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Xu VX, Mogren I, Bergström C, Edvardsson K, Small R, Flood M, Holmlund S, Aldrich R, Brennecke S, McDonald S, McEvoy M, Said JM, Shembrey M, Yuen N, East CE. Health professionals' experiences and views on obstetric ultrasound in Victoria, Australia: A cross-sectional survey. Aust N Z J Obstet Gynaecol 2024. [PMID: 39304317 DOI: 10.1111/ajo.13879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 08/25/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND Obstetric ultrasound is an important tool, aiding in screening, diagnosis, and surveillance throughout pregnancy. AIMS To explore obstetric doctors', midwives', and sonographers' experiences and views of obstetric ultrasound in Victoria, Australia. To investigate the increasing role of obstetric ultrasound for clinical management, and the adequacy of resources and training for appropriate use of ultrasound in clinical management. MATERIALS AND METHODS This cross-sectional study forms part of a multi-national CROss-Country Ultrasound Study (CROCUS) exploring the views of consumers and health professionals from high-, middle- and low-income countries. Qualitative studies conducted in several countries informed the construction of a quantitative survey. These quantitative surveys were distributed to 16 hospitals across regional and metropolitan Victoria, Australia. Descriptive statistics were analysed from the responses. RESULTS There were 354 questionnaires returned from 106 doctors, 222 midwives, and 26 sonographers. Overall, 72% of respondents held concerns about the potential loss of focus on clinical skills with increasing ultrasound use. Midwives were more concerned about the contribution of ultrasound to medicalisation of pregnancy than were doctors (P < 0.001). Many respondents noted that geographical factors (71%), rather than income levels (53%) influenced access to obstetric ultrasound. Over 90% of doctors and midwives believed additional training for their respective professions in ultrasound would enhance its reach and effectiveness. CONCLUSIONS Our survey findings confirm that clinicians place high levels of trust in the diagnostic findings of obstetric ultrasound antenatal care in Australia. Access to routine ultrasound could be improved for women in rural and lower-income areas.
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Affiliation(s)
- Vicky X Xu
- Pregnancy Research Centre, Department of Maternal-Fetal Medicine, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Ingrid Mogren
- Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå, Sweden
| | - Cecilia Bergström
- Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå, Sweden
| | - Kristina Edvardsson
- Northern Hospital, Melbourne, Victoria, Australia
- Judith Lumley Centre, School of Nursing & Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Rhonda Small
- Judith Lumley Centre, School of Nursing & Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Margaret Flood
- Judith Lumley Centre, School of Nursing & Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Sophia Holmlund
- Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå, Sweden
| | | | - Shaun Brennecke
- Pregnancy Research Centre, Department of Maternal-Fetal Medicine, Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Susan McDonald
- Judith Lumley Centre, School of Nursing & Midwifery, La Trobe University, Melbourne, Victoria, Australia
- Mercy Hospital for Women, Melbourne, Victoria, Australia
| | | | - Joanne M Said
- Department of Obstetrics and Gynaecology and Newborn Health, University of Melbourne, Melbourne, Victoria, Australia
- Joan Kirner Women's and Children's at Sunshine Hospital, Western Health, Melbourne, Victoria, Australia
| | | | - Nicola Yuen
- Bendigo Health, Bendigo, Victoria, Australia
| | - Christine E East
- Judith Lumley Centre, School of Nursing & Midwifery, La Trobe University, Melbourne, Victoria, Australia
- Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia
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Mogren I, Thi Lan P, Phuc HD, Holmlund S, Small R, Ntaganira J, Sengoma JPS, Kidanto HL, Ngarina M, Bergström C. Vietnamese health professionals' views on the status of the fetus and maternal and fetal health interests: A regional, cross-sectional study from the Hanoi area. PLoS One 2024; 19:e0310029. [PMID: 39259744 PMCID: PMC11389908 DOI: 10.1371/journal.pone.0310029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 08/22/2024] [Indexed: 09/13/2024] Open
Abstract
Obstetric ultrasound is an important tool in managing pregnancies and its use is increasing globally. However, the status of the pregnant woman and the fetus may vary in terms of clinical management, views in the community and legislation. To investigate the views and experiences of Vietnamese health professionals on maternal and fetal health interests, priority setting and potential conflicts, we conducted a cross-sectional study using a structured questionnaire. Obstetricians/gynecologists, midwives and sonographers who manage pregnant women in maternity wards were invited to participate. We purposively chose public health facilities in the Hanoi region of Vietnam to obtain a representative sample. The final sample included 882 health professionals, of which 32.7% (n = 289) were obstetricians/gynecologists, 60.7% (n = 535) midwives and 6.6% (n = 58) sonographers. The majority of participants (60.3%) agreed that "The fetus is a person from the time of conception" and that maternal health interests should always be prioritised over fetal health interests in care provided (54.4%). 19.7% agreed that the fetus is never a patient, only the pregnant woman can be the patient, while 60.5% disagreed. Participants who performed ultrasounds were more likely to agree that fetal health interests are being given more weight in decision-making the further the gestation advances compared to those who did not perform ultrasounds (cOR 2.47, CI 1.27-4.79: n = 811). A significant proportion of health professionals in Vietnam assign the fetus the status of being a person, where personhood gradually evolves during pregnancy. While the fetus is often considered a patient with its own health interests, a majority of participants did give priority to maternal health interests. Health professionals appear to favour increased legal protection of the fetus. Strengthening the legal status of the fetus might have adverse implications for maternal autonomy. Measures to restrict maternal autonomy might require close observation to ensure that maternal reproductive rights are protected.
