Improving the effectiveness of point of care tests for malaria and anaemia: a qualitative study across three Ghanaian antenatal clinics

Background: Anaemia and malaria are both major contributors to maternal and child mortality, and morbidity,

with some of the worst outcomes occurring in sub-Saharan Africa. Point of care tests (POCT), if used appropriately,

provide a simple, inexpensive form of diagnostic testing, as a reliable alternative when laboratory tests are not

readily available. In such resource limited settings, clinical staff tend to rely on symptom-based diagnosis and

presumptive treatment. This study uses qualitative methods to identify the current practice of POCT use for malaria

and anaemia, to explore the enablers and barriers to effective implementation of these POCT, and to determine

how relationships between each of the stakeholder groups may impact on POCT use.

Methods: Staff (clinical and laboratory) and patients (pregnant women) at three antenatal care facilities within the

Ashanti Region of Ghana participated in interviews and focus group discussions (FGDs). An initial coding framework

was developed based on the pre-defined objectives of the study. Thematic analysis was used to identify subthemes

and categories within each of the key themes.

Results: At the time data were collected all three facilities used malaria POCT either as an adjunct to microscopy, or

as their only form of malaria testing. Although all three facilities were familiar with haemoglobin colour scale (HCS),

none of the facilities used them routinely. Clinical staff perceived symptom-based diagnosis was a quick way to

diagnosis because access to POCT during consultations was unreliable, but recognized disadvantages associated

with symptom-based diagnosis.

Perceived advantages of malaria and anaemia POCT were user-friendliness, improved diagnosis and opportunity for

patient engagement, as well as lower cost implication for patients. Perceived disadvantages included likelihood of

missed diagnosis of mild anaemia, as well as likelihood of human error leading to in accurate diagnosis which

could impact on patient trust. Poor communication and lack of trust between staff groups was also identified as a

barrier to effective uptake of POCT.

Conclusions: Consistent supply of POCT as well as staff training and staff and patient engagement, are

fundamental to successful uptake of POCT for effective malaria and anaemia management.

Keywords: Antenatal care, Malaria and anaemia in pregnancy, Active participation, Rapid diagnostic test,

Haemoglobin colour scale, LMIC, Ghana