Operational assessment of point-of-care diagnostics in rural primary healthcare clinics of KwaZulu-Natal, South Africa: a cross-sectional survey

T P Mashamba-Thompson; B Sartorius; P K Drain

doi:10.1186/s12913-018-3207-6

Operational assessment of point-of-care diagnostics in rural primary healthcare clinics of KwaZulu-Natal, South Africa: a cross-sectional survey

BMC Health Serv Res. 2018 May 29;18(1):380. doi: 10.1186/s12913-018-3207-6.

Authors

T P Mashamba-Thompson¹, B Sartorius², P K Drain^{3

4

5

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Affiliations

¹ Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, 2nd Floor, George Campbell Building, Science Drive, Howard College Campus, Durban, 4001, South Africa. Mashamba-Thompson@ukzn.ac.za.
² Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, 2nd Floor, George Campbell Building, Science Drive, Howard College Campus, Durban, 4001, South Africa.
³ International Clinical Research Center, Department of Global Health, University of Washington, Seattle, USA.
⁴ Division of Infectious Diseases, Department of Medicine, University of Washington, Seattle, USA.
⁵ Department of Epidemiology, University of Washington, Seattle, USA.
⁶ Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.

Abstract

Background: The World Health Organization (WHO) called for new clinical diagnostic for settings with limited access to laboratory services. Access to diagnostic testing may not be uniform in rural settings, which may result in poor access to essential healthcare services. The aim of this study is to determine the availability, current usage, and need for point-of-care (POC) diagnostic tests among rural primary healthcare (PHC) clinics in South Africa's KwaZulu-Natal (KZN) province.

Methods: We used the KZN's Department of Health (DoH) clinic classification to identify the 232 rural PHC clinics in KZN, South Africa. We then randomly sampled 100 of 232 rural PHC clinics. Selected health clinics were surveyed between April to August 2015 to obtain clinic-level data for health-worker volume and to determine the accessibility, availability, usage and need for POC tests. Professional healthcare workers responsible for POC testing at each clinic were interviewed to assess the awareness of POC testing. Data were survey weighted and analysed using Stata 13.

Results: Among 100 rural clinics, the average number of patients seen per week was 2865 ± 2231 (range 374-11,731). The average number of POC tests available and in use was 6.3 (CI: 6.2-6.5) out of a potential of 51 tests. The following POC tests were universally available in all rural clinics: urine total protein, urine leukocytes, urine nitrate, urine pregnancy, HIV antibody and blood glucose test. The average number of desired POC diagnostic tests reported by the clinical staff was estimated at 15 (CI: 13-17) per clinic. The most requested POC tests reported were serum creatinine (37%), CD4 count (37%), cholesterol (32%), tuberculosis (31%), and HIV viral load (23%).

Conclusion: Several POC tests are widely available and in use at rural PHC clinics in South Africa's KZN province. However, healthcare workers have requested additional POC tests to improve detection and management of priority disease conditions.

Trial registration: Clinical Trials.gov Identifier: NCT02692274.

Keywords: Diagnostic testing; Health services; KwaZulu-Natal; Point-of-care test; Primary healthcare clinics; Rural health; South Africa.

Publication types

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

MeSH terms

Ambulatory Care Facilities*
Attitude of Health Personnel
Cross-Sectional Studies
Female
HIV Infections / drug therapy
Health Personnel
Humans
Interviews as Topic
Male
Mass Screening
Point-of-Care Testing*
Pregnancy
Primary Health Care* / organization & administration
Rural Health Services*
South Africa

Associated data

ClinicalTrials.gov/NCT02692274

Abstract

Publication types

MeSH terms

Associated data

Grants and funding