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Affiliation(s)
- Ingrid Mogren
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - Pham Thi Lan
- Department of Dermatology and Venereology, Hanoi Medical University, Hanoi, Vietnam
| | - Ho Dang Phuc
- Institute of Mathematics, Vietnam Academy of Science and Technology, Hanoi, Vietnam
| | - Sophia Holmlund
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
- Department of Nursing, Umeå University, Umeå, Sweden
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Rhonda Small
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Joseph Ntaganira
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | | | - Matilda Ngarina
- Department of Obstetrics and Gynaecology, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Cecilia Bergström
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
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Terefe FT, Yang B, Jemal K, Ayana D, Adefris M, Awol M, Tesema M, Dagne B, Abeje S, Bantie A, Loewenberger M, Adams SJ, Mendez I. Advancing Antenatal Care in Ethiopia: The Impact of Tele-Ultrasound on Antenatal Ultrasound Access in Rural Ethiopia. Telemed J E Health 2024. [PMID: 39229684 DOI: 10.1089/tmj.2024.0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024] Open
Abstract
Introduction: Access to antenatal ultrasound is limited in low-income countries such as Ethiopia. Virtual care platforms that facilitate supervision and mentoring for ultrasound scanning may improve patient access by facilitating task-sharing of antenatal ultrasound with midlevel providers. The purpose of this study was to assess the feasibility of a large volume tele-ultrasound program in Ethiopia, its impact on antenatal care (ANC) and patient access, and its sustainability as it transitioned from a pilot project to a continuing clinical program. Methods: Health care providers at two health centers in the North Shoa Zone, Ethiopia, performed antenatal tele-ultrasound exams with remote guidance from obstetricians located in urban areas. Data regarding ANC and ultrasound utilization, participant travel, ultrasound findings, specialist referrals, and participant experience were collected through a mobile app. Results: Between November 2020 and December 2023, 7,297 tele-ultrasound exams were performed. Of these, 489 tele-ultrasound exams were performed during the period of data collection from October to December 2022. The availability of tele-ultrasound at the two health centers significantly reduced participant travel distance (4.2 km vs. 10.2 km; p < 0.01; one-way distance). Most participants (99.2%) indicated the tele-ultrasound service was very important or important, with high levels of satisfaction. Clinically significant findings were identified in 26 cases (5.3%), leading to necessary referrals. Conclusion: This study demonstrated the feasibility of a large volume tele-ultrasound program in Ethiopia, its impact on improving the quality of ANC, and its sustainability. These findings lay a foundation upon which low-income countries can develop tele-ultrasound programs to improve antenatal ultrasound access.
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Affiliation(s)
- Felagot Taddese Terefe
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Bonnie Yang
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Kemal Jemal
- School of Nursing, Queen's University, Kingston, Ontario, Canada
| | - Dereje Ayana
- Department of Medicine, College of Medicine and Health Sciences, Salale University, Fitche, Ethiopia
| | - Mulat Adefris
- Department of Obstetrics and Gynecology, University of Gondar, Gondar, Ethiopia
| | - Mukemil Awol
- Department of Midwifery, College of Medicine and Health Sciences, Salale University, Fitche, Ethiopia
| | - Mengistu Tesema
- Department of Public Health, College of Medicine and Health Sciences, Salale University, Fitche, Ethiopia
| | - Bewunetu Dagne
- Department of Computer Science, College of Natural Sciences, Salale University, Fitche, Ethiopia
| | - Sandra Abeje
- Canadian Physicians for Aid and Relief, Addis Ababa, Ethiopia
| | - Alehegn Bantie
- Canadian Physicians for Aid and Relief, Addis Ababa, Ethiopia
| | | | - Scott J Adams
- Department of Medical Imaging, University of Saskatchewan, Saskatoon, Canada
| | - Ivar Mendez
- Department of Surgery, University of Saskatchewan, Saskatoon, Canada
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Tefera M, Mezmur H, Jemal M, Assefa N. Health professionals' perspectives on the role of obstetric ultrasonography in maternity care in rural eastern Ethiopia: a qualitative descriptive study. BMJ Open 2024; 14:e075263. [PMID: 38658007 PMCID: PMC11043749 DOI: 10.1136/bmjopen-2023-075263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 03/28/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVE The purpose of this exploratory study was to assess healthcare providers' perspectives on maternity care following the introduction of ultrasound services in the area. DESIGN The qualitative descriptive study. STUDY SETTING This study was carried out in health centres under Child Health and Mortality Prevention Surveillance (CHAMPS) pregnancy surveillance catchment areas in Kersa, Haramaya and Harar districts in eastern Ethiopia. PARTICIPANTS The study participants were 14 midwives working in the maternity units and 14 health centre managers in the respective health facilities. Purposive sampling was used to select participants for in-depth interviews using a semistructured interview guide. Data were analysed using thematic analysis. RESULTS We identified one overarching theme "improved perinatal care" and six subthemes. Based on the accounts of the participants, the introduction of ultrasound services has led to a remarkable transformation in the overall provision of maternity care at health centres. The participants have reported a substantial rise in the utilisation of antenatal, delivery and postnatal care services. The availability of ultrasound has enabled midwives to deliver comprehensive maternity care. CONCLUSION Ultrasound service utilisation at health centres improves maternity care. The utilisation of ultrasound in healthcare enables providers to closely monitor the growth and development of the fetus, identify potential complications or abnormalities and administer timely interventions. This integration of ultrasound technology translates into enhanced prenatal care, early detection of issues and prompt management, ultimately leading to improved outcomes for both the mother and the baby.
