Abstract Objective Reliable diagnostic services and testing capacity are fundamental to quality health care delivery. Yet data on such testing and services are often sparse in low- and-middle-income countries. The objective of this study was to obtain these data from the African country of Malawi by surveying a range of clinical laboratories and diagnostic services. Methods We conducted a cross-sectional survey of clinical pathology services and infrastructure among laboratories across Malawi. Subject matter experts developed a structured instrument covering staffing, infrastructure, equipment, and test menus by discipline. Surveys were distributed through the American Society for Clinical Pathology international listserv (May-Oct 2022), with targeted follow-up to Malawian institutions (November 2022-July 2025). Results Nine laboratories from the northern, central, and southern regions of Malawi submitted complete responses: 6 public and 3 private (2 tertiary facilities and 7 district, secondary, or research centers). All sites reported point-of-care/rapid diagnostics, chemistry, microbiology, and hematology services. Blood bank/transfusion services were available at 7 sites, 2 of which had all 5 queried products available (red blood cells, plasma, platelets, cryoprecipitate, and whole blood). Coagulation testing (2 sites), flow cytometry (2 sites), and cytogenetics (0 sites) were limited. Infrastructure gaps included inconsistent electricity or lack of backup generators (3 sites), limited internet access (5 sites), and need for more trained staff (4 sites). Conclusions Basic diagnostic services were widely available among this sample of Malawian laboratories, whereas advanced modalities and infrastructure were constrained outside tertiary centers. The baseline data obtained from this study could inform national planning and partner investments as external funding landscapes evolve.
McKenzie et al. (Sat,) studied this question.