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. 2023 Mar 30;23(1):306.
doi: 10.1186/s12913-023-09296-9.

Investigating rapid diagnostic testing in Kenya's health system, 2018-2020: validating non-reporting in routine data using a health facility service assessment survey

Angela K Moturi #  1 , Bibian N Robert #  2 , Felix Bahati  3 , Peter M Macharia  2   4 , Emelda A Okiro  2   5
Affiliations

Investigating rapid diagnostic testing in Kenya's health system, 2018-2020: validating non-reporting in routine data using a health facility service assessment survey

Angela K Moturi et al. BMC Health Serv Res. .

Abstract

Background: Understanding the availability of rapid diagnostic tests (RDTs) is essential for attaining universal health care and reducing health inequalities. Although routine data helps measure RDT coverage and health access gaps, many healthcare facilities fail to report their monthly diagnostic test data to routine health systems, impacting routine data quality. This study sought to understand whether non-reporting by facilities is due to a lack of diagnostic and/or service provision capacity by triangulating routine and health service assessment survey data in Kenya.

Methods: Routine facility-level data on RDT administration were sourced from the Kenya health information system for the years 2018-2020. Data on diagnostic capacity (RDT availability) and service provision (screening, diagnosis, and treatment) were obtained from a national health facility assessment conducted in 2018. The two sources were linked and compared obtaining information on 10 RDTs from both sources. The study then assessed reporting in the routine system among facilities with (i) diagnostic capacity only, (ii) both confirmed diagnostic capacity and service provision and (iii) without diagnostic capacity. Analyses were conducted nationally, disaggregated by RDT, facility level and ownership.

Results: Twenty-one per cent (2821) of all facilities expected to report routine diagnostic data in Kenya were included in the triangulation. Most (86%) were primary-level facilities under public ownership (70%). Overall, survey response rates on diagnostic capacity were high (> 70%). Malaria and HIV had the highest response rate (> 96%) and the broadest coverage in diagnostic capacity across facilities (> 76%). Reporting among facilities with diagnostic capacity varied by test, with HIV and malaria having the lowest reporting rates, 58% and 52%, respectively, while the rest ranged between 69% and 85%. Among facilities with both service provision and diagnostic capacity, reporting ranged between 52% and 83% across tests. Public and secondary facilities had the highest reporting rates across all tests. A small proportion of health facilities without diagnostic capacity submitted testing reports in 2018, most of which were primary facilities.

Conclusion: Non-reporting in routine health systems is not always due to a lack of capacity. Further analyses are required to inform other drivers of non-reporting to ensure reliable routine health data.

Keywords: Health facility survey; Kenya; Rapid diagnostic test; Routine data; Triangulation.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart outlining overall study approach. (1Kenya Harmonised Health Facility Assessment, 2District Health Information System version 2, 3Master Facility List Code)
Fig. 2
Fig. 2
Spatial distribution of 2821 health facilities used in triangulation sampled in the facility survey and registered on DHIS2.
Fig. 3
Fig. 3
Proportion of health facilities reporting in DHIS2 (blue) among those with confirmed diagnostic capacity from KHFA. The circle size of each test corresponds to the total number of facilities with confirmed capacity, lowest (CRAG) to highest (HIV). Percentage reporting is shown in the figure
Fig. 4
Fig. 4
Proportion of health facilities reporting in DHIS2 among those with confirmed diagnostic capacity from cross-sectional survey data. Panels are disaggregated by level, primary (top left) and secondary level (top right) and by ownership, private (bottom left) and public facilities (bottom right)
Fig. 5
Fig. 5
Heat plot of responses to service and test availability questions in the survey (labelled service & test) compared to DHIS2 reports (labelled reported) for each of the 2821 facilities (Panel 1). Panel 2 shows the proportion of health facilities reporting in DHIS2 among those with confirmed service provision and diagnostic capacity from cross-sectional survey data. TPHA is an uncommon Syphilis test
Fig. 6
Fig. 6
Proportion of health facilities reporting tests performed in DHIS2 despite confirmed lack of diagnostic capacity as per a cross-sectional survey for 2018 only, N = 2821(Panel 1). Panel 2 shows the proportion of reporting in Panel 1 that is due to primary facilities
See this image and copyright information in PMC

References

    1. Fleming KA, Horton S, Wilson ML, Atun R, DeStigter K, Flanigan J, Sayed S, Adam P, Aguilar B, Andronikou S. The Lancet Commission on diagnostics: transforming access to diagnostics. The Lancet. 2021;398(10315):1997–2050. doi: 10.1016/S0140-6736(21)00673-5. - DOI - PMC - PubMed
    1. Catharina B, Madhukar P. Diagnostic Gaps in Global Health. https://www.thinkglobalhealth.org/article/diagnostic-gaps-global-health. Accessed August 2022.
    1. Yadav H, Shah D, Sayed S, Horton S, Schroeder LF. Availability of essential diagnostics in ten low-income and middle-income countries: results from national health facility surveys. The Lancet Global Health. 2021;9(11):e1553–60. doi: 10.1016/S2214-109X(21)00442-3. - DOI - PMC - PubMed
    1. Carter JY, Lema OE, Wangai MW, Munafu CG, Rees PH, Nyamongo JA. Laboratory testing improves diagnosis and treatment outcomes in primary health care facilities. Afr J Lab Med. 2012;1(1):1–6. - PMC - PubMed
    1. Wilson ML, Fleming KA, Kuti MA, Looi LM, Lago N, Ru K. Access to pathology and laboratory medicine services: a crucial gap. The Lancet. 2018;391(10133):1927–38. doi: 10.1016/S0140-6736(18)30458-6. - DOI - PubMed