Accessibility of pregnancy-related point-of-care diagnostic tests for maternal healthcare in rural primary healthcare facilities in Northern Ghana: A cross-sectional survey

Heliyon, Volume 5, No. 2, Year 2019

Interpretation

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 pregnancy-related point-of-care (POC) diagnostic tests 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 PHC clinicss obtained from the Regional Health Directorate. Selected clinics were surveyed from February to March 2018, using an adopted survey tool. We obtained data for clinic-level staffing, availability, usage, and desired POC diagnostic tests. Stata 14 was used for data analysis. Findings: Majority (64%) of the respondents were midwives. The mean ± standard deviation (SD) years of work experience and working hours per week were estimated at 5.6 years ± 0.4 and 122 hours ± 5.2 respectively. Average antenatal clinic attendance (clinic census) per month was 65 ± 67 pregnant women (Range: 3–360). The mean ± SD POC tests available and use was 4.9 tests ± 2.2. POC tests for malaria, HIV, urine pregnancy, and blood pressure monitoring devices were available in most clinics. POC tests requested by the clinics to assist them care for pregnant women 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 to pregnancy-related POC diagnostic tests for maternal healthcare due to low availability (≤5 tests per PHC clinic) of POC tests in rural PHC clinics in northern Ghana. 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. Data for this study are the property of the University of KwaZulu-Natal and can be made available publicly. All interested researchers/readers/persons who meet the criteria to access confidential data can access the dataset via Dr Tivani Mashamba-Thompson, the project supervisor and the Academic Leader (Research) for the School of Nursing and Public Health via this email address: [email protected]. Data access may also be requested from the University of KwaZulu-Natal Biomedical Research Ethics Committee (BREC) from the following contacts: The Chairperson Biomedical Research Ethics Administration Research Office, Westville Campus, Govan Mbeki Building University of KwaZulu-Natal P/Bag {“type”:”entrez-nucleotide”,”attrs”:{“text”:”X54001″,”term_id”:”2135″,”term_text”:”X54001″}}X54001, Durban, 4000 KwaZulu-Natal, South Africa Tel.: +27 31 260 4769 Fax: +27 31 260 4609 Email: [email protected]. We conducted a cross-sectional survey of PHC clinics in the Upper East Region (UER) of Ghana. We obtained a list of 356 PHC clinics rendering antenatal care from the Upper East Regional Health Directorate (RHD) of the Ghana Health Service (GHS). We randomly chose a weight-based sample of 100 PHC clinics from all the 13 districts in the region. To ensure uniformity of sampled clinics in all the districts, the following procedure was used: The clinics were first grouped into 13 clusters, with each cluster representing a district in the region. After this, we stratified the clinics into two strata. The first stratum comprised of 232 clinics with antenatal clinic attendance ≤100 per month, whilst the second stratum consisted of 124 clinics with antenatal clinic attendance ≥100 per month. Probability proportionate to size (PPS) was used to determine the proportion of clinics to be selected from each cluster and stratum, using this formula: nh=(Nh/N)×n [7], where nh is the sample size for cluster h, Nh the population size for cluster h, N the total population size and n is the total sample size. Based on this, 65 clinics were to be sampled from the first stratum and 35 clinics from the second stratum. Proportionate stratification was also applied to obtain the total number of clinics to be sampled from stratum one and two in each of the 13 strata (Table 1). Finally, a simple random sampling technique was used to draw the clinics for the study. Convenient sampling was however, used to select the respondents for the study. Distribution of sampled PHC clinics for this study. Data were collected from February to March, 2018, using an adopted POC diagnostics survey tool from Mashamba-Thompson et al., 2016 [7]. The survey tool (Supplementary file 1) was pre-tested in ten non-participatory rural PHC clinics in the UER and adjusted to suit the local context based on feedback from respondents. We surveyed each selected clinic and collected data on clinic type, ownership, number of health professionals’ available, category of health professionals available, and work experience of the respondents. We also took data on the average number of pregnant women seen per month and the respondent average available working hours per week to determine the health facility characteristics. Data on POC diagnostics availability, usage, and future needs for POC tests were obtained from the respondents in order to measure the accessibility of POC diagnostic services in the UER, using the survey tool. Data on pregnancy-related POC diagnostic tests needed by the clinics to aid diagnosis at the clinic and facilitate their work were also obtained. We obtained the average monthly antenatal clinic attendance of each of the clinics in the region as recorded in the District Health Information Management System from the RHD. The primary outcome of the study included: availability of POC tests for maternal healthcare, and use of the available POC diagnostic tests in the PHC clinics in UER, Ghana. The secondary outcome of this study was to ascertain the current POC diagnostic tests needed to help with early disease detection during pregnancy and prompt linkage to care. Availability of diagnostic tests was determined as follows: 11–15 tests = high availability; 6–10 tests = average availability and 1–5 = low availability. Responses on POC usage were analysed using a 0–100% score scale, where ‘100% = I do use’ and ‘0% = I do not use’. Data were processed in Microsoft Excel and exported to Stata statistical software, version 14, for all analyses. Frequencies, means, standard deviations (SD) and 95% confidence intervals were generated for responses.

