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MBDS Lab Strategy Activity
Laboratory Field Survey Narrative Report
1 Purpose
The mission of the Mekong Basin Disease Surveillance (MBDS) lab survey is to provide technical support
to the MBDS Executive Board Committee and Country Coordinator Committee, for better understanding
the status quo of laboratory capacity to address specified diseases in MBDS regional, especially in the
border areas and province, and to guide the MBDS lab strategy plan development to strengthen lab
capacity in this region.
2 Description
MBDS Yunnan helps establish the standards and procedures for lab assessment, prepares the
questionnaires (annex 1) with support from Pasteur Institute, Cambodia and GHSi, and in coordination
with MBDS Coordination Office and Country Lab Coordinators, we forms the schedule of lab survey.
(Annex 2) The questionnaires are designed to address the capacity of 7 core diseases (sever pneumonia,
dengue fever, malaria, Japanese Encephalitis, cholera, EV71 and typhoid) identified by country lab
coordinator in Phnom Penh MBDS regional forum 2008.
2.1 Method
Use questionnaires for national, provincial, district and cross border lab in each member country, also a
questionnaire to general information in the country; interview with key informant in each lab and lab
visiting.
There are 8 parts related to lab capacity asked in each questionnaire.
a) lab diagnosis, including sample transportation and MBDS core diseases diagnosis capacity
b) lab human resource
c) lab equipment
d) Biosafety
e) Technical training
f) support for surveillance and response
g) Quality assurance/Quality Control
h) Urgent need for training and research
2.2 Country Assessment Results
2.2.1 Cambodia lab assessment was carried out from 22-28 Mar., we covered 3 labs from national,
provincial and cross border levels. In national level, with support from Pasteur Institute of Cambodia, it is
capable to test 5 core diseases except sever pneumonia and EV 71, and lab supply is relatively sufficient.
And the national lab also involved with a lot international lab quality assurance program. As aspect of
provincial and cross border level, the capacity is lagged for the core diseases diagnosis, in the labs we
surveyed, the labs only diagnose malaria due to not sufficient supply and human resource. Moreover,
biosafety is also a big problem to them, there is not sufficient personal protection equipment and very low
rate of biosafety training to lab staffs cause the lab staff worked in exposure environment. Suggestion
solution: Provide basic lab apparatus (standard glasswares, basic equipment and reagents) and PPE to
cross border and provincial levels, training of biosafety and basic lab operation, support national level
research on food microbiology test and clinic virology/bacteriology.
2.2.2 China (Guangxi and Yunnan) lab assessment was carried out from 2-17 Feb., we covered 7 labs
from provincial and cross border levels. In our survey to the 5 cross border sites, 3 core diseases
diagnosis (malaria, cholera and typhoid) were carrying out, and to the other 4, samples will be sent to
prefecture or provincial level for testing. And the provincial level of Yunnan and Guangxi, they all have the
capacity to diagnose the 7 core disease with sufficient lab human resource and capacity. In the past 2
years, Chinese central government implement Central/Western China Province (including Yunnan and
Guangxi) lab capacity building program, and 360,000RMB (approximate 52,900 USD) was allocated to
each county (cross border site located) to procure basic lab equipment as needed. By this year, most
equipment is ready. Finding: The priority in next stage is to training on food poisoning and virology
diagnosis of the 7 core diseases in the provincial and cross border sites, and provide research support on
rapid test, respiratory virology separation and identification, molecular biological application and
molecular epidemiology.
2.2.3 Laos lab assessment was carried out from 15-22 Jan., we covered 9 labs from national, provincial
and cross border levels. In national level, it is capable to test 6 core diseases except EV 71, and lab
supply is relatively sufficient. However, the biosafety is a gap since there is no biosafety program even in
the national level and only some SOPs included the biosafety part, that leads the coverage of biosafety
trained rate relatively lower. As for provincial and cross border level, most labs there are based in hospital,
and capacity shows great diversity in different provinces. Generally, most province can diagnose 4-5 core
diseases, and 2-3 in the cross border district. Moreover, the QA/QC program is not carried out in the lab
system. Suggest solution: Provide basic lab equipment and PPE to cross border and provincial levels,
develop comprehensive biosafety program in the national level and provide training of biosafety and
QA/QC to lower level lab staffs. On the research aspect, provide molecular diagnosis support to national
level and the QA/QC training to lower lever as well as relevant virology and bacteriology diagnosis.
