A study to better understand under-utilization of laboratory tests for antenatal care in Senegal.

Anna Helena Van’T Hoog,Christophe Longuet,Pascale Ondoa,Winny Koster,Aicha Sarr,Constance Schultsz,Jean Sakande,Souleymane Diallo,Ahmad Iyane Sow,Louis Delorme

doi:10.1371/journal.pone.0225710

Abstract

ObjectiveTo better understand factors contributing to underutilization of laboratory services for health care delivery in sub-Saharan Africa, we conducted a study in Senegalese Antenatal Care clinics (ANC) and laboratories to determine the extent of underutilization, contributing factors, and bottlenecks in the cascade of care from first ANC visit, test uptake, to availability of test results and appropriate clinical management.MethodsAt 16 health facilities, pregnant women attending for their first ANC visit were consecutively recruited and information was prospectively collected on the request, execution, results and clinical management of seven nationally recommended laboratory screening tests for normal pregnancy: hemoglobin concentration (Hb), syphilis serology, HIV serology, determination of proteinuria (PU), determination of blood group and Rhesus factor, Emmel test to detect sickle cell disease, and glycaemia. Health facility staff were interviewed on human resource capacity, management of the ANC and the laboratory, and availability and use of guidelines.ResultsOf 1246 ANC attendants, 400 (32%) had complete results. Completeness varied between facilities from 0–99%. In multilevel logistic regression analysis of women nested in facilities, complete uptake was lower if women started ANC later in pregnancy; very low in rural ANC attendants who ever delivered compared to urban primigravidae (OR 0.064; 95%CI 0.00–0.52); and higher if the facility routinely recommended all seven tests. In the cascade from test request to clinical management, the most frequent bottleneck was non-execution of requested tests, while unavailability of results for executed test was uncommon (<2%). Overall, of 525 abnormal test results 97(18%) had a record of adequate clinical management.ConclusionOur study illustrates challenges to test uptake even when laboratory testing capacity is in place, with large differences between facilities, and underscores the importance of management, policy, and the importance of considering local context in order to improve service delivery to expectant mothers.

Highlights

It is increasingly recognized that inadequate laboratory infrastructure in Low- and MiddleIncome Countries (LMICs) hampers the contribution of laboratory diagnostics to evidencebased clinical care[1]
In multilevel logistic regression analysis of women nested in facilities, complete uptake was lower if women started Antenatal care (ANC) later in pregnancy; very low in rural ANC attendants who ever delivered compared to urban primigravidae
Our study illustrates challenges to test uptake even when laboratory testing capacity is in place, with large differences between facilities, and underscores the importance of management, policy, and the importance of considering local context in order to improve service delivery to expectant mothers

Summary

Introduction

It is increasingly recognized that inadequate laboratory infrastructure in Low- and MiddleIncome Countries (LMICs) hampers the contribution of laboratory diagnostics to evidencebased clinical care[1] This recognition has resulted in laboratory capacity building initiatives [2,3,4], and in the development of simple, rapid, and affordable point-of-care tests (POCTs), which do not require electricity, a laboratory, or highly trained staff[5]. Antenatal care (ANC) provides a relevant model to study factors contributing to utilization of laboratory testing for health care delivery. Relevant indicators for the utilization of laboratory screening tests in the context of ANC are scarce, with the exception of syphilis for which 59% of pregnant women in sub-Saharan Africa were tested in 2010 [9]

Methods

Results

Conclusion