Abstract
BackgroundHypertensive disorders of pregnancy (HDP) are associated with high maternal mortality in Ghana and globally. Evidence shows that there is poor availability of pregnancy-related point-of-care (POC) tests in Ghana’s primary healthcare (PHC) clinics (health centre or community-based health planning services facilities). Therefore, we employed geographic information systems to estimate the geographical distribution of and physical accessibility to HDP POC testing services in the Upper East Region (UER), Ghana.MethodsWe collected data on 100 out of 365 PHC clinics, public hospitals providing HDP testing, PHC clinic type, ownership, and availability of urine dipsticks and blood pressure (BP) devices. We also obtained the geo-located data of the PHC clinics and hospitals using the global positioning system. We employed ArcGIS 10.4 to measure the distance and travel time from the location of each PHC clinic without HDP POC testing services as well as from all locations of each district to the nearest hospital/clinic where the service is available. The travel time was estimated using an assumed motorised tricycle speed of 20 km/hour. We further calculated the spatial distribution of the hospitals/clinics providing HDP POC testing services using the spatial autocorrelation tool in ArcMap, and Stata version 14 for descriptive statistical analysis.ResultsOf the 100 participating PHC clinics, POC testing for HDP was available in 19% (14% health centres and 5% community-based health planning services compounds) in addition to the 10 hospitals use as referral points for the service. The findings indicated that the spatial pattern of the distribution of the health facilities providing HDP POC testing was random (z-score = -0.61; p = 0.54). About 17% of the PHC clinics without HDP POC testing service were located > 10 km to the nearest facility offering the service. The mean distance and travel time from PHC clinics without HDP POC testing to a health facility providing the service were 11.4 ± 9.9 km and 31.1 ± 29.2 min respectively. The results suggest that if every 19% of the 365 PHC clinics are offering HDP POC testing in addition to these 10 hospitals identified, then the estimated coverage (health facility-to-women in fertility age ratio) in the UER is 1: 3,869.ConclusionsThere is poor physical accessibility to HDP POC testing services from PHC clinics without HDP POC testing in the UER. Mothers who obtain maternal healthcare in about 17% of the PHC clinics travel long distances (> 10 km) to access the service when needed. Hence, there is a need to improve the availability of HDP POC diagnostic tests in Ghana’s rural clinics.
Highlights
Hypertensive disorders of pregnancy (HDP) are associated with high maternal mortality in Ghana and globally
Of the 100 participating primary healthcare (PHC) clinics, POC testing for HDP was available in 19% (14% health centres and 5% community-based health planning services compounds) in addition to the 10 hospitals use as referral points for the service
The mean distance and travel time from PHC clinics without HDP POC testing to a health facility providing the service were 11.4 ± 9.9 km and 31.1 ± 29.2 min respectively
Summary
Hypertensive disorders of pregnancy (HDP) are associated with high maternal mortality in Ghana and globally. In 2014, a World Health Organization (WHO) systematic review evinced that hypertensive disorders accounted for about 14% of the 60 799 total maternal deaths globally from 2003 to 2009 [7]. Proteinuria is no longer essential for the diagnosis of preeclampsia according to the International Society for the Study of Hypertension in Pregnancy (ISSHP) [2, 3]. To facilitate early detection and diagnosis of preeclampsia, ISSHP recommends blood pressure (BP) monitoring of women at each antenatal care (ANC) visit, urine test for protein if the blood pressure is high, and symptoms as headache, visual disturbance, and epigastric pain using visual dipstick testing according to the manufacturer’s specification. ISSHP recommends that every ANC clinic/unit should have as a minimum a dedicated sphygmomanometer and urine dipsticks for detecting proteinuria [2] It further recommends training of healthcare workers on how to measure BP appropriately using the correct technique [2]
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