2.2.4 Myanmar lab assessment was carried out from 2-8 Mar., we covered 8 human diseases labs from
national, provincial and cross border levels, at the same time, 4 animal labs were also provided precious
information to the assessment group. That is great help for us to better understand the cooperation
between human and animal sector on zoonosis, that’s also one strategy of MBDS. For human diseases
lab, in national level, it is capable to test 6 core diseases except EV 71, and questionnaires reflect the lab
supply is insufficient, moreover, there is no biosafety program even in the national level and SOPs do not
included the biosafety part; that leads the coverage of biosafety trained rate quite low (2/164). In the
survey, we noticed most lab also emphasized on the HIV/AIDS diagnosis, although it is not in the core
disease list. As for animal labs, 4 zoonosis (High pathogenic avian influenza, rabies, tuberculosis and
brucellosis) is selected as core diseases in the questionnaires, unlike human disease system, the
biosafety in animal sector is much more developed, all level already set up manuals and/or SOPs,
however, the training seems not carrying out well. And reagent and equipment of AI and serology test is
urgent needed. Suggest solution: Provide basic lab equipment and PPE to human and animal labs,
develop comprehensive biosafety program in the national level of human diseases lab and provide
training of biosafety and QA/QC to lower level lab staffs. On the research aspect, provide dengue
serology research and HIV/AIDS and STDs transmission research.
2.2.5 Thailand lab assessment was carried out from 4-9 Apr., we covered 6 labs from national, provincial
and cross border levels. In national level, it has strong capacity to diagnose all 7 core diseases, and lab
supply and equipment are sufficient. Besides, the National Institute of Health (NIH) also passed the ISO
15189, now the whole national level lab running and management complies with this standard. And a
department is newly founded to coordinate and manage in the whole lab system. Other function of NIH is
also responsible for the quality control and quality assurance system in Thailand, in the survey, we
noticed a data management system running effectively from provincial level to the central level, all the
data sheet are stored in categories and monitoring and evaluation to lower level lab is carried regularly at
least once a year. Moreover, there are 14 Regional Medical Health Center (RMHC) spread in whole
country, covered all the area of the country. Using this network, the province could transfer the sample to
the nearest RMHC in shortest time. We also surveyed one RMHC (based in Chiang Rai Province) in
Thailand, the lab there can diagnose most bacteria test, and the virus related disease samples (EV71 and
JE) will transfer to NIH. The provincial and cross border lab mostly based in hospital, Compare to the NIH
and RMHC, the lab supplies and equipment is relatively insufficient, and biosafety is also a gap in those 2
levels, especially in the cross border labs. Suggest solution: Provide basic lab equipment, PPE and lab
technician training to cross border and provincial levels, provide molecular diagnosis support to regional
level and train cross border lever on virology and bacteriology diagnosis. Provide exchange program of
lab technician with neighboring countries to regional lab.
2.2.6 Vietnam lab assessment was carried out from 19-25 Feb., we covered 7 labs from national,
provincial levels. In national level (NIHE), it is capable to test all the 7 core diseases, and lab supply and
equipment is sufficient. Biosafety program is running well now and a department in the NIHE responsible
of it, and the program also implements in each province we assessed. On the other hand, the provincial
level lab can also diagnosis most of the core diseases (5-7), but reagent and basic equipment is
insufficient. Moreover, the QA/QC system doesn’t carry out in the provincial level. Suggest solution:
Provide basic lab equipment and PPE to provincial level, develop comprehensive QA/QC program in the
national level and provide training of it to lower level lab staffs, as what reflect in the survey results, most
province hope to receive training on microbiology, food safety and occupational health, and specimen
transportation is also a priority. On the research aspect, the priority is the zoonosis diseases such as
H5N1 and rabies.
3 Recommendations
3.1 An elaborated assessment report should be developed, after reviewed by all 6 countries’ lab
coordinators, the report will be disseminated to MBDS Country Coordinators, Executive board and
Coordination Office for technical support on the lab capacity strengthening, and share with development
partners and other network.
3.2 Conduct lab resource mapping in this region to determine reference lab on specific core disease(s).
3.3 Convene MBDS lab coordinator workshop in coming MBDS regional forum to prioritize countries
needs, revise the MBDS regional lab strengthening proposal and submit to development partner.
