**3. Situation of medical equipment dedicated to the analysis of hemoglobinopathies**

In the field there are currently different types of electrophoresis equipment. However, to date, it is difficult to determine their number, origins, and brands, *Contribution of Biomedical Equipment Management to Better Management of Sickle Cell Disease… DOI: http://dx.doi.org/10.5772/intechopen.92546*

given the country's size, diverse supply methods, and ineffective control mechanisms. Nevertheless, some facilities stand out from the others in terms of their number, mainly for historical and geographical, economic, and commercial reasons.

Historically and geographically, sickle cell disease was first discovered in black populations in Africa and in the Arabian Peninsula; to date it remains more frequent in these geographical areas. Initially, this disease, which later turned out to be hereditary, did not directly affect the Indo-European populations.

However, due to massive immigration, countries with well-organized prevention programs are now faced with the problems of uninformed couples of allochthonous origin, as well as variations in specific population characteristics, which is rare among indigenous populations [16].

In the early 1970s, screening tests were launched in the United States, and the American population of African origin was indeed very affected. In 1981, an experimental neonatal screening program began in the French Antilles and metropolitan France. It is set up by the Association Française pour le Dépistage et la Prévention du Handicap (AFDPHE). It was only in 2000 that neonatal screening for sickle cell disease was, this time, extended in whole France [17].

As a result of the above, electrophoresis systems are initially more equipped with routine programs dedicated to serum protein analysis; programs for the analysis of hemoglobinopathies will gradually come into operation. Indeed, the implementation of new programs involves significant costs that the manufacturer cannot incur without a guaranteed return on investment.

Since the greatest need for sickle cell disease management is in Africa, countries with strong historical ties to the continent will find it easier to sell their technologies to this potential market. Among them we will mention the most prominent firms such as HELENA, TITAN, BECKMAN SEBIA, and BIORAD.

In financial terms, the choice of equipment for routine needs will focus more on technical solutions that offer good results at lower cost. From this point of view, for the analysis of hemoglobinopathies, there is an established correlation between agarose gel electrophoresis on the one hand and capillary electrophoresis on the other [18]. On the other hand, high-performance liquid chromatography (HPLC) and capillary techniques are complementary and can be used routinely, knowing that capillary diagrams are easier to read and interpret than those obtained in HPLC. Even better, the development of the capillary technique for the characterization of hemoglobin variants suggested that it would become the first method of choice for screening in many clinical laboratories [19].

This trend is confirmed with regular innovations from certain manufacturers, and this is the case of SEBIA, which has added to its range for the screening of hemoglobinopathies [20]. In addition, the capillary technique is more sensitive than the HPLC technique for the detection of certain variants such as hemoglobin New York [21].

On the commercial level, thanks to their historical links with Africa, the first companies are more easily organized and set up local representations of their firms to facilitate the sale of their products. Among the first to obtain country-level representation are HELENA and BECKMAN.

But for almost two decades, we have been observing the rise of the SEBIA company, which offers different models of equipment according to the needs and which regularly innovates its products. Today, this firm, now a world leader in the field of electrophoresis, is among those with a large number of distributors in Africa.

Apart from the abovementioned brands, it is worth noting a slow penetration of products of Asian origin in the field. However, while the financial offer is attractive, distribution is still struggling to be structured in terms of regularity, reliability, and operation.

needs, acquisition, and maintenance of the systems acquired, are among the issues addressed. These topics involve a lot of money that will have to be put to good use; otherwise they can be a source of conscious or unconscious waste of scarce resources. In the case of the DR Congo, a reflection carried out on the medical technical platform shows that the objectives assigned to medical infrastructure and equipment through national programs are never achieved and the situation is getting more complicated every year. And yet, after evaluation, the same programs continue with the same objectives and use practically the same methods [10]. In order to minimize procurement costs, the WHO proposes a strategic procurement approach to achieve

This diagram raises fundamental questions that need to be answered if we are to

The fourth path, a corollary to the third, consists of mobilizing and structuring human skills, each in its own sector, to boost the strategic purchasing process. Since the problem of strategic purchasing concerns all sectors, what can the biomedical

From this point of view, the biomedical engineer can play an important role as a technical interface between the hospital, suppliers, and industry to make the right choices, as he is considered responsible for the research and development, architecture, selection, management, and safe use of all types of medical devices including single-use, reusable, prosthetic, implantable, and bionic devices, among

For several decades, a developed country like France has been efficiently involving biomedical engineers in the medical equipment procurement process [13]. It organizes hospital purchasing, where biomedical engineers play a leading role in the purchasing function that has developed in companies over the last 30 years or so [14]. Better still, it is developing a purchasing policy that, among other things, brings together the skills of biomedical engineers to offer end customer equipment negotiated at attractive prices through group purchasing [15].