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Affiliation(s)
- Maleda Tefera
- School of Nursing, Haramaya University, College of Health and Medical Sciences, Haramaya, Ethiopia
| | - Haymanot Mezmur
- School of Nursing, Haramaya University, College of Health and Medical Sciences, Haramaya, Ethiopia
| | - Mohammed Jemal
- Child Health and Mortality Prevention Surveillance, Haramaya University College of Health and Medical Sciences, Haramaya, Ethiopia
| | - Nega Assefa
- School of Nursing, Haramaya University, College of Health and Medical Sciences, Haramaya, Ethiopia
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Johnston BK, Darling EK, Malott A, Thomas L, Murray-Davis B. Canadian midwives' perspectives on the clinical impacts of point of care ultrasound in obstetrical care: A concurrent mixed-methods study. Heliyon 2024; 10:e27512. [PMID: 38533003 PMCID: PMC10963237 DOI: 10.1016/j.heliyon.2024.e27512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/29/2024] [Accepted: 02/29/2024] [Indexed: 03/28/2024] Open
Abstract
Introduction Point of Care Ultrasound (POCUS) is used globally in obstetrics to conduct real time bedside ultrasound scans to answer a clinical question, and it may be conducted by a non-sonography healthcare practitioner. The College of Midwives of Ontario expanded the scope of practice in 2018 to allow registered midwives to perform POCUS during clinical assessments. In response, a POCUS training curriculum for practicing midwives was developed. This paper reports on the perceptions of learners about the impact of this training on their clinical practice. Methods We conducted a mixed-methods study to understand learner perceptions. Data collection included surveys at four time points over a year, and semi-structured interviews. Quantitative data were analyzed through descriptive statistics, and qualitative analyses used a constructivist approach to grounded theory. Results The frequency of POCUS use within antenatal care increased among learners, with common applications including assessment of fetal presentation and confirmation of viability. POCUS was seen to holistically aid practitioners care by providing additional skills and knowledge to improve care quality and access to care, particularly for remote areas where ultrasounds are not easily available. However, participants articulated a need for clearer regulatory guidelines outlining how this technology should be applied in midwifery. Equipment purchasing and maintaining costs were a barrier for many midwives. Conclusions Participants who had access to a device are continuing to use sonography within their clinics to provide comprehensive midwifery care informed by real-time ultrasound assessments. POCUS scans were seen to offer many benefits to improve patient care.
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Affiliation(s)
- Bronte K. Johnston
- Health Sciences Education Program, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- McMaster Midwifery Research Centre, Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - Elizabeth K. Darling
- Health Sciences Education Program, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- McMaster Midwifery Research Centre, Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - Anne Malott
- Health Sciences Education Program, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- McMaster Midwifery Research Centre, Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - Laura Thomas
- Centre for Integrated and Advanced Medical Imaging Medical Radiation Sciences Program, Mohawk-McMaster Institute for Applied Health Sciences, McMaster University and Mohawk College, Hamilton, ON, Canada
| | - Beth Murray-Davis
- Health Sciences Education Program, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- McMaster Midwifery Research Centre, Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
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Tefera M, Mezmur H, Jemal M, Assefa N. Midwives' experiences of performing obstetric ultrasounds in antenatal care in eastern Ethiopia: Qualitative exploratory study. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241228135. [PMID: 38366806 PMCID: PMC10874160 DOI: 10.1177/17455057241228135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 12/12/2023] [Accepted: 01/04/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND In 2016, the World Health Organization recommended inclusion of an ultrasound scan as part of routine antenatal care to improve pregnancy outcomes. However, most rural women in Ethiopia do not have access to ultrasound scanning as part of their routine antenatal care. Recently, ultrasonography services were introduced at health centers in Harar, Kersa, and Haramaya districts in Eastern Ethiopia. This expoloratory study aimed to examine experiences of pregnancy surveillance midwives in the Child Health and Mortality Prevention Surveillance (CHAMPS) who performed ultrasonography at health centers that are in the catchment area of Health and Demographic Surveillance Systems, in Eastern Ethiopia. OBJECTIVE To explor midwives' experiences across 14 health centers in Eastern Ethiopia, located in the Kersa, Haramaya, and Harar Health and Demographic Surveillance Systems from February to April 2022. DESIGN Exploratory qualitative study. METHODS The methods used were based on the Standards for Reporting Qualitative Research framework. Purposeful sampling was used to explore experiences