AI Digest

Study Justification:

– Improving access to maternal healthcare in resource-limited settings is crucial for improving maternal health outcomes and reducing maternal deaths.
– This study aims to assess the current accessibility of pregnancy-related point-of-care (POC) diagnostic tests for maternal healthcare in rural primary healthcare (PHC) clinics in northern Ghana.
– Identifying barriers and challenges in rural clinics will help inform strategies for successful implementation of maternal healthcare services.

Study Highlights:

– Majority (64%) of the respondents were midwives.
– The average years of work experience and working hours per week were 5.6 years and 122 hours respectively.
– The average antenatal clinic attendance per month was 65 pregnant women.
– The average number of POC tests available and used in the clinics was 4.9 tests.
– POC tests for malaria, HIV, urine pregnancy, and blood pressure monitoring devices were available in most clinics.
– POC tests requested by the clinics to assist in caring for pregnant women included tests for glucose-6-phosphate dehydrogenase, hepatitis C, sickling, tuberculosis, blood glucose, blood type, urinary tract infection, urine protein, hepatitis B, haemoglobin, and syphilis.
– Poor accessibility to pregnancy-related POC diagnostic tests for maternal healthcare was identified due to low availability of POC tests in rural PHC clinics in northern Ghana.

Recommendations:

– Increase the availability of pregnancy-related POC diagnostic tests in rural PHC clinics.
– Ensure that clinics have the necessary POC tests to aid in early disease detection during pregnancy and prompt linkage to care.
– Provide training and support to healthcare professionals in the usage and interpretation of POC diagnostic tests.
– Strengthen the supply chain management system to ensure consistent availability of POC tests in rural clinics.
– Conduct further research to explore additional barriers and challenges in accessing maternal healthcare in rural settings.

Key Role Players:

– Ministry of Health: Responsible for policy formulation and implementation of maternal healthcare services.
– Regional Health Directorate: Provides oversight and support to PHC clinics in the region.
– Navrongo Health Research Centre: Conducts research and provides evidence-based recommendations for improving healthcare.
– University of KwaZulu-Natal: Provides academic support and expertise in healthcare research.

Cost Items for Planning Recommendations:

– Procurement of pregnancy-related POC diagnostic tests.
– Training and capacity building for healthcare professionals.
– Strengthening the supply chain management system.
– Research and data collection.
– Monitoring and evaluation of the implementation of recommendations.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study provides detailed information on the accessibility of pregnancy-related point-of-care diagnostic tests in rural primary healthcare clinics in northern Ghana. The study design is cross-sectional, which allows for data collection at a specific point in time. The sample size of 100 primary healthcare clinics is reasonable, and data analysis was conducted using appropriate statistical software. However, the abstract does not mention the specific methodology used for data collection, such as the survey tool or sampling technique. Additionally, the abstract does not provide information on the limitations of the study or potential biases. To improve the strength of the evidence, the abstract should include a clear description of the methodology, including the survey tool and sampling technique used. It should also address any limitations or potential biases in the study.