But in the Democratic Republic of the Congo in particular and in sub-Saharan Africa in general, the biomedical engineering component does not seem to be sufficiently integrated at its best in the administrative and technical response mechanisms for improving health care. This aspect of things can only lead to a waste of funds when the actors at this stage do not master the equipment.

In the field there are currently different types of electrophoresis equipment. However, to date, it is difficult to determine their number, origins, and brands,

**3. Situation of medical equipment dedicated to the analysis of**

succeed in our efforts. Indeed, countries cannot simply spend their money on universal health coverage. They must master purchasing, define the relationships between suppliers and buyers, define a purchasing strategy on the basis of useful data before disbursement, and finally move from passive purchasing to strategic

engineer's contribution be as far as it is concerned?

purchasing.

others [12].

**hemoglobinopathies**

**182**

universal health coverage [11]. The illustration below is more explicit.

*Human Blood Group Systems and Haemoglobinopathies*

In the present case of the management of sickle cell disease and in order to make his contribution relevant and effective, the biomedical engineer must make an inventory of the existing situation in the field, evaluate the technologies in the state of the art, and propose material solutions that present a better compromise between technical and technological contributions and optimization of the financial aspect.

edges of the support, and the center moves faster, distorting the migration band. Finally, the Joule effect heats the substrate and therefore evaporates the solvent; this is gradually replaced by the liquid of the vessels which rises in the support by capillary action, opposite both ends of the support, and annulling in the middle [23].

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

The supports must be chemically inert (low adsorbent) and homogeneous (reg-

Paper is a natural cellulose; it is no longer used much because it is not homogeneous. Paper electrophoresis provides a strong electroendosmosis current and is a source of parasitic adsorptions (added chromatography), resulting in poor resolution; the Joule effect is important with heating, evaporation, and even electrolysis of the buffer. At high pressure (1000–3000 V), paper electrophoresis is mainly used to

Cellulose acetate is much more homogeneous than paper; this support allows densitometric reading, but the electroendosmosis current remains high. The applications of cellulose acetate are mainly found in medical biology, allowing a quantitative densitometric reading of the protein fractions rather roughly separated (plasma and urinary proteins, lipoproteins, and hemoglobins), or finer (isoen-

However, at alkaline pH (typically pH 8.6), Hb A2, Hb C, Hb E, and Hb O migrate to the same area, and Hb S, Hb D, and Hb G migrate at the same rate. In the case of suspicions of such hemoglobin abnormalities, an additional technique should

Starch gel is a polyoside; electrophoresis on this gel allows the separation of complex or heterogeneous oligomeric protein associations. Starch gel is little used

Agarose is desulfonated agar (purified agar); removal of sulfonates greatly limits the flow of electroendosmosis; agarose gels between 0.5 and 2% are not very viscous. They make it possible to carry out native electrophoresis as with the previous supports, that is, without denaturation of the macromolecules. Potential gradients up to 50 V cm<sup>1</sup> are usable for protein separation; agarose gel is gradually replacing cellulose acetate in most biomedical applications because agarose improves resolution and remains colorless, allowing a good densitometric reading. The agarose gel is also very homogeneous, thus ensuring good reproducibility, and is well adapted to

The distinction between the different variants Hb A2, Hb C, Hb E, and Hb O, as well as Hb S, Hb D, and Hb G, is most often made by electrophoresis on agarose gel

. Resolution is

zymes), applying the potential gradients of the order of 30 V cm<sup>1</sup>

ular microporous structure), have good mechanical resistance (handling), and

*4.1.2.2 Supports*

*4.1.2.2.1 Paper*

possibly allow densitometric reading [24].

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

separate peptides and amino acids.

poor, and reproducibility is average.

*4.1.2.2.3 Starch gel (cross-linked starch)*

because it is opaque, fragile, and not very reproducible.

therefore be considered [25].

*4.1.2.2.4 Agarose gel*

zymographic reading [23].

**185**

*4.1.2.2.2 Cellulose acetate*