of midwives who performed ultrasonography at selected health centers. The Midwives are recurited, trained and stationed at the health ceners to do ultrasound scanning and other activities by the Child Helath and Mortality Prevention Surveillance (CHAMPS) pregancny surveillance activities. Among 17 midwives who had undergone ultrasonography training and who were actively involved in ultrasound scanning at health centers in Kersa, Haramaya, and Harar Health and Demographic Surveillance Systems, three midwives who worked at health centers with no power or near a hospital were excluded. Using tape recordings and note-taking, data were collected through in-depth interviews based on a semi-structured interview guide. Thematic analysis used for data categorization, and the trustworthiness of data was kept throughout the procedure using credibility, dependability, confirmability, and transferability. RESULTS In this study, we identified five main themes: Ultrasonography positively impacts midwives trained as sonographers; performing ultrasound scans enhances the skills and confidence of midwives, improving their professional development, Individual perception of self-efficacy; midwives' belief in their abilities to perform ultrasound scans effectively influences their job satisfaction and motivation, Provision of care; integrating ultrasound into antenatal care enhances the quality, therapeutic communication, and personalized nature of care provided to pregnant women, Barriers to providing ultrasonography services; challenges such as shortage of ultrasonography-trained staff and workload can hinder the delivery of ultrasound services in rural areas, Community acceptance; the level of community understanding, trust, and support towards ultrasound technology and midwives as sonographers impacts the successful implementation and sustainability of ultrasound services. CONCLUSION Ultrasonography performed by midwives at rural health centers had a considerable impact on antenatal care services and incareased confidence of midwives.
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Affiliation(s)
- Maleda Tefera
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Haymanot Mezmur
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mohammed Jemal
- Child Health and Mortality Prevention Surveillance, College of Health and Medical Sciences Haramaya University, Harar, Ethiopia
| | - Nega Assefa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Bergström C, Ngarina M, Abeid M, Kidanto H, Edvardsson K, Holmlund S, Small R, Sengoma JPS, Ntaganira J, Lan PT, Mogren I. Health professionals' experiences and views on obstetric ultrasound in Tanzania: A cross-sectional study. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241273675. [PMID: 39206633 PMCID: PMC11363060 DOI: 10.1177/17455057241273675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 06/25/2024] [Accepted: 07/04/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Obstetric ultrasound is considered important for determining gestational age, identifying single or multiple pregnancies, locating the placenta and fetal anomalies and monitoring fetal growth and pregnancy-related complications in order to improve patient management. OBJECTIVES To explore health professionals' perspectives on different aspects of obstetric ultrasound in Tanzania regarding self-reported skills in performing ultrasound examinations and what could improve access to and utilization of obstetric ultrasound in the clinical setting. DESIGN Cross-sectional study. MATERIAL AND METHODS Data was collected between November and December 2017 using a questionnaire based on previous qualitative research results from the CROss Country UltraSound Study (CROCUS Study). Seventeen healthcare facilities in 5 urban and semiurban municipalities in the Dar-es-Salaam region were included, with 636 health professionals participating (physicians, n = 307 and midwives/nurses, n = 329). RESULTS Most health professionals (82% physicians, 81% midwives/nurses) believed that obstetric ultrasound was decisive in the clinical management of pregnancy. Results indicate proficiency gaps across disciplines: 51% of physicians and 48.8% of midwives/nurses reported no or low-level skills in assessing cervical length. Similarly, deficiencies were observed in evaluating the four-chamber view of the fetal heart (physicians: 51%, midwives/nurses: 61%), aorta, pulmonary artery (physicians: 60.5%, midwives/nurses: 65%) and Doppler assessments (umbilical artery: physicians 60.6%, midwives/nurses 56.1%). Compared to midwives/nurses, physicians were significantly more likely to agree or strongly agree that utilization would improve with more ultrasound machines (odds ratio (OR) 2.13; 95% confidence intervals (CI) 1.26-3.61), better quality of ultrasound machines (OR 2.27; 95% CI 1.10-4.69), more training for health professionals currently performing ultrasound (OR 2.11; 95% CI 1.08-4.17) and more physicians trained in ultrasound (OR 2.51; 95% CI 1.30-4.87). CONCLUSIONS Improving the provision of obstetric ultrasound examinations in Tanzania requires more and better-quality ultrasound machines, enhanced training for health professionals and an increased number of physicians trained in ultrasound use. To further increase the accessibility and utilization of obstetric ultrasound in maternity care in Tanzania, it is essential to provide training for midwives in basic obstetric ultrasound techniques.