Abstract

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. Data for this study are the property of the University of KwaZulu-Natal and can be made available publicly. All interested researchers/readers/persons who meet the criteria to access confidential data can access the dataset via Dr Tivani Mashamba-Thompson, the project supervisor and the Academic Leader (Research) for the School of Nursing and Public Health via this email address: [email protected]. Data access may also be requested from the University of KwaZulu-Natal Biomedical Research Ethics Committee (BREC) from the following contacts: The Chairperson Biomedical Research Ethics Administration Research Office, Westville Campus, Govan Mbeki Building University of KwaZulu-Natal P/Bag {“type”:”entrez-nucleotide”,”attrs”:{“text”:”X54001″,”term_id”:”2135″,”term_text”:”X54001″}}X54001, Durban, 4000 KwaZulu-Natal, South Africa Tel.: +27 31 260 4769 Fax: +27 31 260 4609 Email: [email protected]. We conducted a cross-sectional survey of PHC clinics in the Upper East Region (UER) of Ghana. We obtained a list of 356 PHC clinics rendering antenatal care from the Upper East Regional Health Directorate (RHD) of the Ghana Health Service (GHS). We randomly chose a weight-based sample of 100 PHC clinics from all the 13 districts in the region. To ensure uniformity of sampled clinics in all the districts, the following procedure was used: The clinics were first grouped into 13 clusters, with each cluster representing a district in the region. After this, we stratified the clinics into two strata. The first stratum comprised of 232 clinics with antenatal clinic attendance ≤100 per month, whilst the second stratum consisted of 124 clinics with antenatal clinic attendance ≥100 per month. Probability proportionate to size (PPS) was used to determine the proportion of clinics to be selected from each cluster and stratum, using this formula: nh=(Nh/N)×n [7], where nh is the sample size for cluster h, Nh the population size for cluster h, N the total population size and n is the total sample size. Based on this, 65 clinics were to be sampled from the first stratum and 35 clinics from the second stratum. Proportionate stratification was also applied to obtain the total number of clinics to be sampled from stratum one and two in each of the 13 strata (Table 1). Finally, a simple random sampling technique was used to draw the clinics for the study. Convenient sampling was however, used to select the respondents for the study. Distribution of sampled PHC clinics for this study. Data were collected from February to March, 2018, using an adopted POC diagnostics survey tool from Mashamba-Thompson et al., 2016 [7]. The survey tool (Supplementary file 1) was pre-tested in ten non-participatory rural PHC clinics in the UER and adjusted to suit the local context based on feedback from respondents. We surveyed each selected clinic and collected data on clinic type, ownership, number of health professionals’ available, category of health professionals available, and work experience of the respondents. We also took data on the average number of pregnant women seen per month and the respondent average available working hours per week to determine the health facility characteristics. Data on POC diagnostics availability, usage, and future needs for POC tests were obtained from the respondents in order to measure the accessibility of POC diagnostic services in the UER, using the survey tool. Data on pregnancy-related POC diagnostic tests needed by the clinics to aid diagnosis at the clinic and facilitate their work were also obtained. We obtained the average monthly antenatal clinic attendance of each of the clinics in the region as recorded in the District Health Information Management System from the RHD. The primary outcome of the study included: availability of POC tests for maternal healthcare, and use of the available POC diagnostic tests in the PHC clinics in UER, Ghana. The secondary outcome of this study was to ascertain the current POC diagnostic tests needed to help with early disease detection during pregnancy and prompt linkage to care. Availability of diagnostic tests was determined as follows: 11–15 tests = high availability; 6–10 tests = average availability and 1–5 = low availability. Responses on POC usage were analysed using a 0–100% score scale, where ‘100% = I do use’ and ‘0% = I do not use’. Data were processed in Microsoft Excel and exported to Stata statistical software, version 14, for all analyses. Frequencies, means, standard deviations (SD) and 95% confidence intervals were generated for responses.

Materials

https://efashare.b-cdn.net/materials/c99004da1278d01066c892dbe39521d78a0283450d2a2747cd81fba0c65295f4/mmc1.docx

Innovations

The study titled “Accessibility of pregnancy-related point-of-care diagnostic tests for maternal healthcare in rural primary healthcare facilities in Northern Ghana: A cross-sectional survey” aimed to assess the current accessibility of pregnancy-related point-of-care (POC) diagnostic tests in rural primary healthcare (PHC) clinics in northern Ghana. The study found that there is poor accessibility to pregnancy-related POC diagnostic tests for maternal healthcare in rural PHC clinics in northern Ghana due to low availability of POC tests.

