The main objective of this scoping review is to understand and map evidence of multi-dimensional pre-analytical factors that influence diagnostic efficacy of diseases in SSA. Specifically, the main objectives of the scoping review are: (1) To map evidence of pre-analytical stressors impacting diagnostic integrity in SSA. (2) To identify the most frequent specimen rejection criteria (e.g., haemolysis, clotted samples, insufficient volume, mislabelling) reported in SSA laboratory settings. (3) To determine the correlation between environmental/pre-analytical stressors and the rate of specimen rejection in rural vs. urban diagnostic chains.