**5. Discussion on the choice to be made for equipment acquisition**

For better use of data in **Table 1**, it will be broken down below with two subsidiaries: **Tables 2** and **3**.

The information contained in **Table 2** will highlight the performance of the equipment according to different migration or embedded media available, while those in **Table 3** will compare the systems sold compared to hardware, installation constraints, execution time, and cost.

A cursory reading shows that the most efficient migration support remains one of the capillary methods (liquid vein): this support brings in itself the best return for the resolution, reproducibility, discrimination, and quantification, while the parasitic effects are almost nonexistent. But medical needs and health goals differ from one level to another and do not require in all cases the acquisition of such technology.

For routine screening for sickle cell disease, for example, the performance of migration on cellulose acetate amply suffices needs. This assumes that the precise separation variants like Hb A2, Hb C, Hb E, and Hb O are not a need first. On the other hand, as part of the requirements to cover, the effective separation of Hb S and Hb C variant is needed, and migration on agarose gel will best meet this requirement.

systems, the materials that make up, their costs, and maintenance requirements. Below we provide a table that can guide us in assessing the choices to be made. The line "migration support" is added in order to link **Tables 2** and **3**. The analysis of the table shows that as the system moves from manual to fully automated, the necessary hardware is gradually being integrated into a compact module. From this point of view, this development provides an appreciable response

**Performances Migration support**

Separation of Hb A2 from Hb C, Hb E, and Hb O — x (migrate in

Separation of Hb S and Hb from Hb D and G — x (migrate at

Homogeneity ✓

Resolution ✓

Separation of plasma and urine proteins, lipoproteins,

*DOI: http://dx.doi.org/10.5772/intechopen.92546*

Quantification of hemoglobin with low concentration

Electroendosmosis current Very

*Performance comparison based on migration support.*

hemoglobin, and isoenzymes

(Hb A2)

**Table 2.**

**193**

Nonnative electrophoresis ✓ ✓ Native electrophoresis ✓✓ ✓ ✓ Separation of amino acids and peptides ✓✓ ✓ ✓

*Contribution of Biomedical Equipment Management to Better Management of Sickle Cell Disease…*

Separation of Hb C from Hb E and Hb O — x ✓ ✓

Separation of Hb S and Hb O — x x ✓ Separation of Hb D and Hb G — x x ✓ Rapidity Low Good Good Fast

Detection of fast-migrating variants (Hb H, Hb Bart's) — x x ✓ Precise quantification of hemoglobin fractions — x x ✓ Flexible (small and wide series) — x x ✓

Joule effect ✓ — —— Pest adsorption ✓ x xx Reproducibility — ✓ (medium) ✓ ✓ Water quality Normal Normal Normal High Demanding environment Normal Normal Normal High

**Paper Cellulose acetate**

(poor)

(bad)

high

**Agarose gel**

✓ (medium) ✓ (good) ✓

✓ (poor) ✓ ✓

✓ ✓

✓ ✓

— ✓ ✓✓

the same area)

the same rate)

— x x ✓

High High High

**Liquid vein**

to the ergonomic problems that are becoming very frequent in laboratories. On the other hand, we observe that the installation constraints are more demanding when the analysis module becomes more compact. Indeed, in addition to the quality of the electrical ground line and voltage which greatly affect the operation of systems provided, the environment requires better temperature control (air conditioning), for example, besides the requirements of the water quality.

If, during treatment, abnormal forms of hemoglobin are associated, then the choice of medium will be directed towards agarose gel for a qualitative indication or the liquid vein for a quantitative indication of Hb A2. Indeed, abnormally low Hb A and abnormally high Hb A2 correlate with the presence of some abnormal forms of hemoglobin (alpha or beta thalassemia, etc.).

If precise separation and precise quantification of the variants Hb A2, Hb C, Hb E, and Hb O are required, then the liquid vein (capillary) support should be readily chosen.

Depending on work previously defined criteria, this table can guide the choice of performance basis based migration media.

