Factors influencing the utilization of routine antenatal laboratory screening tests package; case study: Kamuli district, Uganda

Abstract

The burden of maternal and child mortality and morbidity has remained high globally with pronounced effects in Sub Saharan Africa. Despite improvements in global ANC first visits to about 86% only half of these receive adequate antenatal care. In particular, antenatal laboratory screening tests uptake has been low in many developing countries yet results or absence of results from such tests can determine the quality of antenatal care given to pregnant women. Global and national guidelines recommend that all women attending antenatal care get laboratory screening tests for HIV, Hemoglobin level (Hb), Syphilis, Blood Grouping/ABO and Rhesus grouping and Urine tests. Study objectives included: establishing socio demographic, client and health facility factors that influenced utilization of antenatal laboratory test and establishing the proportion of women that received antenatal screening tests at health facilities in Kamuli district. Methods: The study was a mixed methods descriptive cross-sectional, using both qualitative and quantitative methods of data collection with concurrent triangulation. Predetermined survey questionnaires for pregnant women, and maternity staff were administered. In-depth interviews were conducted with laboratory staff and health facility/maternity in charges, with focus group discussions and observation checklists as other forms of data collection. Pearson’s Chi Square and Ordinal logistic regression were used for bivariate and multivariate analyses respectively. Results: Study findings show that only 14.1% of women received adequate laboratory tests, 38.5% and 47.4% received inadequate and moderate laboratory tests respectively. Individually, 40.9%, 34.2%, 21.1%, 91.1% and 24.1% received a syphilis test, Urine test, Blood grouping, HIV and Hb measurement respectively. Women that attended ANC1 and ANC2 were 60% less likely to receive adequate testing (OR: 0.391 CI: 0.206-0.741) and (OR: 0.386 CI: 0.201-0.740) respectively in comparison to those making 4 or more visits. Women attending at Public facilities were slightly more likely to receive high levels of tests utilization by a factor 1.037, C1:0.593-1.815 compared to those attending at PNFPs. It was also however found that majority 59.6% of those that received adequate testing were at PNFP facilities. Employment status, attendance to ANC talks and the person a woman stayed with were also other factors that affected laboratory tests utilization. The unavailability of test kits and reagents, frequent stock outs, cost of tests and lack of test requests were identified as main barriers to testing. Conclusion: Antenatal test uptake was significantly low especially for Hb measurement and ABO. There is need for timely supply of all test kits in the recommended quantities, with minimal bias towards particular tests. Robust supervision measures should be taken to ensure that tests supplied are administered for the intended purposes, in addition to allocating health workers basing on outputs rather than level of healthcare.