3.4 Using the assessment results to leverage fund for MBDS lab strategy.
Annex 1
MBDS Laboratory Core Capacity Questionnaire
(General Information, suggested completed by Lab CO)
Country/Provincial
Key informant:
Tel:
Email:
2007 2008
1 General information
1.1 No. of National level lab(s)
1.2 Total number of provinces in your country
1.2.1 No. of provincial lab(s)
1.3 No. of cross border sites
1.3.1 No. of lab(s) at cross border
1.4 National Reference Labs designated by national
authority
1.4.1 Activities covered by the National Reference
laboratories
1.4.2 No. and location of BSL-3 Laboratories
1.4.3 No. and location of BSL-2 Laboratories
1.4.4 No. and location of animal facilities and
insectariums
1.5 No. and location of WHO accredited lab. (Polio,
dengue, JEV, malaria, NIC, others)
1.6 Existing links with WHO Reference Labs for
specimen sharing (pathogens, name of the WHO
Reference lab)
MBDS Laboratory Core Capacity Questionnaire
(National level)
Country/Provincial/District: Key informant:
Tel: Fax:
Email:
2 National lab(s)
2.1 Lab Policy/guideline
2.1.1 Did MoH develop lab services policy/strategy?
2.1.2 Is there any unit/person in MoH responsible for
lab coordination?
2.1.3 Was lab inventory carried out?
2.2 Lab diagnosis
2.2.1 Are there SOPs for specimen collection, storage
and transport?
2.2.2 Are National labs participating to any
international quality assessment program? If
yes, specify
2.2.3 Are lab supplies sufficient?
2.2.4 Is there a guideline for supplies stock
management?
2.2.5 Specify the diagnostic methods used for the
following diseases or syndromes
2.2.5.1 Sever pneumonia
2.2.5.2 Dengue Fever
2.2.5.3 Malaria
2.2.5.4 Japanese Encephalitis
2.2.5.5 cholera
2.2.5.6 Enterovirus type 71
2.2.5.7 Typhoid
2.2.6 Are there any rapid tests adopted for the
diseases listed above?
Please specify.
2.3 Human resources
2.3.1 Total No. of lab staff
2.3.2 No. of Biologists/Pathologists
2.3.3 No. of Lab Assistants/Supervisors
2.3.4 No. of Lab. Technicians
2.3.5 Others
2.4 Lab Equipment (in good condition)
2.4.1 No. of biosafety cabinets (specify if there is a
maintenance contract to change filters and to
control the number of particles)
2.4.2 No. of deep freezers (-80°C)
2.4.3 No. of fridges and -20°C freezers
2.4.4 No. of microscopes (specify: standard, inverted
or fluorescence)
2.4.5 No. of centrifuges (specify : standard or
refrigerated)
2.4.6 No. of ELISA washer and reader
2.4.7 No. of incubtors (specify : standard and CO2)
2.4.8 No. of computers used for lab data management
2.4.9 Are equipments under maintenance contract
with the suppliers or controlled regularly by a
technician ?
2.5 Biosafety
2.5.1 Did MoH establish biosafety program? /was the
program implemented and reviewed regularly?
2.5.2 Were SOPs/manuals for biosaftety prepared?
2.5.3 How many lab staffs were trained on biosatety?
2.6 Technical training
2.6.1 No. of staff trained in 2007 & 2008
2.6.2 No. of training courses held (mention aims of
training courses)
2.7 Support of surveillance and response
2.7.1 No. of lab staff included in SRRT
2.7.2 In how many outbreaks lab investigations were
conducted?
2.7.3 Total No. of outbreaks (per disease or
syndrome)
2.8 Quality assurance/Quality control
2.8.1 Check list developed for quality assessment of
non-national labs ?
2.8.2 Quality assurance program carried out for
non-national labs ?
Others
Priority research needs
Priority training needs
MBDS Laboratory Core Capacity Questionnaire
(Provincial level)
Country/Provincial/District: Key informant:
Email: Mobile:
3 Regional/Provincial level labs
3.1 Lab diagnosis
3.1.1 Are there SOPs for specimen collection,
storage and transport?
3.1.2 Participating any internal/external quality
assessment program?