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Affiliation(s)
- Cecilia Bergström
- Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå, Sweden
| | - Matilda Ngarina
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
- Department of Obstetrics and Gynaecology, Muhimbili National Hospital, Dar-es-Salaam, Tanzania
| | - Muzdalifat Abeid
- Department of Obstetrics and Gyneacology, Aga Khan University, Dar-es-Salaam, Tanzania
| | - Hussein Kidanto
- Department of Obstetrics and Gyneacology, Aga Khan University, Dar-es-Salaam, Tanzania
| | - Kristina Edvardsson
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia
| | - Sophia Holmlund
- Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå, Sweden
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Rhonda Small
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia
- Department of Women’s and Children’s and Reproductive Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Joseph Ntaganira
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Pham Thi Lan
- Department of Dermatology and Venereology, Hanoi Medical University, Hanoi, Vietnam
| | - Ingrid Mogren
- Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå, Sweden
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Lukhele S, Mulaudzi FM, Sepeng N, Netshisaulu K, Ngunyulu RN, Musie M, Anokwuru R. The training of midwives to perform obstetric ultrasound scan in Africa for task shifting and extension of scope of practice: a scoping review. BMC MEDICAL EDUCATION 2023; 23:764. [PMID: 37828497 PMCID: PMC10571413 DOI: 10.1186/s12909-023-04647-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 09/04/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION Ultrasound scan is one of the essential assessments that is crucial in the early identification of health risks during antenatal care. Its accessibility to women in low-and middle-income countries remains a serious challenge because ultrasound scans are not within the scope of practice for midwives. However, task shifting and extension of scope of practice aim to train midwives to assess pregnant women through an ultrasound scan. This paper aims to report the findings of a scoping review on the training of midwives to perform obstetric ultrasound scans in Africa. METHODS The 6-step iterative framework for scoping reviews by Arksey and O'Malley was used to determine the extent of qualitative and quantitative evidence available on the training of midwives on obstetric ultrasound scans, which includes specifying the research question, identifying relevant studies, selecting studies, extracting and charting data, collating, summarising, and synthesising and reporting findings. RESULTS A total of 12 articles from eight African countries were included in this scoping review. Three main themes and 13 sub-themes emerged and they are: obstetric ultrasound scan training, challenges experienced by midwives from task shifting and extension of scope of practice regarding obstetric ultrasound scan, and the value of task shifting and extension of scope of practice regarding obstetric ultrasound scan to midwives. DISCUSSION Despite the available evidence that the training of midwives on obstetric ultrasound scans is essential to ensure the accessibility of quality antenatal health services, the training of midwives on obstetric ultrasound scans in some African countries remains a serious challenge. It is evident from this scoping review results that there is a need for African countries to incorporate obstetric ultrasound scans as part of the scope of practice of midwives. Task shifting necessitates prioritising the training of midwives on the use of obstetric ultrasound scans as one of the steps towards the achievement of the United Nations Sustainable Development Goal number 3 targets by 2030.
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Affiliation(s)
- Sanele Lukhele
- Department of Nursing, University of Johannesburg, Johannesburg, Republic of South Africa.
| | | | - Nombulelo Sepeng
- Department of Nursing, University of Pretoria, Pretoria, Republic of South Africa
| | - Khathutshelo Netshisaulu
- Department of Advanced Nursing Science, University of Venda, Thohoyandou, Republic of South Africa
| | | | - Maurine Musie
- Department of Nursing, University of Pretoria, Pretoria, Republic of South Africa
| | - Rafiat Anokwuru
- Department of Nursing, University of Pretoria, Pretoria, Republic of South Africa
- Department of Maternal and Child Health, Ilishan School of Nursing, Babcock University, Remo, Ogun State, Nigeria
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Casmod Y, Armstrong SJ. Obstetric ultrasound training programmes for midwives: A scoping review. Health SA 2023; 28:2163. [PMID: 36873781 PMCID: PMC9983282 DOI: 10.4102/hsag.v28i0.2163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/06/2022] [Indexed: 02/04/2023] Open
Abstract
Background Antenatal care is essential for all expectant mothers and assists in reducing maternal mortality rates thus addressing the Sustainable Development Goal 3. Obstetric ultrasound complements antenatal care and is used in pregnancy to identify and monitor high-risk pregnancies. However, disparities exist and in low- and middle-income countries, ultrasound services are not readily available. This contributes to maternal and neonatal morbidity and mortality within these populations. Short ultrasound training programmes for midwives can be beneficial in alleviating some of the challenges experienced. Aim The aim of this scoping review was to identify global ultrasound education programmes for midwives. Method Articles containing suitable keywords were retrieved from databases suitable to nursing, education and ultrasound. Themes were developed based on the articles included in the review. Results A total of 238 articles were identified, and after the duplicates and irrelevant studies were removed, 22 articles were included. Articles were analysed and discussed under the identified themes and categories. Conclusion It is essential that sufficient training is provided to medical professionals performing obstetric ultrasound so that adequate and safe care is offered to expectant mothers. With the introduction of ultrasound in low-resource settings, the knowledge of safety and competencies required to operate the equipment necessitate adequate training. Developed programmes have been found to meet the demands of the ever-changing workforce and allow for midwives to perform focused obstetric ultrasound examinations. Contribution This scoping review highlighted ultrasound training programmes for midwives and provided guidance on the development of future midwifery ultrasound training programmes.
