Barriers to uptake of antenatal maternal screening tests in Senegal

Background: Evidence exists that selective antenatal maternal screening tests contribute to the reduction of maternal morbidity and mortality. However, data are lacking on coverage with the complete set of recommended tests. The study aimed to identify barriers to uptake of the complete set of tests recommended by the Ministry of Health in Senegal. Methods: Data were collected in communities, antenatal care (ANC) clinics and the laboratories of 11 public health care facilities across Senegal. Mixed-methods included ethnography (observations and informal conversations), in-depth interviews and workshops at the health facilities; structured interviews with 283 women receiving antenatal tests (“women in the lab”); in-depth interviews with 81 women in communities who were pregnant or had recently delivered (“community women”). Results: Only 13% of community women and 22% of women in the lab had received the complete set of tests. For various social, financial and antenatal care-related reasons 38% of community women who visited antenatal care facilities did not access a laboratory. The lowest test uptake was in women receiving antenatal care at health posts. Barriers at the laboratory level were the cost of the test, stock-outs of reagents, and broken equipment. Midwives were the main gatekeepers of the laboratory, not requesting (all) tests because of assumptions about women's financial problems and reliance on clinical symptoms. Conclusion: In Senegal, recommended antenatal maternal screening tests are substantially underutilized. Efforts to increase test uptake should include accessible testing guidelines, reducing the cost of tests, raising awareness about the reasons for tests, and making the complete test set in point-of-care format accessible in peripheral health posts. National and international antenatal care policies and programs should facilitate access to maternal screening tests as a contribution to reducing maternal and infant morbidity and mortality. Keywords: Senegal, Antenatal care, Maternal screening tests, Laboratory, Access to care, Multi-level study, Mixed method

A comparison of phenotypic traits related to trypanotolerance in five west african cattle breeds highlights the value of shorthorn taurine breeds.

Animal African Trypanosomosis particularly affects cattle and dramatically impairs livestock development in sub-Saharan Africa. African Zebu (AFZ) or European taurine breeds usually die of the disease in the absence of treatment, whereas West African taurine breeds (AFT), considered trypanotolerant, are able to control the pathogenic effects of trypanosomosis. Up to now, only one AFT breed, the longhorn N'Dama (NDA), has been largely studied and is considered as the reference trypanotolerant breed. Shorthorn taurine trypanotolerance has never been properly assessed and compared to NDA and AFZ breeds.This study compared the trypanotolerant/susceptible phenotype of five West African local breeds that differ in their demographic history. Thirty-six individuals belonging to the longhorn taurine NDA breed, two shorthorn taurine Lagune (LAG) and Baoulé (BAO) breeds, the Zebu Fulani (ZFU) and the Borgou (BOR), an admixed breed between AFT and AFZ, were infected by Trypanosoma congolense IL1180. All the cattle were genetically characterized using dense SNP markers, and parameters linked to parasitaemia, anaemia and leukocytes were analysed using synthetic variables and mixed models. We showed that LAG, followed by NDA and BAO, displayed the best control of anaemia. ZFU showed the greatest anaemia and the BOR breed had an intermediate value, as expected from its admixed origin. Large differences in leukocyte counts were also observed, with higher leukocytosis for AFT. Nevertheless, no differences in parasitaemia were found, except a tendency to take longer to display detectable parasites in ZFU.We demonstrated that LAG and BAO are as trypanotolerant as NDA. This study highlights the value of shorthorn taurine breeds, which display strong local adaptation to trypanosomosis. Thanks to further analyses based on comparisons of the genome or transcriptome of the breeds, these results open up the way for better knowledge of host-pathogen interactions and, furthermore, for identifying key biological pathways

A study to better understand under-utilization of laboratory tests for antenatal care in Senegal

Objective: To better understand factors contributing to underutilization of laboratory services for health care delivery in sub-Saharan Africa, we conducted a study in Senegalese Antenatal Care clinics (ANC) and laboratories to determine the extent of underutilization, contributing factors, and bottlenecks in the cascade of care from first ANC visit, test uptake, to availability of test results and appropriate clinical management. Methods: At 16 health facilities, pregnant women attending for their first ANC visit were consecutively recruited and information was prospectively collected on the request, execution, results and clinical management of seven nationally recommended laboratory screening tests for normal pregnancy: hemoglobin concentration (Hb), syphilis serology, HIV serology, determination of proteinuria (PU), determination of blood group and Rhesus factor, Emmel test to detect sickle cell disease, and glycaemia. Health facility staff were interviewed on human resource capacity, management of the ANC and the laboratory, and availability and use of guidelines. Results: Of 1246 ANC attendants, 400 (32%) had complete results. Completeness varied between facilities from 0-99%. In multilevel logistic regression analysis of women nested in facilities, complete uptake was lower if women started ANC later in pregnancy; very low in rural ANC attendants who ever delivered compared to urban primigravidae (OR 0.064; 95%CI 0.00- 0.52); and higher if the facility routinely recommended all seven tests. In the cascade from test request to clinical management, the most frequent bottleneck was non-execution of requested tests, while unavailability of results for executed test was uncommon (<2%). Overall, of 525 abnormal test results 97(18%) had a record of adequate clinical management. Conclusion: Our study illustrates challenges to test uptake even when laboratory testing capacity is in place, with large differences between facilities, and underscores the importance of management, policy, and the importance of considering local context in order to improve service delivery to expectant mothers

Results of the linear mixed effects model on PCV.

<p>Results of the linear mixed effects model on PCV.</p

Evolution of PCV over the time course of infection.

<p>PCV is expressed as a percentage of blood volume. A. PCV evolution for the LAG, ZFU and BOR breeds. B. PCV evolution for the LAG, NDA and BAO breeds. The continuous lines are the average per breed and the surrounding areas represent the confidence intervals of the means at 95%.</p

Meaning and results on synthetic phenotypic variables.

<p>Meaning and results on synthetic phenotypic variables.</p

Results of the generalized linear mixed effects model on parasitaemia.

<p>Results of the generalized linear mixed effects model on parasitaemia.</p

Evolution of TWBC over the time course of infection.

<p>TWBC is expressed as million leukocytes/ml of blood. A. TWBC evolution for the LAG, ZFU and BOR breeds. B. TWBC evolution for the LAG, NDA and BAO breeds. The continuous lines are the average per breed and the surrounding areas represent the confidence intervals of the means at 95%.</p

Results of the non-linear mixed effects model on TWBC.

<p>Results of the non-linear mixed effects model on TWBC.</p

Map representing the geographical origin of the breeds used in the experiment.

<p>DIVA-GIS software version 7.5 [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0126498#pone.0126498.ref035" target="_blank">35</a>] with the BIOCLIM system [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0126498#pone.0126498.ref036" target="_blank">36</a>] was used to obtain the map. The different agro-climatic zones were defined based on the annual precipitation of the Worldclim database (<a href="http://www.worldclim.org/" target="_blank">http://www.worldclim.org</a>) and according to the OECD 2009 criteria [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0126498#pone.0126498.ref037" target="_blank">37</a>]. According to [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0126498#pone.0126498.ref038" target="_blank">38</a>], the current northern limit of tsetse presence is slightly above the limit between the semi-arid and sub-humid dry areas. DIVA-GIS and spatial data are freely available and downloadable from <a href="http://www.diva-gis.org/" target="_blank">http://www.diva-gis.org/</a></p