Laboratory support for rural health care.

Lack of technical facilities to support diagnostic and curative medicine discourages physicians from providing rural health care. In developing countries, therefore, the first decision on most health problems is often made by auxiliaries. Such staff, in conducting basic community medicine, collect specimens for appropriate investigations. Simple tests performed by the auxiliaries themselves can assist in routine surveillance, in establishing priorities of medical care and in systematizing referrals to health centres. The simplest screening tests--of weight, temperature and haemoglobin--are the most useful. Serial weighing in childhood can monitor malnutrition, acute or chronic infections and infestations; in young adults, it can point to ill-health requiring further investigation. The finding of fever and examination of a blood film may reveal acute bacterial infection, malnutrition, malaria, hookworm, bilharzia and sickling, and thus be followed up by a thin blood film, or tests for sickle-cell and stool hookworm ova, pus cells or amoeba. The repertoire of simple laboratory investigations is largely completed by examination of sputum for acid-fast bacilli, or diplococci; by urine microscopy, with haematuria; and tests for protein or sugar, in cases of oedema or polyuria. A limited range of more elaborate tests may be available in the laboratories of district or regional hospitals. Human and technological factors which bear on the modus operandi of rural laboratories are identified and discussed.