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Antenatal testing for anaemia, HIV and syphilis in Indonesia – a health systems analysis of low coverage

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Baker, C, Limato, R, Tumbelaka, P, Rewari, BB, Nasir, S, Ahmed, Rukhsana and Taegtmeyer, Miriam ORCID: https://orcid.org/0000-0002-5377-2536 (2020) 'Antenatal testing for anaemia, HIV and syphilis in Indonesia – a health systems analysis of low coverage'. BMC Pregnancy and Childbirth, Vol 20, Issue 326.

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Abstract

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
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
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 (2,816 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
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.

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WC Communicable Diseases > Sexually Transmitted Diseases > WC 160 Syphilis
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.1 Diagnosis
WH Hemic and Lymphatic Systems > Hematologic Diseases. Immunologic Factors. Blood Banks > WH 155 Anemia
WQ Obstetrics > Pregnancy Complications > WQ 256 Infectious diseases
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1186/s12884-020-02993-x
Depositing User: Rachel Dominguez
Date Deposited: 01 Jun 2020 10:37
Last Modified: 02 Jun 2020 10:15
URI: https://archive.lstmed.ac.uk/id/eprint/14434

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