Every year, thousands of people in Africa die from malaria and other easily treatable diseases simply because of incorrect or delayed diagnosis.

That this may soon be a thing of the past was demonstrated during a groundbreaking workshop in early health diagnostics held recently in Nairobi.

Organised by 31-year-old Dr Ratmir Derda from the University of Alberta, the workshop brought together an interdisciplinary team of biomedical engineers, doctors, and researchers from the departments of biology, physics and chemistry, with medical students from Africa, Europe and America in attendance.

Dr Derda donated part of his research prize money to the workshop, alongside the Institute of Primate Research, Kenya, and other sponsors.

Quite simply, the workshop showed that diagnostic kits can be cheap to make, and highly accurate.

“The prototype diagnostic exhibited here can be easily assembled in less equipped labs in developing countries. We asked IPR not to provide us with any equipment except a centrifuge, a socket, an oven and a printer,” said Dr Derda.

Early health diagnostics is vital to correctly identify diseases, and stop their spread at individual and national levels. In Africa, it’s mostly private hospitals and clinics that offer early diagnostics at a fee.

“In most cases in Africa,” said Dr Tom Kariuki of IPR, “we treat without testing, on the basis of symptoms, because we lack good diagnostic tools and testing centres.”

A recent statistic from the Kenyan Ministry of Health website shows that 169,000 cases of malaria were reported in one week.

“Out of those, only 58 per cent were confirmed by diagnostics; 42 per cent of the cases were treated without prior diagnosis, and based purely on clinical symptoms. What that means is that 42 per cent of the cases could have been treated for malaria instead of typhoid or any other disease that causes fever in patients,” said Dr Kariuki.

“This may trigger side-effects and be counter-effective,” he continued. “By offering drugs that people don’t need, we’re offering the disease-causing malaria parasite the chance to develop resistance to those same drugs, something which is already being witnessed in Asia for first line Artemisinin-based combination drugs for malaria.”

Said Dr Derda, “The new generation diagnostic tools and equipment must be cheap, easily available, of high quality and easy to use for clinicians and lab technicians. By high quality, we mean that the equipment has to be 100 per cent sensitive and specific in detecting parasites, which means that we don’t confuse malaria with typhoid, or the HIV virus with other viral infections.”

Cheap and best

One cheap answer to diagnostics is good old paper. Dr Derda showed me a prototype of a paper “petri dish” he has invented that can be assembled with scotch tape and blotting paper in a few minutes.

The petri dish, invented by Julius Petri (1852-1921) to grow and identify bacteria responsible for many diseases, is still the undisputed king of the lab. However, the manufacture of petri-dishes in developing countries is a challenge due to the high cost of production and the technology used.

Using paper is the breakthrough. “Paper has certain useful chemical properties, allowing molecules to flow right through it. So you place your sample of urine, blood or saliva from the patient on one side, and on the other side the detecting agent. Both flow to the middle and meet. If the colour changes to red, the test is positive, while blue is a negative reading. This can be used for testing diseases ranging from cancer to rheumatoid arthritis,” said Dr Derda.

“For innovative diagnostics we need interdisciplinary teams like biomedical engineers, chemists and physics working together. As a country we’re not making much progress because we’re not looking at interdisciplinary sciences.

"For example, to design the paper diagnostic kit, you need a material scientist who understands fluid dynamics and knows what kind of paper works best, to work in collaboration with a biologist who is familiar with the disease.

"And then you need clinicians to evaluate the diagnostic tools and policy makers and regulators who will take custody of the diagnostic device when it’s ready to be rolled out into the national healthcare system,” said Dr Kariuki.

“This group is driven by the desire to use the best science to deliver the best tools to people who need them the most,” said Kariuki.

“We want to draw international scientists, innovators and medical engineers both locally and internationally to form a point-of-care diagnostic working group that is going to try to deal with production of tools based on good science, with on-site production, like at IPR for the paper-based technologies, instead of importing everything from the West.

"We want to evaluate them locally because not everything developed in the West works well locally, and to get all stakeholders in the healthcare system involved. We want to get to a level where the patient can say to their doctor, ‘Please do not give me a prescription until l have been diagnostically tested.’ We want to have the best diagnostic tools available in the remotest clinics.”

The engineers also unveiled a simple, easily assembled microscope as a DIY tool for use in clinics, and as a teaching tool in science classes, cutting the cost of equipping laboratories.

Salama Ashur is studying mechanical microbiology at Kenyatta University and is a researcher at the Kenya Medical Research Institute (Kemri).

“Some great ideas came out of this workshop,” she said. “The best were the practical hands-on demos. The paper-based detection kit is useful because I can use it to work with my project on the detection of the Rift Valley Fever Virus.”