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Affiliation(s)
- Yasmin Casmod
- Department of Nursing Education, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Medical Imaging and Radiation Sciences, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Susan J Armstrong
- Department of Nursing Education, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Luntsi G, Ugwu AC, Ohagwu CC, Kalu O, Sidi M, Akpan E. Impact of ultrasound scanning on pregnant Women's compliance with attendance at antenatal care visits and supervised delivery at primary healthcare centres in northern Nigeria: Initial experiences. Radiography (Lond) 2022; 28:480-486. [PMID: 35123883 DOI: 10.1016/j.radi.2022.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/18/2021] [Accepted: 01/16/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The world health organisation (WHO) recommends at least one ultrasound scan amidst eight antenatal care visits, however, most pregnant women in low and middle-income countries do not achieve this. This study aims to assess the impact of limited obstetrics ultrasound (LOUS) within primary healthcare centres in northern Nigeria. METHODS A cross sectional study was conducted across selected primary healthcare centres in Bauchi and Kano States (northern Nigeria). The study protocol was approved by the Ministry of Health in each State. Within each State a total of nine primary healthcare centres were randomly selected. Information on all complete antenatal care (ANC) records of women who used the primary healthcare facility for 12 months prior to introduction of ultrasound (January 2016 to December 2016) and 12 months after (January 2018 to December 2018) were collected. Study data were analysed using descriptive (mean, standard deviations) and inferential statistics. Independent sample t-test were used to find out if there was a statistical difference between the pre and post-intervention data on women compliance to ANC visits, facility based delivery, maternal and child mortality. Data were analysed using the Statistical Package for Social Sciences and significance was set at p ≤ 0.05. RESULTS There was a significant increase in the number of ANC visits and supervised facility delivery after introduction of ultrasound services (LOUS) in the primary healthcare centres. The number of ANC visits in Kano State was 2637.6 ± 972.0 before and 3793.0 ± 517.5 after the introduction of ultrasound services. The number of ANC visits in Bauchi State was 1866.6 ± 488.3 before and 2854.0 ± 631.3 after the introduction of ultrasound services. The number of supervised facility deliveries in Kano state was 520.1 ± 128.7 before and 1021.1 ± 217.0 after the introduction of LOUS. The number of supervised facility deliveries for Bauchi state was 553.1 ± 309.9 before and 1056.3 ± 295.4 after introduction of LOUS. A total of 2486 (11.0%) women were referred for further imaging due to equivocal ultrasound findings. A total of 2185 (9.7%) pregnant women were referred for appropriate care due to multiple gestations. CONCLUSION This study found that LOUS, in resource scarce settings, has the potential of improving ANC visits, facility delivery rates and reduce maternal and child mortality. It also leads to change in patient management plans resulting in referrals for appropriate care. IMPLICATION FOR PRACTICE Technological interventions using ultrasound have the potential to motivate pregnant women to attend ANC, give birth in a healthcare facility and thus reduce maternal and child morbidity and mortality. This is in line with the global drive to reduce maternal and child death by 2030 to less than 70 maternal deaths in 100,000 live births and neonatal mortality reduction to 12 in 1000 live births and under 5 mortality reduction to 25 in 1000 live births.
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Affiliation(s)
- G Luntsi
- Department of Medical Radiography, Faculty of Allied Health Sciences, College of Medical Sciences, University of Maiduguri, Nigeria.
| | - A C Ugwu
- Department of Radiography and Radiological Sciences, Faculty of Health Sciences, Nnamdi Azikiwe University, Awka, Nigeria.
| | - C C Ohagwu
- Department of Radiography and Radiological Sciences, Faculty of Health Sciences, Nnamdi Azikiwe University, Awka, Nigeria.
| | - O Kalu
- Department of Radiography and Radiological Sciences, Faculty of Health Sciences, Evangel University Ebonyi State, Nigeria.
| | - M Sidi
- Department of Medical Radiography, Faculty of Allied Health Sciences, College of Medical Sciences, Bayero University Kano, Nigeria.
| | - E Akpan
- Grayscale International Ltd Lagos, Nigeria.
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Abawollo HS, Tsegaye ZT, Desta BF, Beshir IA, Mengesha BT, Guteta AA, Heyi AF, Mamo TT, Gebremedhin ZK, Damte HD, Zelealem M, Argaw MD. Contribution of portable obstetric ultrasound service innovation in averting maternal and neonatal morbidities and mortalities at semi-urban health centers of Ethiopia: a retrospective facility-based study. BMC Pregnancy Childbirth 2022; 22:368. [PMID: 35484533 PMCID: PMC9052561 DOI: 10.1186/s12884-022-04703-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The maternal and neonatal mortalities in Ethiopia are high. To achieve the Sustainable Development Goals, innovations in ultrasound scanning and surveillance activities have been implemented at health centers for over 2 years. This study aims to estimate the contribution of obstetric ultrasound services on averted maternal and neonatal morbidities and mortalities in Ethiopia. METHODS A retrospective facility-based cross-sectional study design was conducted in 25 selected health centers. Data were extracted from prenatal ultrasound registers. SPSS version 25 was used for analysis. To claim statistically significant relationship among sartorial variables, a chi-square test was analyzed and P < 0.05 was the cut-off point. RESULTS Over the 2 years, 12,975 pregnant women were scanned and 52.8% of them were residing in rural areas. Abnormal ultrasound was reported in 12.7% and 98.4% of them were referred for confirmation of diagnosis and treatment. The ultrasound service has contributed to the prevention of 1,970 maternal and 19.05 neonatal morbidities and mortalities per 100,000 and 1,000 live births respectively. The averted morbidities and mortalities showed a statistically significant difference among women residing in rural and semi-urban areas, X,2 df (10) = 24.07, P = 0. 007 and X,2 df (5) = 20.87. P = 0.00, 1 respectively. CONCLUSION After availing the appropriate ultrasound machines with essential supplies and capacitating mid-level providers, significant number of high-risk pregnant women were identified on time and managed or referred to health facilities with safe delivery services. Therefore, scaling-up limited obstetric ultrasound services in similar setups will contribute to achieving the Sustainable Development Goals by 2030. It is recommended to enhance community awareness for improved utilization of ultrasound services by pregnant women before the 24th week of gestational age.