Based on the findings of this study, a recommendation to improve access to maternal health would be to increase the availability of pregnancy-related POC diagnostic tests in rural PHC clinics. This can be achieved through the following steps:

1. Strengthen the supply chain: Ensure a consistent and reliable supply of pregnancy-related POC diagnostic tests to rural PHC clinics. This may involve improving logistics and distribution systems to ensure timely delivery of tests to these facilities.

2. Training and capacity building: Provide training and capacity building programs for healthcare providers in rural PHC clinics on the proper use and interpretation of pregnancy-related POC diagnostic tests. This will enhance their ability to effectively utilize these tests for maternal healthcare.

3. Infrastructure improvement: Invest in improving the infrastructure of rural PHC clinics to accommodate the storage and use of pregnancy-related POC diagnostic tests. This may include providing adequate laboratory space and equipment to conduct these tests.

4. Collaboration and partnerships: Foster collaboration and partnerships between government agencies, non-governmental organizations, and other stakeholders to support the implementation and sustainability of improved access to pregnancy-related POC diagnostic tests. This can include sharing resources, expertise, and best practices.

5. Monitoring and evaluation: Establish a system for monitoring and evaluating the availability and usage of pregnancy-related POC diagnostic tests in rural PHC clinics. This will help identify any gaps or challenges and allow for timely interventions and improvements.

By implementing these recommendations, access to maternal health can be improved in rural areas, leading to better maternal health outcomes and a reduction in maternal deaths.

AI Innovations Description

By implementing these recommendations, access to maternal health can be improved in rural areas, leading to better maternal health outcomes and a reduction in maternal deaths.

AI Innovations Methodology

The methodology used in the study titled “Accessibility of pregnancy-related point-of-care diagnostic tests for maternal healthcare in rural primary healthcare facilities in Northern Ghana: A cross-sectional survey” involved the following steps:

1. Sample selection: A total of 100 primary healthcare (PHC) clinics providing maternal healthcare were randomly selected from a list of 356 clinics obtained from the Regional Health Directorate in northern Ghana. The clinics were stratified into two groups based on antenatal clinic attendance, and probability proportionate to size (PPS) sampling was used to determine the number of clinics to be selected from each group.

2. Data collection: Data was collected from the selected clinics using an adopted survey tool. The survey tool was pre-tested in non-participatory rural PHC clinics and adjusted based on feedback. The data collected included clinic-level staffing, availability and usage of pregnancy-related point-of-care (POC) diagnostic tests, and the desired POC tests requested by the clinics.

3. Data analysis: The collected data was analyzed using Stata 14 statistical software. Frequencies, means, standard deviations, and 95% confidence intervals were generated for the responses. The availability of POC tests was categorized as high, average, or low based on the number of tests available. The usage of POC tests was analyzed on a scale of 0-100%.

4. Ethical considerations: The study was approved by the Navrongo Health Research Centre Institutional Review Board/Ghana Health Service and the University of KwaZulu-Natal Biomedical Research Ethics Committee. Permission was obtained from the Upper East Regional Health Directorate, and informed consent was obtained from all study participants.

The findings of the study revealed that there is poor accessibility to pregnancy-related POC diagnostic tests for maternal healthcare in rural PHC clinics in northern Ghana due to low availability of POC tests.

Based on these findings, the study recommends several steps to improve access to maternal health, including strengthening the supply chain, providing training and capacity building for healthcare providers, improving infrastructure, fostering collaboration and partnerships, and establishing a system for monitoring and evaluation.

Overall, the study provides valuable insights into the current accessibility of pregnancy-related POC diagnostic tests in rural PHC clinics in northern Ghana and offers recommendations to address the identified barriers and improve access to maternal health services.

Author

Dima Health

Statistics:

Citations: 16

Identifiers:

DOI: 10.1016/j.heliyon.2019.e01236

ISSN: 24058440

Research Areas:

Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Noncommunicable Diseases, Quality of Care, Sexual and Reproductive Health, Social Determinants, Workforce

Study Countries:

Ghana, Multi-Countries, South Africa

Study Design:

Cross Sectional Study

Study Approach:

Quantitative

Participants Gender:

Female