Screening
CHWs collect samples of vaginal flora and urine during home visits between 13 and 19 weeks gestation. Vaginal specimens are collected via sterile self-administered vaginal swabs. Self-administered vaginal swabs have been used with high acceptability and quality in diverse populations including in Bangladesh, providing cost-savings and cost effectiveness for STI testing [43]–[46]. Women are instructed by the CHW to insert a Dacron swab ~4–5 cm into the vagina, allow the swab to stand for 15 s, and rub the lateral walls of the vagina for 4–5 s prior to withdrawal [47]. The CHW gently rolls the swab onto a plain glass slide and allows it to air dry prior to transport to the Sylhet field laboratory. A clean catch midstream urine specimen is obtained for urine culture. The CHW instructs the mother to spread the labia widely before collecting 20–30 mL of the midstream urine into a sterile wide-mouthed container.