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

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.