http://localhost:8080/xmlui/handle/123456789/67 2026-10-23T09:26:24Z http://localhost:8080/xmlui/handle/123456789/5330 Title: Evaluation of Sample Rejection Rates in the Biochemistry and Hematology Departments at Parirenyatwa Group of Hospitals: A Retrospective Review from January 2024 to December 2024 Authors: Zumbani, Melinda S. Abstract: The efficacy and reliability of clinical laboratory services are foundational to patient safety and appropriate clinical decision-making, necessitating robust Quality Management Systems (QMS). Sample rejection, primarily due to pre-analytical errors, represents a critical failure in the total testing process, leading to delayed diagnoses, increased healthcare costs, and the potential for adverse patient outcomes. This retrospective observational study aimed to comprehensively assess the magnitude and causes of sample rejection at the Parirenyatwa Group of Hospitals (PGH) over a 12-month period (January to December 2024), focusing on the Clinical Chemistry and Hematology departments. The study pursued three specific objectives: to determine the overall rejection rate, identify the most common pre-analytical causes and compare rejection rates between the two major laboratory sections. Utilizing a systematic random sampling procedure for a sample size of N=385 from historical laboratory records, the data were subjected to descriptive analysis to calculate rates and frequencies of error. The results revealed a critically high overall sample rejection rate of 8.0% across both departments, substantially exceeding the international quality benchmark of less than 2% recommended by the World Health Organization. Biochemistry recorded a marginally higher rate (8.3%) compared to Hematology (7.7%). Analysis of rejection reasons confirmed that the problem is overwhelmingly pre-analytical in nature, with the three leading causes being clotted samples (31.1%), hemolyzed samples (21.3%), and insufficient sample volume (18.0%). The majority of rejected specimens originated from inpatient wards. The minimal 0.6% difference in rejection rates between Hematology and Biochemistry is a pivotal finding, suggesting that the root causes are systemic, primarily related to inconsistent phlebotomy techniques, training deficits, and lack of rigorous supervision across the hospital rather than being confined to specific departmental processes. In conclusion, the high and unsustainable sample rejection rate at PGH demands urgent, hospital-wide intervention to safeguard diagnostic quality. Key recommendations include strengthening mandatory phlebotomy training and periodic competency assessments, enhancing quality control and supervision within inpatient wards— the main source of errors—and implementing stricter sample labelling and identification protocols. Addressing these systemic pre-analytical vulnerabilities is essential for improving laboratory efficiency, reducing costs, and ultimately supporting optimal patient management and clinical outcomes. 2025-01-01T00:00:00Z http://localhost:8080/xmlui/handle/123456789/5329 Title: D-Dimer Levels and Their Impact on Predicting COVID-19 Disease Progression: A Retrospective Study at Diagnostic Laboratory, Zimbabwe from December 2019–December 2020 Authors: Shumba, Lenah Abstract: The COVID-19 pandemic, caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), is frequently associated with a hypercoagulable state often reflected by elevated D-dimer levels. This retrospective observational cohort study aimed to evaluate the prognostic utility of D-dimer levels upon patient presentation for predicting subsequent COVID-19 disease progression and overall patient outcomes in a Zimbabwean healthcare context. The study analyzed existing medical records of COVID-19 positive patients tested at the Diagnostic Laboratory Services (DLS) in Bulawayo, Zimbabwe, between December 2019 and December 2020.Data collected included demographic information, D-dimer values, and COVID-19 disease progression, with patients stratified by ward (Casualty, Isolation, High Dependency Unit, and Intensive Care Unit ) to assess severity.Results showed a clear correlation between elevated D-dimer values and increased disease severity. A Receiver Operating Characteristic (ROC) curve analysis was used for predicting severe disease yielded a strong Area Under the Curve (AUC) of 0.881. The optimal D-dimer cutoff value to predict severe COVID-19 was found to be 1.12 μg/mL. Using this cutoff would correctly capture 82% of severe patients (sensitivity). A logistic regression further confirmed D-dimer as a strong predictor, showing that higher D-dimer values were associated with a sharply increased probability of severe disease. In conclusion, this study demonstrates that D dimer is a valuable, readily accessible biomarker for rapid risk stratification. This early, effective stratification can facilitate the timely implementation of intensified monitoring, appropriate anti coagulation strategies, and ultimately contributing to improved clinical outcomes and survival rates within the Zimbabwe healthcare system. 