Improving the effectiveness of point of care tests for malaria and anaemia: a qualitative study across three Ghanaian antenatal clinics

Abstract

Background: Anaemia and malaria are both major contributors to maternal and child mortality, and morbidity, with some of the worst outcomes occurring in sub-Saharan Africa. Point of care tests (POCT), if used appropriately, provide a simple, inexpensive form of diagnostic testing, as a reliable alternative when laboratory tests are not readily available. In such resource limited settings, clinical staff tend to rely on symptom-based diagnosis and presumptive treatment. This study uses qualitative methods to identify the current practice of POCT use for malaria and anaemia, to explore the enablers and barriers to effective implementation of these POCT, and to determine how relationships between each of the stakeholder groups may impact on POCT use. Methods: Staff (clinical and laboratory) and patients (pregnant women) at three antenatal care facilities within the Ashanti Region of Ghana participated in interviews and focus group discussions (FGDs). An initial coding framework was developed based on the pre-defined objectives of the study. Thematic analysis was used to identify subthemes and categories within each of the key themes. Results: At the time data were collected all three facilities used malaria POCT either as an adjunct to microscopy, or as their only form of malaria testing. Although all three facilities were familiar with haemoglobin colour scale (HCS), none of the facilities used them routinely. Clinical staff perceived symptom-based diagnosis was a quick way to diagnosis because access to POCT during consultations was unreliable, but recognized disadvantages associated with symptom-based diagnosis. Perceived advantages of malaria and anaemia POCT were user-friendliness, improved diagnosis and opportunity for patient engagement, as well as lower cost implication for patients. Perceived disadvantages included likelihood of missed diagnosis of mild anaemia, as well as likelihood of human error leading to in accurate diagnosis which could impact on patient trust. Poor communication and lack of trust between staff groups was also identified as a barrier to effective uptake of POCT.

A Scoping Review of Supply Chain Management Systems for Point of Care Diagnostic Services: Optimising COVID-19 Testing Capacity in Resource-Limited Settings

“…The eligible studies were published between 2011 and 2021. The 31 articles included 15 reviews [ 10 , 12 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ], 1 website of an international organisation [ 33 ], 2 randomised controlled trials [ 34 , 35 ], 1 cross-sectional study [ 36 ], 1 case study [ 37 ], 1 cohort study [ 38 ] and 10 studies that used mixed method approaches ranging from focus group discussions to interviews to direct observations [ 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ]. The included articles presented evidence of research conducted in the following countries: Mozambique [ 34 , 36 , 44 ], Zimbabwe [ 49 ], Ghana [ 12 , 21 , 22 , 40 , 45 , 48 ], Malawi [ 42 ], Namibia [ 41 ], India [ 43 ], Sierra Leone [ 37 ], Burkina Faso [ 38 ], The Philippines [ ...…”

“…Evidence on the following POC diagnostic tests were provided: COVID-19 [ 27 , 28 , 33 ]; HIV [ 10 , 12 , 22 , 23 , 24 , 25 , 26 , 34 , 36 , 42 , 49 ]; malaria [ 10 , 12 , 22 , 23 , 34 , 35 , 38 , 40 , 41 , 43 , 44 , 46 , 47 , 48 ]; syphilis [ 10 , 12 , 23 , 32 , 34 , 39 , 42 , 45 ]; tuberculosis [ 30 , 31 ] and others comprising of anaemia [ 34 , 40 ], UTI [ 37 ], diabetes [ 12 , 31 ], blood glucose [ 22 ], preeclampsia urinalysis [ 37 ], urine pregnancy [ 22 ], urine protein [ 22 , 34 ], haemoglobin [ 22 ], dyslipidaemia […”

“…The 15 studies that were appraised for methodological quality scored between 90% and 100%, which showed high methodological quality. Twelve studies scored the highest quality score of 100% [ 34 , 35 , 36 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 47 , 48 ]. One study scored 95% [ 38 ].…”

“…Sixteen articles reported stockouts due to procurement issues [ 10 , 12 , 21 , 24 , 25 , 26 , 34 , 36 , 40 , 41 , 42 , 43 , 44 , 45 , 47 , 49 ]. Of the 16 articles, one article reported an adequate inventory of test kits more than 89% of the time across the 75 facilities from a study conducted in Mozambique [ 36 ].…”

Acceptability of single screening and treatment policy for the control of malaria in pregnancy: perceptions of providers and pregnant women from selected health facilities in Lindi region, Tanzania

“…Furthermore, HCWs perceived RDTs to be easy and quick to use in addition to reducing waiting time compared to microscopy. Ghanaian HCWs similarly had no concerns with incorporating RDT screening into their existing workload, as it is easy to use and they reported improved engagement with clients as a result of being able to provide them malaria testing results [ 31 ]. Regular supervision was highlighted by the HCWs as an important aspect of the SST implementation to improve malaria services including quality control and quality assurance (QAQC) for testing and treatment.…”