But the only performance criteria are not sufficient to make a choice of appropriate materials. It will also take into account industrial supply in terms of existing *Contribution of Biomedical Equipment Management to Better Management of Sickle Cell Disease… DOI: http://dx.doi.org/10.5772/intechopen.92546*


#### **Table 2.**

More sophisticated technology includes a capillary thermoregulation system, a control system comprising various sensors that manage optics, robotics, pneumatics, and detection, and a set of intelligent electronic cards capable of communicating with each other. Unlike previous methods, this method allows both to launch samples in an emergency without restriction and to process large series of samples. In view of the complexity of its technology, management requires competent personnel who are regularly trained by the manufacturer. Water quality and user maintenance of equipment are of paramount importance to ensure the quality of results. This assumes that the supplier provides user training for the best care.

*Human Blood Group Systems and Haemoglobinopathies*

Thanks to their flexibility in the work organization, these automated systems can equip laboratories with small volumes of samples, as well as those which process large volumes. Indeed, there are small and large models of automata to cover all these needs. Because of their high prices, these automata are acquired in public hospitals on the basis of research projects and specific programs. Private clinics acquire them for routine because of their performance. However they do have a few requirements that must be observed: the operating environment must be less dusty, the quality of

We present in **Table 1** a summary of different devices that we have reviewed.

For better use of data in **Table 1**, it will be broken down below with two sub-

The information contained in **Table 2** will highlight the performance of the equipment according to different migration or embedded media available, while those in **Table 3** will compare the systems sold compared to hardware, installation

A cursory reading shows that the most efficient migration support remains one of the capillary methods (liquid vein): this support brings in itself the best return for the resolution, reproducibility, discrimination, and quantification, while the parasitic effects are almost nonexistent. But medical needs and health goals differ from one level to another and do not require in all cases the acquisition of such technology. For routine screening for sickle cell disease, for example, the performance of migration on cellulose acetate amply suffices needs. This assumes that the precise separation variants like Hb A2, Hb C, Hb E, and Hb O are not a need first. On the other hand, as part of the requirements to cover, the effective separation of Hb S and Hb C variant is needed, and migration on agarose gel will best meet this requirement. If, during treatment, abnormal forms of hemoglobin are associated, then the choice of medium will be directed towards agarose gel for a qualitative indication or the liquid vein for a quantitative indication of Hb A2. Indeed, abnormally low Hb A and abnormally high Hb A2 correlate with the presence of some abnormal forms of

If precise separation and precise quantification of the variants Hb A2, Hb C, Hb E, and Hb O are required, then the liquid vein (capillary) support should be readily chosen. Depending on work previously defined criteria, this table can guide the choice of

But the only performance criteria are not sufficient to make a choice of appropriate materials. It will also take into account industrial supply in terms of existing

electricity flawless, the quality of pure water, and regular maintenance.

**5. Discussion on the choice to be made for equipment acquisition**

*4.2.3.3 Use*

sidiaries: **Tables 2** and **3**.

constraints, execution time, and cost.

hemoglobin (alpha or beta thalassemia, etc.).

performance basis based migration media.

**192**

*Performance comparison based on migration support.*

systems, the materials that make up, their costs, and maintenance requirements. Below we provide a table that can guide us in assessing the choices to be made.

The line "migration support" is added in order to link **Tables 2** and **3**.

The analysis of the table shows that as the system moves from manual to fully automated, the necessary hardware is gradually being integrated into a compact module. From this point of view, this development provides an appreciable response to the ergonomic problems that are becoming very frequent in laboratories.

On the other hand, we observe that the installation constraints are more demanding when the analysis module becomes more compact. Indeed, in addition to the quality of the electrical ground line and voltage which greatly affect the operation of systems provided, the environment requires better temperature control (air conditioning), for example, besides the requirements of the water quality.


non-justified expenditure of 8000€. Worse still, such equipment oversizing com-

*Contribution of Biomedical Equipment Management to Better Management of Sickle Cell Disease…*

The management of any pathology implies the appropriate choice of techniques

Very often in sub-Saharan countries, the aspect of the consequent acquisition of the necessary technology is not always thorough, and this can lead a poor quality of reported results, the inaccessible test cost for the poorest people, and the delicate

The choice of equipment performed after an objective needs analysis enables to optimize the process of acquiring, to ensure the quality of reported results, and to

According to WHO recommendations, technology assessment, device evaluation, needs planning, selection and acquisition, installation, commissioning, and finally monitoring should be part of a successful acquisition procedure [35].