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Affiliation(s)
- Hailemariam Segni Abawollo
- USAID Transform: Primary Health Care Activity, JSI Research & Training Institute Inc, Addis Ababa, Ethiopia.
| | - Zergu Tafesse Tsegaye
- USAID Transform: Primary Health Care Activity, JSI Research & Training Institute Inc, Addis Ababa, Ethiopia
| | - Binyam Fekadu Desta
- USAID Transform: Primary Health Care Activity, JSI Research & Training Institute Inc, Addis Ababa, Ethiopia
| | - Ismael Ali Beshir
- USAID Transform: Primary Health Care Activity, JSI Research & Training Institute Inc, Addis Ababa, Ethiopia
| | - Birhan Tenaw Mengesha
- USAID Transform: Primary Health Care Activity, JSI Research & Training Institute Inc, Addis Ababa, Ethiopia
| | - Asfaw Adugna Guteta
- USAID Transform: Primary Health Care Activity, JSI Research & Training Institute Inc, Addis Ababa, Ethiopia
| | - Atrie Fekadu Heyi
- USAID Transform: Primary Health Care Activity, JSI Research & Training Institute Inc, Addis Ababa, Ethiopia
| | - Tsega Teferi Mamo
- USAID Transform: Primary Health Care Activity, JSI Research & Training Institute Inc, Addis Ababa, Ethiopia
| | - Zenawork Kassa Gebremedhin
- USAID Transform: Primary Health Care Activity, JSI Research & Training Institute Inc, Addis Ababa, Ethiopia
| | - Heran Demissie Damte
- USAID Transform: Primary Health Care Activity, JSI Research & Training Institute Inc, Addis Ababa, Ethiopia
| | - Meseret Zelealem
- Ministry of Health, Maternal and Child Health Directorate, Addis Ababa, Ethiopia
| | - Mesele Damte Argaw
- USAID Transform: Primary Health Care Activity, JSI Research & Training Institute Inc, Addis Ababa, Ethiopia
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Roro MA, Aredo AD, Kebede T, Estifanos AS. Enablers and barriers to introduction of obstetrics ultrasound service at primary care facilities in a resource-limited setting: a qualitative study in four regions of Ethiopia. BMC Pregnancy Childbirth 2022; 22:278. [PMID: 35366824 PMCID: PMC8976309 DOI: 10.1186/s12884-022-04609-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 03/22/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The World Health Organization (WHO) recommends a minimum of eight ANC contacts during pregnancy, of which having one ultrasound examination before 24 weeks of gestation is indicated. Ultrasound plays a significant role in the surveillance and management of high-risk pregnancies. However, the obstetric ultrasound coverage in resource limited settings remains low. Evidence examining the barriers and facilitators to obstetrics ultrasound use in a resource-limited setting like Ethiopia is lacking. This qualitative study explored the facilitators and barriers to introducing obstetric Vscan Access ultrasound in primary health care facilities in Ethiopia.
Methods
The study employed a qualitative descriptive exploratory study design using in-depth interviews (IDIs) and focus group discussions (FGDs). The study participant were mothers who have had recent birth, community members, maternal and newborn service providers, and their managers. We employed an inductive thematic analysis to analyze the data.
Result
We conducted a total of ten FGDs, three with community members and seven with maternal and newborn service providers, and 52 IDIs with the service providers and health facility managers. Two major themes, health system related and client-related factors, emerged from the analysis. The health system related enablers include increased knowledge and skill of the providers, improved mothers and providers’ motivation, increased service utilization, and improved quality of maternal and newborn care (MNC), and enhanced referral system. The health system related barriers include service interruption, staff shortage/workload, and the providers’ limited capacity. Under the main theme of client-related factors, barriers include perceived limited knowledge and skills of providers and the small size of the ultrasound machine while the facilitators include mothers’ needs and interest in ultrasound scan, availability of free of charge ultrasound service, and increased demand for ultrasound scan service.
Conclusion
Our data suggest that the health system provides an enabling context to introduce limited obstetric ultrasound service and routinely provide the service through mid-level maternal care providers at primary health care level in resource limited settings. Overcoming the health system and client related barriers will maximize and sustain the use of the technology.