3.1.3 Are lab supplies (reagents, equipments, ..)
sufficient? If no, what are the needs
3.1.4 Is there guideline for supplies stock
management?
3.1.5 Specify the diagnostic methods used for the
following diseases or syndromes
3.1.5.1 Sever pneumonia
3.1.5.2 Dengue Fever
3.1.5.3 Malaria
3.1.5.4 Japanese Encephalitis
3.1.5.5 Cholera
3.1.5.6 Enterovirus type 71
3.1.5.7 Typhoid
3.2 Human resources
3.2.1 Total No. of lab staff
3.2.2 No. of Biologists/Pathologists
3.2.3 No. of Lab Assistants/Supervisors
3.2.4 No. of Lab. Technicians
3.2.5 Others
3.3 Lab Equipment
3.3.1 No. of biosafety cabinets (specify if there is a
maintenance contract to change filters and to
control the number of particles)
3.3.2 No. of deep freezers (-80°C)
3.3.3 No. of fridges and -20°C freezers
3.3.4 No. of microscopes (specify: standard, inverted
or fluorescence)
3.3.5 No. of centrifuges (specify : standard or
refrigerated)
3.3.6 No. of ELISA washer and reader
3.3.7 No. of incubators (specify : standard and CO2)
3.3.8 No. of computers used for lab data
management
3.3.9 Are equipments under maintenance contract
with the suppliers or controlled regularly by a
technician?
3.4 Biosafety
3.4.1 Were SOPs/manuals for biosaftety prepared?
3.4.2 How many lab staffs were trained on biosafety?
3.5 Technical training
3.5.1 No. of staff trained in 2007 & 2008
3.5.2 No. of training courses held (mention aims of
training courses)
3.6 Support of surveillance and response
3.6.1 No. of lab staff included in SRRT
3.6.2 In how many outbreaks lab investigations were
conducted?
3.6.3 Total No. of outbreaks (per disease or
syndrome)
3.7 Quality assurance/Quality control
3.7.1 Check list developed for quality assessment of
lower level lab?
3.7.2 Quality assurance program carried out
internal/external?
Others
Priority training needs
Is there any policy to refer systematically some specimens
to National Lab? If yes, please specify
MBDS Laboratory Core Capacity Questionnaire
(Cross border)
Country/Provincial/District: Key informant:
Tel: Fax:
Email:
4 Regional/Provincial level labs
4.1 Lab diagnosis
4.1.1 Are there SOPs for specimen collection,
storage and transport?
4.1.2 Participating any internal/external quality
assessment program?
4.1.3 Are lab supplies (reagents, equipments, ..)
sufficient? If no, what are the needs
4.1.4 Is there guideline for supplies stock
management?
4.1.5 Specify the diagnostic methods used for the
following diseases or syndromes
4.1.5.1 Sever pneumonia
4.1.5.2 Dengue Fever
4.1.5.3 Malaria
4.1.5.4 Japanese Encephalitis
4.1.5.5 Cholera
4.1.5.6 Enterovirus type 71
4.1.5.7 Typhoid
4.2 Human resources
4.2.1 Total No. of lab staff
4.2.2 No. of Biologists/Pathologists
4.2.3 No. of Lab Assistants/Supervisors
4.2.4 No. of Lab. Technicians
4.2.5 Others
4.3 Lab Equipment
4.3.1 No. of biosafety cabinets (specify if there is a
maintenance contract to change filters and to
control the number of particles)
4.3.2 No. of deep freezers (-80°C)
4.3.3 No. of fridges and -20°C freezers
4.3.4 No. of microscopes (specify: standard, inverted
or fluorescence)
4.3.5 No. of centrifuges (specify : standard or
refrigerated)
4.3.6 No. of ELISA washer and reader
4.3.7 No. of incubtors (specify : standard and CO2)
4.3.8 No. of computers used for lab data
management
4.3.9 Are equipments under maintenance contract
with the suppliers or controlled regularly by a
technician?
4.4 Biosafety
4.4.1 Were SOPs/manuals for biosaftety prepared?
4.4.2 How many lab staffs were trained on biosatety?
4.5 Technical training
4.5.1 No. of staff trained in 2007 & 2008
4.5.2 No. of training courses held (mention aims of
training courses)
4.6 Support of surveillance and response
4.6.1 No. of lab staff included in SRRT
4.6.2 In how many outbreaks lab investigations were
conducted?
