Investigating potential strategies to improve access to antenatal care in Western Kenya

Abstract

The World Health Organization (WHO) recommends that pregnant women should initiate the first antenatal care (ANC) visit in the first trimester of pregnancy because early ANC access is central to identifying pregnancy complications and managing pre-existing conditions. However, in western Kenya, less than 20% of pregnant women are estimated to present for ANC in the first trimester. Barriers to early initiation of ANC such as uncertainty of pregnancy status during the first trimester and limited access to health facilities can potentially be addressed by improving access to pregnancy testing among pregnant women and task shifting services to community-level cadres of care such as community pharmacies. However, little is known about how often women use pregnancy self-tests or the characteristics of these women. Additionally, little is known about the extent to which community pharmacies provide services for pregnant women or the potential capacity of community pharmacies to provide such services. Therefore, in Aim 1 of the following study we conducted a cross-sectional survey among pregnant women enrolling in the PrEP Implementation for Mothers in Antenatal Care (PrIMA) study to determine the prevalence and factors associated with pregnancy self-testing among women in western Kenya. In Aim 2, we conducted a scoping review to determine the scope, type, and nature of services that are delivered through community pharmacies for pregnant women and to identify research gaps and opportunities for developing the evidence base. Overall in our study population, the prevalence of pregnancy self-testing was 22% and higher among women who were employed, currently in school, had previous pregnancy complications, received services from urban health facilities, and had partners who had at least attended secondary school. The most reported reasons for non-use of pregnancy self-tests included not thinking it was necessary, lack of knowledge, and lack of money to pay for the test. In the scoping review, we found a limited body of research on the role of community pharmacists in providing care to pregnant women. Among selected articles (n = 7), pharmacists were primarily involved in prevention (e.g. anemia and malaria), treatment, health education activities, and referral activities. Future research should focus on understanding the knowledge and attitudes of women toward pregnancy self-testing and pharmacy-based delivery of ANC services as well as the motivations and attitudes of community pharmacists toward providing services for pregnant women.