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Review
. 2022 Jan 22;18(1):5.
doi: 10.1186/s12992-022-00796-7.

The challenges of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing in low-middle income countries and possible cost-effective measures in resource-limited settings

Zamathombeni Duma  1   2 , Anil A Chuturgoon  3 , Veron Ramsuran  4 , Vinodh Edward  5 , Pragalathan Naidoo  4   6 , Miranda N Mpaka-Mbatha  4   6   7 , Khethiwe N Bhengu  4   6   7 , Nomzamo Nembe  4   6 , Roxanne Pillay  4   6   7 , Ravesh Singh  4 , Zilungile L Mkhize-Kwitshana  4   6
Affiliations
Review

The challenges of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing in low-middle income countries and possible cost-effective measures in resource-limited settings

Zamathombeni Duma et al. Global Health. .

Abstract

Diagnostic testing for the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection remains a challenge around the world, especially in low-middle-income countries (LMICs) with poor socio-economic backgrounds. From the beginning of the pandemic in December 2019 to August 2021, a total of approximately 3.4 billion tests were performed globally. The majority of these tests were restricted to high income countries. Reagents for diagnostic testing became a premium, LMICs either cannot afford or find manufacturers unwilling to supply them with expensive analytical reagents and equipment. From March to December 2020 obtaining testing kits for SARS-CoV-2 testing was a challenge. As the number of SARS-CoV-2 infection cases increases globally, large-scale testing still remains a challenge in LMICs. The aim of this review paper is to compare the total number and frequencies of SARS-CoV-2 testing in LMICs and high-income countries (HICs) using publicly available data from Worldometer COVID-19, as well as discussing possible interventions and cost-effective measures to increase testing capability in LMICs. In summary, HICs conducted more SARS-CoV-2 testing (USA: 192%, Australia: 146%, Switzerland: 124% and Canada: 113%) compared to middle-income countries (MICs) (Vietnam: 43%, South Africa: 29%, Brazil: 27% and Venezuela: 12%) and low-income countries (LICs) (Bangladesh: 6%, Uganda: 4% and Nigeria: 1%). Some of the cost-effective solutions to counteract the aforementioned problems includes using saliva instead of oropharyngeal or nasopharyngeal swabs, sample pooling, and testing high-priority groups to increase the number of mass testing in LMICs.

Keywords: Cost-effective strategies; Diagnostic testing challenges; Low-middle-income countries; Resource-limited settings; SARS-CoV-2.

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Conflict of interest statement

There are no competing interests declared by the authors.

Figures

Fig. 1
Fig. 1
Prisma flow chart for SARS-CoV-2 literature articles and data search strategies
Fig. 2
Fig. 2
The number of SARS-CoV-2 tests (%) performed in high-income and middle-low-income countries and these samples represents counties of each income group. High-income countries are highlighted in red, middle-income countries are highlighted in yellow, and low-income countries are highlighted in green [10]. High-income countries (USA, Switzerland, Australia, Canada, Germany). Middle-income countries (Venezuela, Vietnam, South Africa, Brazil). Low-income countries (Bangladesh, Uganda, Nigeria)
Fig. 3
Fig. 3
Comparison between the total population size (million) and the total number of SARS-CoV-2 tests performed (million) in each country [10]. High-income countries (USA, Switzerland, Australia, Canada, Germany). Middle-income countries (Venezuela, Vietnam, South Africa, Brazil). Low-income countries (Bangladesh, Uganda, Nigeria)
Fig. 4
Fig. 4
A summary of the major challenges that LMICs have when it comes to SARS-CoV-2 testing, as well as possible cost-effective strategies for increasing mass testing
See this image and copyright information in PMC

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