Challenges facing the implementation of the national guidelines for antenatal screening in the Acornhoek district

Abstract

BACKGROUND: Common preventable causes of maternal and perinatal mortality such as HIV, anaemia, gestational proteinuric hypertension, syphilis and Rhesus disorders can be identified early with simple antenatal screening, however this screening is not always efficiently and effectively done. It is critical to identify challenges and possible solutions to ensure effective implementation of the national antenatal screening guidelines for these conditions. Even within existing inadequate resources, there is always room for improved efficiency. METHODS: The aim of this study was to evaluate the implementation of the national guidelines for antenatal screening in the Acornhoek district, Mpumalanga. It was a prospective, cross-sectional study of the antenatal screening programme in the Acornhoek district. Data was collected from an analysis of antenatal and medical records of all women who received antenatal care in the Acornhoek district and ultimately delivered at Tintswalo Hospital, Acornhoek, during the study period of one calendar month. Standardised questionnaires were administered at each of the 15 antenatal clinics referring to Tintswalo Hospital to identify the challenges preventing the effective implementation of the national guidelines for antenatal screening that were experienced by the nurses at the clinics. RESULTS: 428 women were interviewed post partum. 335 were included in the study (87 had received antenatal care out of the district and 6 were unbooked). 85.7% of women had been tested for syphilis antenatally, 84.8% had been tested for anaemia, 72.8% had had blood taken for Rhesus factor and only 64.2% had had pre-test counselling for HIV. 14.3% of women did not have their blood pressure checked at every visit and over 31.4% did not have urine dipstick tests done at every visit. 27% of women booked before 20 weeks, however only 18% had their antenatal bloods taken before 20 weeks. Of the women who had had antenatal blood screening tests done, 18% had not received results by the time of delivery. There was considerable variation between the clinics. Challenges preventing the effective implementation of antenatal screening included variation in knowledge of antenatal screening requirements by clinic staff, barriers to HIV testing, poor infrastructure, equipment and supply problems, laboratory support issues, onsite testing challenges, poor support from the district and passive response to problem solving by clinic staff. CONCLUSIONS: Not all women receiving antenatal care in the Acornhoek district are being screened for HIV, anaemia, GPH, syphilis and Rhesus disorders. From the reasons identified above, interventions such as in-service training of clinic staff in antenatal screening, removing barriers to HIV testing such as appointing lay counsellors at every clinic and offering provider driven or opt-out testing for HIV, improving infrastructure such as installing telephones at every clinic, increasing the laboratory courier service to 5 days a week, introducing on site testing of syphilis, anaemia and Rhesus factor and a rapid pro-active approach to problem solving by district and clinic staff to manage barriers to antenatal screening such as broken equipment and out of stock supplies.