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

Autoři: Anna Helena van’t Hoog aff001;  Aicha Sarr aff003;  Winny Koster aff002;  Louis Delorme aff006;  Souleymane Diallo aff007;  Jean Sakande aff008;  Constance Schultsz aff001;  Christophe Longuet aff006;  Ahmad Iyane Sow aff003;  Pascale Ondoa aff001
Působiště autorů: Department of Global Health, Amsterdam University Medical Centers, Amsterdam, The Netherlands aff001;  Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands aff002;  Directorate of Laboratory Services, Ministry of Public Health and Social Welfare, Dakar, Senegal aff003;  Fondation Mérieux, Dakar, Sénégal aff004;  Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands aff005;  Fondation Mérieux, Lyon, France aff006;  Centre d’Infectiologie Charles Mérieux, Bamako, Mali aff007;  Fondation Mérieux, Ougadougou, Burkina Faso aff008;  Direction of Health Laboratories of Burkina Faso, Ougadougou, Burkina Faso aff009
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225710



To 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.


At 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.


Of 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.


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.

Klíčová slova:

Antenatal care – Clinical laboratories – Government laboratories – Health systems strengthening – HIV – Laboratory tests – Pregnancy – Syphilis


1. Petti CA, Polage CR, Quinn TC, Ronald AR, Sande MA. Laboratory medicine in Africa: a barrier to effective health care. Clin Infect Dis. 2006 Feb 1;42(3):377–82. doi: 10.1086/499363 16392084

2. Nkengasong JN, Nsubuga P, Nwanyanwu O, Gershy-Damet GM, Roscigno G, Bulterys M, et al. Laboratory systems and services are critical in global health: time to endci the neglect? Am J Clin Pathol. 2010 Sep;134(3):368–73. 10.1309 doi: 10.1309/AJCPMPSINQ9BRMU6 20716791

3. Gray I.P. and Carter J.Y., An evaluation of clinical laboratory services in sub-Saharan Africa. Ex africa semper aliquid novi? Clin Chim Acta, 1997. 267(1): p. 103–28. doi: 10.1016/s0009-8981(97)00180-0 9469247

4. Ndihokubwayo J.B.K., F.; Yahaya A.A.; Mwenda J. Strengthening public health laboratories in the WHO African Region: A critical need for disease control. The African Health Monitor, 2010. 47–52.

5. Peeling R.W. and Mabey D., Point-of-care tests for diagnosing infections in the developing world. Clin Microbiol Infect, 2010. 16(8): p. 1062–9. doi: 10.1111/j.1469-0691.2010.03279.x 20670288

6. World Health Organization, Standards for Maternal and Neonatal Care, in 1.6 Provision of effective antenatal care. 2007, World Health Organization: Geneva.

7. Partnership for Maternal Newborn and Health Child, Opportunities for Africa’s Newborns. Practical data, policy and programmatic support for newborn care in Africa. 2006: Geneva.

8. UNICEF, UNICEF Data: Monitoring the Situation of Children and Women. https://www.unicef.org/.

9. World Health Organization, Joint United Nations Programme on HIV/AIDS (UNAIDS)., United Nations Children's Fund., Global HIV/AIDS response: epidemic update and health sector progress towards universal access. 2011, World Health Organization: Geneva.

10. Koster W, Ondoa P, Sarr AM, Sow AI, Schultsz C, et al. Barriers to uptake of antenatal maternal screening tests in Senegal. SSM Popul Health. 2016 Oct 13;2:784–792. doi: 10.1016/j.ssmph.2016.10.003 eCollection 2016 Dec. 29349190

11. World Health Organization, World Health Statistics data visualizations dashboard, Monitoring health for the SDGs. 2016, World Health Organization. p. SDG health and health related targets, 3.1 Maternal mortality; 3.2 Newborn and child mortality.

12. WHO, UNICEF, UNFPA, World Bank Group, and United Nations Population Division Maternal Mortality Estimation Inter-Agency Group. Maternal mortality in 1990–2015. Senegal. https://www.who.int/gho/maternal_health/countries/sen.pdf

13. World Health Organization, Global Health Observatory indicator views. Global Health Observatory indicator views. 2016, World Health Organization. p. By indicator: Antenatal care (ANC) attendees tested for syphilis at first ANC visit (%) (Global strategy for women's, children's and adolescents' health).

14. The World Bank, Data by country. 2018, The World Bank Group.

15. Ministère de la Santé de l’Hygiène Publique et de la Prévention, Protocoles de services de SR au Sénégal. 2014, Ministère de la Santé de l’Hygiène Publique et de la Prévention.: Dakar. https://advancefamilyplanning.org/sites/default/files/resources/PMP%202nd%20Version-1_Part1_pp1-95.pdf

16. World Health Organization, Everybody business: strengthening health systems to improve health outcomes: WHO’s framework for action., in Framework for Action. 2007, World Health Organization: Geneva.

17. Hox JJ.Multilevel analysis: techniques and applications. Quantitative Methodology Series. 2nd ed. 2010. Routledge, New York.

18. Stata Corporation, STATAtm version 12.0. Texas, USA.

19. Witter S, Armar-Klemesu M, Dieng T, National fee exemption schemes for deliveries: Comparing the recent experiences of Ghana and Senegal, in Financing obstetric care, Richard F., Witter S., De Brouwere V., Editor. 2008, ITM: Antwerp. p. 167–198.

20. Elbireer AM, Opio AA, Brough RL, Brooks Jackson J, Manabe YC, and al. Strengthening Public Laboratory Service in Sub-Saharan Africa: Uganda Case Study. Laboratory Medicine, 2011. 42(12): p. 719–725.

21. Dieleman M, Gerretsen B, van der Wilt GJ. Human resource management interventions to improve health workers' performance in low and middle income countries: a realist review. Health Research Policy and Systems 2009 7:7. doi: 10.1186/1478-4505-7-7 19374734

22. Barriers to the use of prenatal screening test for maternal health in Senegal. Video. https://www.youtube.com/watch?v=JPX2qTSmxOI. Publication date: 28 April 2016.

23. Gloyd S, Montoya P, Floriano F, Chadreque MC, Pfeiffer J, Gimbel-Sherr K. Scaling up antenatal syphilis screening in Mozambique: transforming policy to action. Sex Transm Dis, 2007. 34(7 Suppl): p. S31–6.

24. Agence Nationale de la Statistique et de la Démographie (ANSD) [Sénégal], et ICF. 2017. Sénégal: Enquête Démographique et de Santé Continue (EDS-Continue 2016). Rockville, Maryland, USA: ANSD et ICF. Available at: https://dhsprogram.com/pubs/pdf/FR331/FR331.pdf

25. Taylor M., Newman L., Ishikawa N., Laverty M., Hayashi C., Ghidinelli, et al. Elimination of mother-to-child transmission of HIV and Syphilis (EMTCT): Process, progress, and program integration. PLoS medicine, 14(6), e1002329. doi: 10.1371/journal.pmed.1002329 28654643

26. De Schacht C, Lucas C, Sitoe N, Machekano R, Chongo P, Temmerman M, et al., Implementation of Point-of-Care Diagnostics Leads to Variable Uptake of Syphilis, Anemia and CD4+ T-Cell Count Testing in Rural Maternal and Child Health Clinics. PLoS One, 2015. 10(8): p. e0135744. doi: 10.1371/journal.pone.0135744 26308345

27. World Health Organization, Global Guidance on criteria and Processes for validation: elimination of mother-to-child transmission of HIV and Syphilis,. 2014, World Health Organization: Geneva.

Článek vyšel v časopise


2020 Číslo 1