Details:

Alternative Title:
PLoS One
Personal Author:
Young, Nicole; Taegtmeyer, Miriam; Aol, George; Bigogo, Godfrey M.; Phillips-Howard, Penelope A.; ... More +
Young, Nicole; Taegtmeyer, Miriam; Aol, George; Bigogo, Godfrey M.; Phillips-Howard, Penelope A.; Hill, Jenny; Laserson, Kayla F.; Ter Kuile, Feiko; Desai, Meghna; Less -
Description:
Background In sub-Saharan Africa, HIV, syphilis, malaria and anaemia are leading preventable causes of adverse pregnancy outcomes. In Kenya, policy states women should be tested for all four conditions (malaria only if febrile) at first antenatal care (ANC) visit. In practice, while HIV screening is conducted, coverage of screening for the others is suboptimal and early pregnancy management of illnesses is compromised. This is particularly evident at rural dispensaries that lack laboratories and have parallel programmes for HIV, reproductive health and malaria, resulting in fractured and inadequate care for women. Methods A longitudinal eight-month implementation study integrating point-of-care diagnostic tests for the four conditions into routine ANC was conducted in seven purposively selected dispensaries in western Kenya. Testing proficiency of healthcare workers was observed at initial training and at three monthly intervals thereafter. Adoption of testing was compared using ANC register data 8.5 months before and eight months during the intervention. Fidelity to clinical management guidelines was determined by client exit interviews with success defined as ≥90% adherence. Findings For first ANC visits at baseline (n = 529), testing rates were unavailable for malaria, low for syphilis (4.3%) and anaemia (27.8%), and near universal for HIV (99%). During intervention, over 95% of first attendees (n = 586) completed four tests and of those tested positive, 70.6% received penicillin or erythromycin for syphilis, 65.5% and 48.3% received cotrimoxazole and antiretrovirals respectively for HIV, and 76.4% received artemether/lumefantrine, quinine or dihydroartemisinin–piperaquine correctly for malaria. Iron and folic supplements were given to nearly 90% of women but often at incorrect doses. Conclusions Integrating point-of-care testing into ANC at dispensaries with established HIV testing programmes resulted in a significant increase in testing rates, without disturbing HIV testing rates. While more cases were detected and treated, treatment fidelity still requires strengthening and an integrated monitoring and evaluation system needs to be established.
Subject:
[+]
Adult
Anemia
Anti-Bacterial Agents
Anti-HIV Agents
Antimalarials
Artemether, Lumefantrine Drug Combination
Artemisinins
Dietary Supplements
Erythromycin
Female
Folic AcidGuideline Adherence
Health Personnel
HIV Infections
Humans
Iron, Dietary
Laboratory Proficiency Testing
Longitudinal Studies
Malaria
Penicillins
Point-of-Care Testing
Pregnancy
Pregnancy Complications, Hematologic
Pregnancy Complications, Infectious
Prenatal Care
Quinine
Quinolines
Syphilis
Trimethoprim, Sulfamethoxazole Drug Combination

Source:
PLoS One. 13(7).;
Pubmed ID:
30028852
Pubmed Central ID:
PMC6054376
Document Type:
Journal Article;
Place as Subject:
Kenya;
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:bfd3a41f5c5c456ecc7f0f2b27095d9ab830e68a521f5cad02125644c19105ec
File Type:

Supporting Files

• 	pone.0198784.t001.jpg	jpeg
  	pone.0198784.t002.gif	gif
  	pone.0198784.t002.jpg	jpeg
  	pone.0198784.t003.gif	gif
  	pone.0198784.t003.jpg	jpeg
  	pone.0198784.t004.gif	gif
  	pone.0198784.t004.jpg	jpeg
  	pone.0198784.t005.gif	gif
  	pone.0198784.t005.jpg	jpeg
  	pone.0198784.t006.gif	gif
  	pone.0198784.g001.gif	gif
  	pone.0198784.t006.jpg	jpeg
  	pone.0198784.g001.jpg	jpeg
  	pone.0198784.g002.gif	gif
  	pone.0198784.g002.jpg	jpeg
  	pone.0198784.nxml	xml
  	pone.0198784.s001.tif	tiff
  	pone.0198784.s002.docx	docx
  	pone.0198784.t001.gif	gif

More +