Does the introduction of rapid tests in antenatal care actually facilitate access to comprehensive medical examination of pregnant women?

Rapid diagnosis tests are biological tests used to quickly adapt patients’ management in case of detected abnormalities. These tests can be performed outside of a laboratory and without qualified laboratory staff. The availability of these rapid tests prevents situations in which pregnant women miss the minimum screening tests during antenatal care.

The SOCIALAB project, whose objective is to identify barriers and factors related to the under-utilization of prenatal tests in Senegal, looked at the practices of rapid integrated tests of albuminuria and glycosuria (ALB/GLY) in urine, in 16 peripheral health facilities. The ALB/GLY is recommended to identify women at risk of eclampsia and gestational diabetes which may severely endanger the health of mothers and their newborns. When detected early, these conditions can be controlled with simple and accessible treatments.

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Although rapid tests are recommended to facilitate access to care, in Senegal they are actually used at all levels of the health system: central, intermediate and peripheral. This suggests that even with laboratory facilities available, antenatal service providers believe that the use of these rapid tests may further increase the access to screening tests. Based on this background, we explored the logistical and technical aspects of the implementation and use of rapid tests in the peripheral health facilities with laboratory services available. Urine dipsticks combining albuminuria and glycosuria tests were taken as an example.

In the 16 peripheral health facilities visited, we were surprised to see that far from facilitating access to biological assessment, the use of rapid tests in health facilities had unintended consequences, related to quality and cost-effectiveness issues. Each health facility takes the decision to implement the rapid testing at the antenatal clinic or not, in addition to those tests performed at the laboratory itself. When rapid tests are performed at the antenatal clinics results are available within an average of 11.5 minutes and medical care can be immediately provided in case of any anomaly. Pregnant women are usually happy to be tested on site, as these 'point-of-care' tests spare them additional trips to  laboratory facilities to pick results the following day. The tests cost an average of Euros 0.76 (500 CFA), which remains affordable to most Senegalese households.

The money is sometimes directly given to the midwife. Unfortunately, in many cases, we noted that the midwife only use the albuminuria results leaving the glucose urinary test without interpretation, sadly wasting women’s financial resources and missing opportunities for early detection of gestational diabetes. Other bad practices observed in all facilities were; cutting the dipsticks to make several tests out of one (in 3 of 9 structures), reusing the urine containers contaminated by various substances during cleaning (7/9), non-adequate material (9/9) or even outdated dipsticks (1/9). Other errors may be attributed to the midwives overloaded by work and who must perform the rapid tests in addition to their regular duties at the antenatal clinic. These bad practices call into question the results’ reliability, especially where laboratory staff does not do supervision of the rapid test.

When rapid tests are performed in a laboratory facility, the results are usually delayed, up to 24 to 48 hours. This delay creates a missed opportunity to manage emergencies such as eclampsia or diabetes and cancels any benefit related to the use of rapid tests. On top of that, the costs remain high (1.92 Euros / 1,250 FCFA), 2.5 times more than when the test is performed by a midwife. This is because pregnant women have to travel again for results the following day.   

These observations suggest that in some contexts, the use of rapid tests can generate unreliable and delayed results, with a substantial health and financial burden on  pregnant women. The negative effects exist even though conventional screening tests are available within the assessed health facilities.

While the use of simple and cheap technologies is expected to improve access to quality care, the results of the SOCIALAB project invite us to reflect on the conditions of their use.  In addition, we may question the appropriateness of the rapid tests use in facilities where laboratories exist. The implementation of the rapid tests must be better managed to avoid collateral negative impact on the health system. Health care providers should be trained to use rapid tests and subsequently supervised. There is still need for the Senegalese government to provide basic health facilities with adequate laboratory equipment in order to enable them to perform simple biological assessments.

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