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Open AccessArticle

Understanding the Role of the Diagnostic ‘Reflex’ in the Elimination of Human African Trypanosomiasis

1
Department of Global Health & Development, London School of Hygiene & Tropical Medicine, 15–17 Tavistock Place, London WC1H 9SH, UK
2
Centre of African Studies, University of Edinburgh, 15a George Square, Edinburgh EH8 9LD, UK
3
Kemri-Wellcome Trust Research Programme, P.O. Box 230, Kilifi 80108, Kenya
4
Independent consultant, Juba, South Sudan
5
Department of Global Health & Social Medicine, King’s College London, 30 Aldwych, London WC2B 4BG, UK
*
Author to whom correspondence should be addressed.
Trop. Med. Infect. Dis. 2020, 5(2), 52; https://doi.org/10.3390/tropicalmed5020052
Received: 7 December 2019 / Revised: 20 March 2020 / Accepted: 26 March 2020 / Published: 1 April 2020
To successfully eliminate human African trypanosomiasis (HAT), healthcare workers (HCWs) must maintain their diagnostic acuity to identify cases as the disease becomes rarer. HAT experts refer to this concept as a ‘reflex’ which incorporates the idea that diagnostic expertise, particularly skills involved in recognising which patients should be tested, comes from embodied knowledge, accrued through practice. We investigated diagnostic pathways in the detection of 32 symptomatic HAT patients in South Sudan and found that this ‘reflex’ was not confined to HCWs. Indeed, lay people suggested patients test for HAT in more than half of cases using similar practices to HCWs, highlighting the importance of the expertise present in disease-affected communities. Three typologies of diagnostic practice characterised patients’ detection: ‘syndromic suspicion’, which closely resembled the idea of an expert diagnostic reflex, as well as ‘pragmatic testing’ and ‘serendipitous detection’, which depended on diagnostic expertise embedded in hospital and lay social structures when HAT-specific suspicion was ambivalent or even absent. As we approach elimination, health systems should embrace both expert and non-expert forms of diagnostic practice that can lead to detection. Supporting multidimensional access to HAT tests will be vital for HCWs and lay people to practice diagnosis and develop their expertise. View Full-Text
Keywords: South Sudan; human African trypanosomiasis; diagnosis; symptoms; treatment-seeking; case detection; elimination; embodiment; expertise; serendipity South Sudan; human African trypanosomiasis; diagnosis; symptoms; treatment-seeking; case detection; elimination; embodiment; expertise; serendipity
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MDPI and ACS Style

Palmer, J.J.; Jones, C.; Surur, E.I.; Kelly, A.H. Understanding the Role of the Diagnostic ‘Reflex’ in the Elimination of Human African Trypanosomiasis. Trop. Med. Infect. Dis. 2020, 5, 52. https://doi.org/10.3390/tropicalmed5020052

AMA Style

Palmer JJ, Jones C, Surur EI, Kelly AH. Understanding the Role of the Diagnostic ‘Reflex’ in the Elimination of Human African Trypanosomiasis. Tropical Medicine and Infectious Disease. 2020; 5(2):52. https://doi.org/10.3390/tropicalmed5020052

Chicago/Turabian Style

Palmer, Jennifer J.; Jones, Caroline; Surur, Elizeous I.; Kelly, Ann H. 2020. "Understanding the Role of the Diagnostic ‘Reflex’ in the Elimination of Human African Trypanosomiasis" Trop. Med. Infect. Dis. 5, no. 2: 52. https://doi.org/10.3390/tropicalmed5020052

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