Prevalence and correlates of pregnancy self-testing among pregnant women attending antenatal care in western Kenya

Abstract

In sub-Saharan Africa little is known about how often women use pregnancy self-tests or characteristics of these women despite evidence that pregnancy self-testing is associated with early antenatal care (ANC) initiation. Understanding the characteristics of women who use pregnancy self-tests can facilitate more targeted efforts to improve pregnancy testing experiences and entry into the ANC pathway. We conducted a cross-sectional survey among pregnant women enrolling in a pre-exposure prophylaxis (PrEP) implementation study to determine the prevalence and factors associated with pregnancy self-testing among women in western Kenya. Overall, in our study population, 17% of women obtained a pregnancy self-test from a pharmacy. Pregnancy test use was higher among employed women, women with secondary and college-level educated partners, and women who spent 30 minutes or less traveling to the maternal and child health (MCH) clinic. The most reported reasons for non-use of pregnancy self-tests included not thinking it was necessary, lack of knowledge, and money to pay for the test. Future research should focus on understanding the knowledge and attitudes of women toward pregnancy self-testing as well as developing community-based models to improve access to pregnancy testing and ANC.

Understanding factors influencing home pregnancy test use among women in western Kenya: A qualitative analysis

“…Some women did not know they could use a home pregnancy test to confirm their pregnancies, consistent with prior findings from a preliminary survey ( 1 ). These women may have had limited exposure to messages reinforcing home pregnancy test use through local media platforms, school education, friends, partners, or other community sensitization efforts.…”

“…Urine home pregnancy tests were introduced to the global market in the 1970s and continue to provide women with an easy and discrete way to assess their pregnancy status ( 18 ). However, there are limited data on home pregnancy test use in western Kenya, and in one study, few women reported using home pregnancy tests in early pregnancy ( 1 ). This study aimed to understand why women who had previously attended antenatal care at public health facilities in Homa Bay and Siaya counties did not initially use home pregnancy tests to confirm their pregnancies.…”

“…Over 90% of women in Kenya are estimated to receive antenatal care (ANC) from a skilled provider; however, as of 2014, only 20% sought antenatal care before the fourth month of pregnancy. Observational evidence suggests that women who use home pregnancy tests are more likely to present for antenatal care early ( 1 , 2 ), which could lead to earlier identification of risk factors and health problems (e.g., hypertension, HIV, and other sexually transmitted infections) and prompt prevention and treatment during pregnancy, ultimately contributing to improved mother and child outcomes ( 3 , 4 ). However, there is limited literature documenting home pregnancy test use among women in low-and-middle-income countries.…”

“…However, there is limited literature documenting home pregnancy test use among women in low-and-middle-income countries. For example, a 2019 survey found that 20% of women enrolling in ANC clinics in western Kenya used a home pregnancy test to confirm their pregnancies before presenting for ANC—this figure is much lower than in high-income settings where roughly 75% of women use a home pregnancy test ( 1 , 5 ). Most women reported they did not use a home pregnancy test because they did not think it was necessary, did not have the money, or did not know about it ( 1 ).…”

“…For example, a 2019 survey found that 20% of women enrolling in ANC clinics in western Kenya used a home pregnancy test to confirm their pregnancies before presenting for ANC—this figure is much lower than in high-income settings where roughly 75% of women use a home pregnancy test ( 1 , 5 ). Most women reported they did not use a home pregnancy test because they did not think it was necessary, did not have the money, or did not know about it ( 1 ). Women's knowledge and attitudes toward home pregnancy testing, motivations for use, and influences on ANC uptake in Kenya remain unclear.…”