Abstract:
The disproportionate demand for services
related to infectious diseases such as
HIV/AIDS, tuberculosis, and malaria among
pregnant women in sub-Saharan Africa, given
limited health facility attendance, drives a
need to integrate these services with
antenatal care (ANC). This paper uses data
from Service Provision Assessments in Kenya
(2010), Malawi (2013-14), and Tanzania (2014-
15) to examine aspects of integrating
services for HIV, specifically prevention of
mother-to-child transmission (PMTCT),
tuberculosis, and malaria into ANC services.
For the study, we defined five components of
ANC integration with each infectious disease
service and created an integration score for
each infectious disease by averaging the
components. We examined the extent to which
the health facility’s integration capacity
was associated with selected facility
characteristics and women’s receipt of
integrated services during ANC visits.
Overall, facilities with ANC had higher
integration scores for PMTCT and malaria than
for tuberculosis, although availability of
the integration components varied by
background characteristics across and within
countries. Logistic regression results show
that the ANC-malaria integration score was
associated with consuming sulfadoxine-
pyrimethamine (SP) in Kenya and
Tanzania, and the ANC-PMTCT integration score
was associated with receiving HIV counseling
and testing during observed ANC visits in
Tanzania. The only integration component
associated with SP consumption, aside from
having SP available, was the presence of at
least one ANC provider at the facility who
also provides malaria services and has recent
training in these services. The only ANC-
PMTCT component with a significant
association with observation of HIV
counseling and testing,
except for the availability of HIV rapid
diagnostic testing, was having HIV counseling
and ANC services at the same site. More
research is needed to determine the synergies
among the different aspects of integrated
services.
Integration of Infectious Disease Services with Antenatal Care Services at Health Facilities in Kenya, Malawi, and Tanzania (PDF, 1081K)