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

Souhrn

Objective

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.

Methods

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.

Results

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.

Conclusion

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


Zdroje

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PLOS One


2020 Číslo 1