Antenatal testing for anaemia, HIV and syphilis in Indonesia - a health systems analysis of low coverage.
Anemia
/ diagnosis
Community Health Workers
Delivery of Health Care
Female
Focus Groups
HIV
HIV Infections
/ diagnosis
Humans
Indonesia
/ epidemiology
Midwifery
Pregnancy
Pregnancy Complications, Infectious
/ diagnosis
Prenatal Care
/ methods
Prenatal Diagnosis
/ methods
Qualitative Research
Retrospective Studies
Syphilis
/ diagnosis
Systems Analysis
Treponema pallidum
Anaemia
Antenatal testing
Decentralisation
HIV
Indonesia
Syphilis
Journal
BMC pregnancy and childbirth
ISSN: 1471-2393
Titre abrégé: BMC Pregnancy Childbirth
Pays: England
ID NLM: 100967799
Informations de publication
Date de publication:
29 May 2020
29 May 2020
Historique:
received:
18
10
2019
accepted:
06
05
2020
entrez:
31
5
2020
pubmed:
31
5
2020
medline:
30
1
2021
Statut:
epublish
Résumé
Adverse pregnancy outcomes can be prevented through the early detection and treatment of anaemia, HIV and syphilis during the antenatal period. Rates of testing for anaemia, HIV and syphilis among women attending antenatal services in Indonesia are low, despite its mandate in national guidelines and international policy. Midwife-held antenatal care records for 2015 from 8 villages in 2 sub-districts within Cianjur district were reviewed, alongside the available sub-district Puskesmas (Community Health Centre) maternity and laboratory records. We conducted four focus group discussions with kaders (community health workers) (n = 16) and midwives (n = 9), and 13 semi-structured interviews with laboratory and counselling, public sector maternity and HIV management and relevant non-governmental organisation staff. Participants were recruited from village, sub-district, district and national level as relevant to role. We were unable to find a single recorded result of antenatal testing for HIV, syphilis or anaemia in the village (566 women) or Puskesmas records (2816 women) for 2015. Laboratory records did not specifically identify antenatal women. Participants described conducting and reporting testing in a largely ad hoc manner; relying on referral to health facilities based on clinical suspicion or separate non-maternity voluntary counselling and testing programs. Participants recognized significant systematic challenges with key differences between the more acceptable (and reportedly more often implemented) haemoglobin testing and the less acceptable (and barely implemented) HIV and syphilis testing. However, a clear need for leadership and accountability emerged as an important factor for prioritizing antenatal testing and addressing these testing gaps. Practical solutions such as revised registers, availability of point-of-care tests and capacity building of field staff will therefore need to be accompanied by both funding and political will to coordinate, prioritize and be accountable for testing in pregnancy.
Sections du résumé
BACKGROUND
BACKGROUND
Adverse pregnancy outcomes can be prevented through the early detection and treatment of anaemia, HIV and syphilis during the antenatal period. Rates of testing for anaemia, HIV and syphilis among women attending antenatal services in Indonesia are low, despite its mandate in national guidelines and international policy.
METHODS
METHODS
Midwife-held antenatal care records for 2015 from 8 villages in 2 sub-districts within Cianjur district were reviewed, alongside the available sub-district Puskesmas (Community Health Centre) maternity and laboratory records. We conducted four focus group discussions with kaders (community health workers) (n = 16) and midwives (n = 9), and 13 semi-structured interviews with laboratory and counselling, public sector maternity and HIV management and relevant non-governmental organisation staff. Participants were recruited from village, sub-district, district and national level as relevant to role.
