Pixels and Pathology: A Portrait of Digital Diagnostics in Africa

BACKGROUND: There is a severe shortage of anatomical pathologists, cytologists, and technologists in Africa compromising patient care, despite the practice of cytology being well-suited to resource-constrained settings. Digital diagnostics have been proposed as a solution to the lack of laboratory personnel. This study was undertaken to provide an overview of the current implementation and operational status of digital diagnostics in anatomical pathology and cytology in Africa and to assess African laboratory personnel's attitudes regarding these emerging technologies. METHODS: A digitized anonymized survey was disseminated using several African pathology and cytology WhatsApp groups and on the Twitter/X social media platform. RESULTS: There were 87 completed surveys, mainly from respondents in southern Africa. One third of respondents were utilizing whole slide imaging mainly for primary histologic diagnosis and consultations. The use of whole slide imaging in cytology was less. Key challenges with whole slide imaging include high implementation and maintenance costs, suboptimal image quality, particularly for cytology, and slow scanning times. Telepathology and telecytology were employed by 20.7% of respondents, mainly for remote consultations and resident training with users generally expressing positive perceptions of its diagnostic value. However, insufficient infrastructure, particularly unreliable internet connectivity and unstable electricity supply, was identified as a major barrier. CONCLUSION: Respondents without access to digital technologies tended to hold more optimistic expectations regarding their potential benefits than those already using them. This highlights the need to foster more realistic expectations with respect to digital diagnostics and to improve the technical performance and implementation of existing systems.