Accessibility of Point-of-Care Diagnostic Services for Maternal Health in Lower Healthcare Facilities in Northern Ghana: A Cross-Sectional Survey

Abstract

Background: Improving access to maternal healthcare in resource limited settings plays a critical role in improving maternal health outcomes and reducing maternal deaths. However, barriers and challenges may exist in rural clinics and could affect successful implementation. This study assessed the current accessibility of point-of-care (POC) diagnostic services for maternal healthcare in rural primary healthcare (PHC) clinics in Northern Ghana. Method: We randomly selected 100 PHC clinics providing maternal healthcare from a total list of 356 PHCs obtained from the regional health directorate. Selected clinics were surveyed from 15th February to 31st March, 2018 using an adopted survey tool. We obtained data for clinic-level staffing, availability, usage, and desired POC diagnostic tests. One antenatal clinic in-charge or a Physician Assistant from each facility was interviewed to assess their knowledge on POC diagnostic tests. Stata 14 was used for data analysis. Findings: Majority (64%) of the respondents were midwives. Average years of work experience and working hours per week were estimated at 5.6 (CI: 4.8-6.3) and 122 (CI: 111.9-132.6) respectively. Average antenatal clinic attendance per month was 65±67 (range 3-360). Mean POC tests available and use was 4.9 (CI: 4.5-5.4) out of 15 tests. Respondents' knowledge on POC test was 99.2 (CI: 99.7-100.5). The study found a positive correlation between availability and use though regression analysis showed no significance. POC test for malaria; HIV; urine pregnancy; and blood pressure were available in most clinics. Desired POC tests included: Glucose-6-phosphate dehydrogenase (95%); hepatitis c (94%); sickling (91%); tuberculosis, blood glucose and blood type (89%) each; urinary tract infection (87%), urine protein (81%); hepatitis b (78%); haemoglobin (76%); and syphilis (76%). Interpretation: There is poor accessibility of POC diagnostic services for maternal healthcare as results of low availability of POC tests in rural primary healthcare clinics in Northern Ghana. Funding: College of Health Sciences Scholarship. Declaration of interests: None declared. Ethics approval and consent to participate: This study was approved by the Navrongo Health Research Centre Institutional Review Board/Ghana Health Service (approval number: NHRCIRB291) and the University of KwaZulu-Natal Biomedical Research Ethics Committee (approval number: BE565/17). Permission was obtained from the Upper East Regional Health Directorate prior to conducting the study. All study participants signed an informed consent prior to participating in this study.