Bottlenecks in the implementation of essential screening tests in antenatal care: Syphilis, HIV, and anemia testing in rural Tanzania and Uganda

Ulrika Baker; Monica Okuga; Peter Waiswa; Fatuma Manzi; Stefan Peterson; Claudia Hanson; EQUIP study group

doi:10.1016/j.ijgo.2015.04.017

Bottlenecks in the implementation of essential screening tests in antenatal care: Syphilis, HIV, and anemia testing in rural Tanzania and Uganda

Int J Gynaecol Obstet. 2015 Jun:130 Suppl 1:S43-50. doi: 10.1016/j.ijgo.2015.04.017. Epub 2015 Apr 29.

Authors

Ulrika Baker¹, Monica Okuga², Peter Waiswa³, Fatuma Manzi⁴, Stefan Peterson⁵, Claudia Hanson⁶; EQUIP study group

Affiliations

¹ Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institutet, Stockholm, Sweden. Electronic address: ulrika.baker@ki.se.
² Makerere University, College of Health Sciences, School of Public Health, Kampala, Uganda.
³ Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Makerere University, College of Health Sciences, School of Public Health, Kampala, Uganda.
⁴ Ifakara Health Institute, Dar-es-Salaam, Tanzania.
⁵ Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Makerere University, College of Health Sciences, School of Public Health, Kampala, Uganda; International Maternal and Child Health Unit, Women's and Children's Health, Uppsala University, Sweden.
⁶ Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; London School of Hygiene and Tropical Medicine, London, UK.

PMID: 26054252
DOI: 10.1016/j.ijgo.2015.04.017

Abstract

Objective: To identify and compare implementation bottlenecks for effective coverage of screening for syphilis, HIV, and anemia in antenatal care in rural Tanzania and Uganda; and explore the underlying determinants and perceived solutions to overcome these bottlenecks.

Methods: In this multiple case study, we analyzed data collected as part of the Expanded Quality Management Using Information Power (EQUIP) project between November 2011 and April 2014. Indicators from household interviews (n=4415 mothers) and health facility surveys (n=122) were linked to estimate coverage in stages of implementation between which bottlenecks can be identified. Key informant interviews (n=15) were conducted to explore underlying determinants and analyzed using a framework approach.

Results: Large differences in implementation were found within and between countries. Availability and effective coverage was significantly lower for all tests in Uganda compared with Tanzania. Syphilis screening had the lowest availability and effective coverage in both countries. The main implementation bottleneck was poor availability of tests and equipment. Key informant interviews validated these findings and perceived solutions included the need for improved procurement at the central level.

Conclusion: Our findings reinforce essential screening as a missed opportunity, caused by a lack of integration of funding and support for comprehensive antenatal care programs.

Keywords: Antenatal care; Bottlenecks; Implementation; Supply chain; Syphilis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Anemia / diagnosis*
Female
HIV Infections / diagnosis*
Health Care Surveys
Health Plan Implementation*
Health Services Accessibility
Humans
Mass Screening
Pregnancy
Pregnancy Complications / diagnosis*
Prenatal Care / standards
Prenatal Diagnosis / methods
Prenatal Diagnosis / standards*
Rural Population
Syphilis / diagnosis*
Tanzania
Uganda

Grants and funding

MR/K012126/1/MRC_/Medical Research Council/United Kingdom