2025-01-01T00:00:00Z http://localhost:8080/xmlui/handle/123456789/5328 Title: Prevalence, Clinical Distribution, and Antifungal Resistance Patterns of Candida Species Isolated from Patients at Parirenyatwa Group of Hospitals from 2023 to 2025 Authors: Gatiya, Joyleen Abstract: Candida infections are increasingly recognized as a major public health concern, particularly in immunocompromised patients such as those undergoing chemotherapy, living with HIV, or experiencing vaginal and gestational health complications. At Parirenyatwa Group of Hospitals, the absence of routine species-level identification and antifungal susceptibility testing (AST) poses a significant challenge to effective treatment. This study aimed to determine the local prevalence, species distribution, and antifungal resistance patterns of Candida isolates. A combined retrospective (January 2023–July 2025) and prospective (April 2025–October 2025) study was conducted, analyzing 271 patient samples. Of these, 91 (33.6%) were Candida positive. Candida albicans accounted for 56.0% (n=51), while non albicans Candida (NAC) species made up 44.0% (n=40). The majority of isolates were obtained from patients with urinary tract infections (14.3%), those attending antenatal care (13.2%), and patients undergoing chemotherapy (12.1%). Prospective antifungal susceptibility testing, which is not routinely performed at Parirenyatwa, was conducted on 20 isolates using the EUCAST Kirby-Bauer disc diffusion method. Alarmingly high resistance to fluconazole was observed, with 90.0% (n=18/20) of isolates being resistant. Resistance was high in both C. albicans (63.6%) and NAC species (88.9%). Although females (n=49) had slightly more infections than males (n=42), statistical analysis (p=0.9955) showed no significant gender based difference. The predominance of NAC species and the near-total resistance to fluconazole indicate that empirical fluconazole therapy is unreliable and likely to fail in this setting. These findings emphasize the urgent need for routine Candida species identification and antifungal susceptibility testing to guide appropriate therapy and inform updates to local treatment guidelines. Additionally, strengthened infection prevention and control measures are crucial to limit the spread of drug-resistant Candida infections and improve patient outcomes. 2025-01-01T00:00:00Z http://localhost:8080/xmlui/handle/123456789/5327 Title: Antibiotic Susceptibility Profiling of Escherichia Coli Isolated from Clinical Urinary Samples at Lancet Laboratories in Bulawayo Authors: Mbanje, Tafara Abstract: Background and Problem Statement: Antibiotic resistance in uropathogenic Escherichia coli (UPEC) is an escalating public health threat in Zimbabwe. Limited local surveillance data on E. coli susceptibility patterns in Bulawayo hamper evidence-based antibiotic prescribing, leading to inappropriate empirical therapy and contributing to the spread of resistant strains. This study was therefore conducted to address this critical knowledge gap. Methodology: This retrospective cross-sectional study determined antibiotic susceptibility patterns of Escherichia coli isolated from urine samples at Lancet Laboratories Bulawayo between August 2024 and July 2025. Census sampling was employed, and antibiotic susceptibility testing was performed using the disk diffusion method according to Clinical and Laboratory Standards Institute guidelines. Of 2,847 urine samples with significant bacterial growth, E. coli was isolated from 1,523 (53.5%), confirming its predominance as a uropathogen. After applying exclusion criteria, 1,456 isolates were analysed. The study population comprised 78.4% females with a mean age of 42.6 years. High resistance rates were observed for ampicillin (72.6%), trimethoprim-sulfamethoxazole (52.0%), amoxicillin-clavulanate (36.6%), and ciprofloxacin (36.0%). Preserved susceptibility was noted for carbapenems (imipenem 99.0%, meropenem 99.5%), nitrofurantoin (89.1%), and gentamicin (77.2%). Extended-spectrum beta-lactamase production was identified in 26.7% of isolates, and 52.8% demonstrated multidrug resistance. Significant associations were found between antibiotic resistance and advancing age, hospital acquisition, and ESBL production. Temporal analysis revealed increasing ESBL prevalence from 24.7% to 27.8% across study quarters. These findings underscore the urgent need for revised treatment guidelines, comprehensive antimicrobial stewardship programs, and enhanced surveillance systems to address the escalating antibiotic resistance crisis in Bulawayo, Zimbabwe. 2025-01-01T00:00:00Z