Accessibility of essential maternal health related in-vitro point-of-care diagnostic tests at the primary health care level in Luwero district central Uganda

Abstract

Background: Poor maternal outcomes at the Primary Health Care (PHC) level of Low-Income Countries such as Uganda are partly attributed to poor maternal health services including inaccessibility of appropriate maternal diagnostics. The use of maternal health related In-Vitro Point-Of-Care Diagnostic Tests (IVPOCDTs) can bridge the gap between the delay in diagnosis and timely evidence-based maternal interventions such as treatment or referral. The clinical impact of IVPOCDTs on maternal outcomes such as safe birth depends on their accessibility. Objective: The study determined the accessibility of maternal health related IVPOCDTs in terms of their availability, utilization capacity and the technical competency of their operators at the PHC level in Luwero district so as to yield information that will inform health policies/programs that can improve accessibility of such diagnostic tests. Method: Between March and May 2020, we conducted a cross-sectional study in the 3 Health Sub Districts of Luwero district. We accessed the Luwero district inventory list of 75 HCs II and III from which we chose 65 as the study sample using probability proportionate to size stratified random sampling. We collected data on the availability and utilization capacity of IVPOCDTs and also the technical competency of their operators using a standardized, structured and WHO adapted survey tool. Data capture was by Microsoft excel and analysis was by SPSS version 23. Results: While the average number of maternal IVPOCDTs available in the HCs was 7.06 (range: 2-12; SD = 3.01), 41.7% (25/60) of the HCs reported a high availability of the diagnostics (9-12 IVPOCDTs). Almost all (83.3%) (10/12) of the IVPOCDTs had low frequency of utilization. The most frequently utilized IVPOCDT was for malaria (100%) (60/60), while the least frequently utilized was for gonorrhea (12%) (7/60). Only 10% (6/60) of the IVPOCDTs’ operators had degrees, while close to half (46.5%) (28/60) had certificates. Majority (65%) (39/60) of the same operators had a high working experience. Conclusions: There was a suboptimal accessibility of the maternal health related IVPOCDTs at the PHC level of Luwero district Central Uganda. Availability of the maternal IVPOCDTs and the technical competency of their operators were average, while the utilization capacity was low. Recommendations: There is need for policy changes to ensure adequate accessibility of the maternal health related IVPOCDTs in Luwero district to the levels recommended by the WHO guidelines for maternal assessment during pregnancy.