Such an approach should involve all stakeholders, namely, doctors, managers,

For low-income countries, the costs of such facilities are still high overall. Indeed,

the increase in health expenditure, which represents 10% of the world's gross domestic product (GDP), is faster than the growth of the world economy. According to a new World Health Organization report on global health spending, it is increasing rapidly, particularly in low- and middle-income countries, where spending is increasing at an average of 6% per year, compared to 4% in high-income countries. Health expenditure is assumed by governments, by individuals who pay for their own care (out-of-pocket payments), and by other entities such as voluntary health insurance schemes, employer-sponsored schemes, and nongovernmental organizations. On average, 51% of a country's health expenditure is assumed by general government and more than 35% by individuals in the form of direct expenditure. One of the consequences of this situation is that every year 100 million people are

For the countries concerned, the acquisition of these health technologies requires new upstream procurement strategies to meet acquisition and operating costs. And from this point of view, some developed countries such as France are

According to a recent study conducted in the Democratic Republic of the Congo on an investment in capillary electrophoresis equipment for a project on sickle cell disease, this can contribute to improve quality and low cost of tests, if a complete

now developing group procurement procedures in public hospitals.

In the case of sickle cell anemia, the inventory of installed park shows that beside manual methods, diagnostic techniques most common in the Democratic Republic of the Congo and even in sub-Saharan Africa are phenotypic techniques. These include *the electrophoresis at different pH, the isoelectrofocusing, the capillary electrophoresis, and the high-pressure liquid chromatography.* The first three mentioned are most used for their reliability, flexibility, ease of installation, and maintenance. The prices of the equipment listed in the table remain indicative. We have taken into account only good-quality equipment commonly used in the DR Congo and by

and technologies. Indeed, beyond the medical needs that are priority, a control equipment acquisition cost is one of the major parameters providing effective

promises a substantial depreciation because it will be under-utilized.

provide more accessible costs to target populations generally poor.

**6. Conclusion**

support to strategies put in place.

biomedical engineers, and users.

plunged into extreme poverty [36].

analysis of needs is carried out upstream.

**195**

extension in other countries of sub-Saharan Africa.

operation of projects being implemented.

*DOI: http://dx.doi.org/10.5772/intechopen.92546*

#### **Table 3.**

*Comparison of systems in terms of hardware, installation constraints, acquisition cost, and maintenance level.*

The time required to perform the analyses is a very important parameter in the choice of equipment. On the one hand, it allows better management of the patient queue, and on the other hand, it ensures the management of reagents and consumables with a limited life. When the volume of samples to be treated in a routine manner is small, manual systems are suitable for both patient satisfaction and reactive management. If the volume of samples to be processed requires more than 1 day of work, the semiautomated system should be considered to resolve the queue. Finally, if the volume of samples increases further, the fully automated system will better meet expectations.

The management of reagents in the laboratory depends heavily on two important parameters that should be noted: this is the expiry date and the stability time after opening of the reagent. The expiry date indicated on the label is usually the date after which the manufacturer no longer guarantees the validity of the results, while the stability time after opening of the reagent indicates the period after which the manufacturer no longer guarantees its reliability after the first use.

Since the stability time is shorter than the expiry date itself, it will be necessary to ensure that each open reagent is consumed before that time. For example, the use of a reagent that has a stability time of 60 days and can analyze 1000 samples in a laboratory that receives only 10 samples per day is a waste. The use of this reagent before maturity requires an average daily rate of 20 samples, considering that the laboratory operates 6 days a week. Ten samples/day instead of 20 samples/day will theoretically cause the damage of half the reagent.

The level of maintenance, and in turn cost, follows the same trend: more compact system is provided and the higher level of maintenance.

Since the cost of acquiring systems increases with the complexity of the technology, it is important to ask good questions, find good answers, and make good choices based on real needs, to achieve savings. As an example, is it necessary to acquire a semiautomatic agarose gel system when, taking into account the medical needs and the volume of samples to be treated, the manual system on agarose gel support gives us satisfaction? Affirmative answer incurs an additional a

non-justified expenditure of 8000€. Worse still, such equipment oversizing compromises a substantial depreciation because it will be under-utilized.
