diagnostic tests including Bacteriology, Molecular Biology and ELISA techniques. Regular supervision and monitoring visits were conducted in close collaboration with the epidemiologists from ANPHI. As a result, laboratory capacity for initial diagnostics to collect and process stool and blood samples to establish the key AFI/diarrhea etiologies on site was increased. The CPHL serves as an intermediate reference laboratory and NAMRU-3 as the ultimate reference laboratory to confirm a site’s testing results and quality. These seven hospitals now have increased capacity for diagnosing and recording cases of AFI/Diarrhea. Admitted patients and outpatient departments can now receive laboratory confirmation of the spectrum of infectious agents causing AFI and diarrheal diseases. Furthermore, MoPH/ANPHI has used lessons learned from this study and begun to standardize infectious disease diagnosis, shipping of samples, and laboratory biosafety protocol on a national level.