4.6.3 Total No. of outbreaks (per disease or
syndrome)
4.7 Quality assurance/Quality control
4.7.1 Check list developed for quality assessment of
lower level lab?
4.7.2 Quality assurance program carried out
internal/external?
Others
Priority training needs
Is there any policy to refer systematically some specimens
to National Lab? If yes, please specify
Annex 2
MBDS Lab Survey Agenda
Country Lab Name Lab Type Date Key informant
Cambodia
General information 23, Mar,2009 Choup Sokheng
National Lab National 23, Mar,2009 Ly Sovann
Svay Reang Provincial 25, Mar,2009 Ke Rotha
Takeo Cross Border 27, Mar, 2009 Nuth Sinath
China (Guangxi)
General information 2,Feb, 2009 Liu Huiyang
Guangxi CDC Lab Provincial 2, Feb, 2009 Liu Huiyang
Lin Mei, Gong Jian
Dongxing City CDC
lab
District 3-4, Feb, 2009 Zhao Huaide, Pang
Guoqing
Pingxiang City CDC
Lab
District 5-6, Feb, 2009 Chen Chunmao
China (Yunnan)
General information 9, Feb, 2009 Duan Zhiquan,
Chang Litao
Mengla County
CDC Lab
District 11, Feb, 2009 Yang Shunyun
Luchun County
CDC Lab
District 13, Feb, 2009 Bai Hailin
Ximeng Country
CDC Lab
District 17, Feb, 2009 Cheng Xianjun
Laos
General information 15, Jan, 2009 Thongchanh SISOUK
NCLE National 15, Jan, 2009 Thongchanh SISOUK
Bokeo Province Provincial 16, Jan, 2009 Soupha PANYADA
Champasack
province
Provincial 17, Jan, 2009 Bountiem and
Nanthasan
Kong District Cross Border 18, Jan, 2009 Bountiem and
Nanthasan
Savannakhet
Provincial Hospital
Provincial 19, Jan, 2009 Vatsana
Sepone District Cross Border 20, Jan, 2009 Phanmkla BISY
Borikhamxay Provincial 21, Jan, 2009 Somphone and
Douangngong
Khamkeuth Cross Border 22, Jan, 2009 Somephone
Loungnamtha
province
Provincial 23, Jan, 2009 Sengvong and
Khammone
Myanmar
General information 2. Mar,2009 Maung Maung Kyin
National lab national 2. Mar,2009 Maung Maung Kyin
Mandalay provincial 3. Mar,2009 Khin Aye Win
Ayeyarwady, provincial 4. Mar,2009 Sum Dun
Country Lab Name Lab Type Date Key informant
Pathein
Shan (South),
Taungyi
provincial 5. Mar,2009 Aye Aye Than
Shan (North),
Lashio
Cross border 6. Mar,2009 Ma Mya Win
Shan (East), Muse Cross border 7. Mar,2009 Win Win Myint
Shan (East),
Kyaingtone
Cross border 7. Mar,2009 Kyaw Htun Khaing
Kachin, MyitKyiNa Cross border 8. Mar,2009 Khin Ma Ma
Thailand
Don Tan Hospital
Lab
Cross border 4, Apr, 2009
Mukdahan Hospital Provincial 4, Apr, 2009
NIH National 7, Apr, 2009 Rungreung
General Information 7, Apr, 2009 Rungreung, Sirivan
Chiang Rai Hospital
Lab
Provincial 8, Apr, 2009
Regional Medical
Center
provincial 8, Apr, 2009
Maesai Hospital Lab Cross Border 9, Apr, 2009
Vietnam
General Information 19. Feb, 2009 Tran Nhu Duong
NIHE National 19. Feb, 2009 Nguyen Thanh Thuy,
Tran Nhu Duong
Ha Tinh provincial 20. Feb, 2009 Bui Van Bon
An Giang provincial 21. Feb, 2009 Pham Van Be
Lai Chau provincial 22. Feb, 2009 Nguyen Van Doi
Lang Son provincial 23. Feb, 2009 Trieu Cao tan
Quang Ninh provincial 24. Feb, 2009 Nguyen Van Thich
Quang Tri provincial 25. Feb, 2009 Tran Kim Phung
Annex 3 Assessment Photos