Lesson from Indonesia: Covid-19 Testing Strategy In Obstetric Emergency Cases At Low-Resource Health Care Setting
Manggala Pasca Wardhana1, Aditiawarman1, Nareswari Cininta Maniora1, Rozi Aditya1, Khanisyah Erza Gumilar1, Budi Wicaksono1, Muhammad Ilham Aldika Akbar1, Ernawati1, Agus Sulistyono1, Hermanto Tri Juwono1, Erry Gumilar Dachlan
Background: COVID-19 identification in obstetric emergency cases with limited resources is problematic, particularly in asymptomatic cases.
Aim: To examine the screening strategies of COVID-19 obstetric emergency cases in low-resource health care settings.
Method: A retrospective cohort design was carried out on patients with COVID-19 positive screening results. It was assessed based on symptoms, contact history, lymphocytopenia, chest X-rays, and rapid antibody tests compared to RT-PCR results SARS-COV-2.
Result: Out of the 190 cases that came to the delivery room, the staff suspected 69 COVID-19 cases (36.3%) through the first screening protocol. Positive SARS-COV-2 RT-PCR was found in 23 cases with a majority asymptomatic (52.2%). The percentages of sensitivity and specificity from the parameters as follow: 48% and 74% in COVID-19 symptoms (febris or respiratory symptoms); 9% and 100% in contact history; 22% and 83% in lymphocytopenia; 52% and 48% in chest x-ray; 78% and 30% in rapid antibody test. Rapid antibody tests have the highest sensitivity to increase the identification of 12 asymptomatic cases.
Conclusion: Other screening beyond symptoms and contact history such as lymphocytopenia, chest x-ray, and rapid antibody test can improve the identification, especially for asymptomatic cases in areas with the limited testing ability and high Covid-19 transmission
Keywords: Covid-19, Screening, Obstetric Emergency, Low-resource health care