RESULTS
RESULTS
We were unable to find a single recorded result of antenatal testing for HIV, syphilis or anaemia in the village (566 women) or Puskesmas records (2816 women) for 2015. Laboratory records did not specifically identify antenatal women. Participants described conducting and reporting testing in a largely ad hoc manner; relying on referral to health facilities based on clinical suspicion or separate non-maternity voluntary counselling and testing programs. Participants recognized significant systematic challenges with key differences between the more acceptable (and reportedly more often implemented) haemoglobin testing and the less acceptable (and barely implemented) HIV and syphilis testing. However, a clear need for leadership and accountability emerged as an important factor for prioritizing antenatal testing and addressing these testing gaps.
CONCLUSIONS
CONCLUSIONS
Practical solutions such as revised registers, availability of point-of-care tests and capacity building of field staff will therefore need to be accompanied by both funding and political will to coordinate, prioritize and be accountable for testing in pregnancy.
Identifiants
pubmed: 32471383
doi: 10.1186/s12884-020-02993-x
pii: 10.1186/s12884-020-02993-x
pmc: PMC7257553
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
326Subventions
Organisme : Medical Research Council
ID : G1100654
Pays : United Kingdom
Organisme : FP7 Ideas: European Research Council
ID : HEALTH-F3-2012-306090
Organisme : Medical Research Council
ID : MR/T003324/1
Pays : United Kingdom
Références
JAMA. 2000 Mar 1;283(9):1175-82
pubmed: 10703780
Int J Prev Med. 2013 Feb;4(2):193-9
pubmed: 23543625
Soc Sci Med. 2009 Sep;69(6):838-45
pubmed: 19576671
BMC Public Health. 2011 Oct 18;11:812
pubmed: 22008721
BMJ. 1995 Jul 22;311(6999):251-3
pubmed: 7627048
AIDS Behav. 2013 Sep;17(7):2528-39
pubmed: 23474643
Stud Fam Plann. 2009 Mar;40(1):27-38
pubmed: 19397183
Lancet Infect Dis. 2010 Jun;10(6):381-6
pubmed: 20510278
Milbank Q. 2004;82(4):581-629
pubmed: 15595944
Reprod Health Matters. 2003 May;11(21):96-107
pubmed: 12800707
PLoS One. 2016 Mar 07;11(3):e0149568
pubmed: 26949941
BMC Int Health Hum Rights. 2010 Mar 05;10:3
pubmed: 20205724
Lancet. 2008 Apr 12;371(9620):1226-9
pubmed: 18406846
Am J Occup Ther. 1991 Mar;45(3):214-22
pubmed: 2031523
Int J Gynaecol Obstet. 2015 Jun;130 Suppl 1:S15-21
pubmed: 26001704
J Int AIDS Soc. 2016 Dec 14;19(1):21212
pubmed: 27978939
Bull World Health Organ. 2013 Jan 1;91(1):70-4
pubmed: 23397353
Bull World Health Organ. 2013 Mar 1;91(3):217-26
pubmed: 23476094
Health Res Policy Syst. 2009 Apr 16;7:5
pubmed: 19371410
BMC Res Notes. 2015 Dec 09;8:757
pubmed: 26645634
Int J Gynaecol Obstet. 2015 Jun;130 Suppl 1:S32-6
pubmed: 25968490
Clin Microbiol Infect. 2010 Aug;16(8):1062-9
pubmed: 20670288
PLoS Med. 2017 Jun 27;14(6):e1002329
pubmed: 28654643
Int J Health Plann Manage. 2015 Jan-Mar;30(1):E16-30
pubmed: 24825032
Malar J. 2015 Oct 29;14:420
pubmed: 26511932
Fam Pract. 1996 Dec;13(6):522-5
pubmed: 9023528
Sex Transm Infect. 2017 Dec;93(S4):S3-S15
pubmed: 28747410
BMC Pregnancy Childbirth. 2015 Feb 26;15:47
pubmed: 25886505
BMJ Glob Health. 2018 Sep 28;3(5):e000939
pubmed: 30294460
Health Serv Res. 2013 Dec;48(6 Pt 2):2134-56
pubmed: 24279835
BMJ. 2010 Sep 17;341:c4587
pubmed: 20851841