Over six months in Malava Sub-County, the introduction of rapid diagnostic tests (RDTs) and obstetric point-of-care ultrasounds (O-POCUS) at antenatal care visits led to a 15% increase in mothers reporting they received comprehensive blood and urine test results, and enabled early detection and referral of 213 high-risk complications (among 2,822 mothers screened) that would have otherwise been missed.

Susan Amboyi, Medical Laboratory Technologist at Kimangeti Level 2 Hospital, Malava Sub-County, Kakamega County (western Kenya), orienting (from right) Nancy Gitonga, Health Systems Strengthening (HSS) Manager, and Sieglinder Mghenyi, Head of Health Systems Strengthening, on Standard Operating Procedures (SOPs) for sample collection, handling, and processing during the Antenatal Care (ANC) Profiling Pilot activities.

Antenatal testing is a foundational part of early pregnancy care, providing a baseline health assessment to identify conditions that could threaten the health of a mother or baby. It typically includes blood and urine tests for anemia, infections, and other high-risk conditions and is recommended as standard of care by both global and Kenyan guidelines. In Kenya, however, antenatal care (ANC) services often do not deliver the full suite of tests required to detect high-risk pregnancy conditions early. While the Kenya Health Information System (KHIS) shows high national uptake of first ANC visits (up to 98%), there is a critical quality gap: many women don’t receive complete essential tests or results. 

These gaps often stem from gaps in primary health systems such as lack of lab equipment and infrastructure or insufficient lab personnel. Because women are far more likely to seek ANC at the facility closest to their home, it is important that these frontline clinics are equipped to offer complete ANC profiling. When testing isn’t available, many women delay or skip ANC visits altogether, reducing opportunities to detect and manage serious conditions. This includes complications like anemia, UTIs, malaria, HIV, syphilis, Hepatitis B, and gestational diabetes, which require lab-based screening, as well as conditions like high blood pressure and pre-eclampsia, which rely on consistent monitoring across multiple visits. Without timely attendance and comprehensive care, both mothers and babies are at increased risk.

PROMPTS data pinpoints where ANC testing is lacking

Jacaranda Health’s digital health information and referral platform, PROMPTS, surveys mothers shortly after antenatal care (ANC) visits to track what services they received, including basic tests like blood and urine diagnostics. This data, combined with insights from the national Kenya Health Information System (KHIS), identified that in Malava Sub-County, only 6 of 27 PHC public facilities (22%) have the capacity for complete ANC profiling. The remaining 21 facilities lack functional labs, equipment, and staff, leaving nearly half of pregnant women who attended their first ANC visit between July and December 2023 without complete profiling. 

Low-cost diagnostics bring lab services closer to mothers

This data prompted the county government to look for solutions to strengthen PHC delivery in Malava.  As part of this effort, Jacaranda Health partnered with the county to design and implement a time-limited pilot to assess whether low-cost diagnostic tools could close the ANC testing gap. The pilot introduced rapid diagnostic tests (RDTs) in 21 of the 27 PHC facilities across Malava Sub-County. The hypothesis was that these low-cost, portable tools would enable frontline health workers to conduct consistent ANC screenings at the primary care level, closer to where women live. RDTs have been endorsed by the global health community, including WHO, as an acceptable alternative to lab-based testing. At the same time, the county government was rolling out wider use of obstetric point-of-care ultrasound (O-POCUS), presenting an opportunity to align implementation and enhance the overall comprehensiveness of ANC diagnostics.

• RDTs allowed providers to test for hemoglobin levels (for anemia), blood glucose (for gestational diabetes), HIV and syphilis, malaria, and UTIs using finger-prick blood and urine samples.
• O-POCUS enabled quick assessments of fetal wellbeing, placenta location, multiple gestation, and presentation, which is crucial for identifying breech pregnancies and other complications that require specialized delivery planning.

This dual-pronged approach dramatically improved the completeness and quality of ANC visits, making it possible for women to receive comprehensive ANC profiling in a single visit at the facility nearest them. Importantly, the RDT-based approach also proved to be more affordable, costing facilities roughly 2.5 times less per mother (1,829 KSH) than traditional lab-based testing (4,653 KSH).

RDTs and POCUS boost early detection and service uptake

Over a six month implementation period, the initiative led to a 15% increase in women reporting they received both blood and urine tests at ANC visits in Malava (PROMPTS survey data) and, out of a total of 2822 mothers screened, the identification of 213 high-risk pregnancy complications identified early, including:

• Breech and transverse fetal presentations
• Severe anemia
• Suspected infections (e.g., syphilis, UTIs)

Most of these complications would have gone undetected in the absence of RDTs and O-POCUS. For example, 28 women were referred due to anaemia – a highly treatable condition that can only be diagnosed via a blood test. When identified early, anemia can be managed through nutritional support and iron supplementation, reducing the risk of postpartum hemorrhage, preterm birth, and even maternal mortality. Treating this can improve rates of PPH, preterm birth, and even maternal death. Women identified with high-risk conditions were promptly referred to higher-level facilities, increasing their chance of receiving appropriate care.

This early success demonstrates the potential for county governments to adopt similar tools in low-resource settings as part of a broader PHC strengthening effort.

Percentage of women on PROMPTS reporting receipt of blood and urine tests during ANC visits, comparing Malava before and after the intervention to the national average.

Additionally, higher ANC attendance during the pilot allowed providers to detect complications like pre-eclampsia that might have otherwise gone unnoticed. Many women had previously skipped ANC visits due to lack of services; the availability of RDTs and O-POCUS encouraged them to return, enabling more thorough assessments.

Enabling smarter primary health systems

This initiative demonstrates that smart, low-cost diagnostic tools, when embedded into county-led strategies and delivered through primary health facilities, can influence ANC quality of care. By enabling comprehensive screening at the point of first contact, this model helps health systems shift from reactive to preventive maternal care.

Jacaranda’s role in this pilot was to generate local evidence and operational insights to inform government-led decision-making, budgeting and scaling these tools across their entire sub-counties. The integration of real-time feedback via PROMPTS, portable diagnostics, and strategic coordination with county health teams created a proof-of-concept that can be replicated by government systems.