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13
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Argaw MD, Abawollo HS, Tsegaye ZT, Beshir IA, Damte HD, Mengesha BT, Gebremedhin ZK, Heyi AF, Guteta AA, Mamo TT, Anara AA, Emiru ZY, Yadeta FS, Wami AB, Kibret MA, Desta BF. Experiences of midwives on Vscan limited obstetric ultrasound use: a qualitative exploratory study. BMC Pregnancy Childbirth 2022; 22:196. [PMID: 35272631 PMCID: PMC8915526 DOI: 10.1186/s12884-022-04523-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/28/2022] [Indexed: 12/04/2022] Open
Abstract
Background Ethiopia is a low-income country located in the horn of Africa’s sub-Saharan region, with very high incidences of maternal and neonatal mortality. Quality antenatal care improves perinatal health outcomes. The USAID funded Transform: Primary Health Care Activity in collaboration with the Ministry of Health and GE Healthcare introduced Vscan limited obstetric ultrasound services in 120 health centers in Ethiopia. So far, the experiences and opinions of midwives on their use have not been explored and described within the local context. This study therefore aims to explore and describe the experiences and opinions of midwives on Vscan limited obstetric ultrasound services at health centers within Ethiopia. Methods An exploratory and descriptive qualitative study was conducted in Amhara, Oromia, and Southern Nations, Nationalities and Peoples’ (SNNP) regions of Ethiopia. Twenty-four participants were selected through a purposeful sampling technique. In-depth individual interviews with trained midwives with practical hands-on limited obstetric ultrasound service provision experience were conducted. The thematic analysis was conducted manually. Results The qualitative data analysis on the experiences and opinions of midwives revealed three themes, namely: individual perception of self-efficacy, facilitators, and barriers of limited obstetric ultrasound services. The basic ultrasound training, which was unique in its organization and arrangement, prepared and built the self-efficacy of trainees in executing their expected competencies. Support of health systems and health managers in dedicating space, availing essential supplies, and assigning human resources emerged as facilitators of the initiated limited obstetric ultrasound services, whereas high workload on one or two ultrasound trained midwives, interruption of essential supplies like paper towels, gel, and alternative power sources were identified as barriers for limited ultrasound services. Conclusion This study explored the experiences and opinions of midwives who were trained on the provision of limited obstetric ultrasound services and served the community in health centers in rural parts of Ethiopia. The results of this study revealed the positive impacts of the intervention on the perceived self-efficacy, facilitation, and breaking-down of barriers to obstetric ultrasound services. Before scaling-up limited obstetric ultrasound interventions, health managers should ensure and commit to availing essential supplies (e.g., paper towels, ultrasound gel, and large memory hard discs), arranging private rooms, and training other mid-level health professionals. In addition, improving pregnant women’s literacy on the national schedule for ultrasound scanning services is recommended. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04523-3.
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Affiliation(s)
- Mesele Damte Argaw
- USAID Transform: Primary Health Care Activity, JSI Research & Training Institute, Inc. in Ethiopia, P.O. Box 1392 code 1110, Addis Ababa, Ethiopia.
| | - Hailemariam Segni Abawollo
- USAID Transform: Primary Health Care Activity, JSI Research & Training Institute, Inc. in Ethiopia, P.O. Box 1392 code 1110, Addis Ababa, Ethiopia
| | - Zergu Taffesse Tsegaye
- USAID Transform: Primary Health Care Activity, JSI Research & Training Institute, Inc. in Ethiopia, P.O. Box 1392 code 1110, Addis Ababa, Ethiopia
| | - Ismael Ali Beshir
- USAID Transform: Primary Health Care Activity, JSI Research & Training Institute, Inc. in Ethiopia, P.O. Box 1392 code 1110, Addis Ababa, Ethiopia
| | - Heran Demissie Damte
- USAID Transform: Primary Health Care Activity, JSI Research & Training Institute, Inc. in Ethiopia, P.O. Box 1392 code 1110, Addis Ababa, Ethiopia
| | - Birhan Tenaw Mengesha
- USAID Transform: Primary Health Care Activity, JSI Research & Training Institute, Inc. in Ethiopia, P.O. Box 1392 code 1110, Addis Ababa, Ethiopia
| | - Zenawork Kassa Gebremedhin
- USAID Transform: Primary Health Care Activity, JSI Research & Training Institute, Inc. in Ethiopia, P.O. Box 1392 code 1110, Addis Ababa, Ethiopia
| | - Atrie Fekadu Heyi
- USAID Transform: Primary Health Care Activity, JSI Research & Training Institute, Inc. in Ethiopia, P.O. Box 1392 code 1110, Addis Ababa, Ethiopia
| | - Asfaw Adugna Guteta
- USAID Transform: Primary Health Care Activity, JSI Research & Training Institute, Inc. in Ethiopia, P.O. Box 1392 code 1110, Addis Ababa, Ethiopia
| | - Tsega Teferi Mamo
- USAID Transform: Primary Health Care Activity, JSI Research & Training Institute, Inc. in Ethiopia, P.O. Box 1392 code 1110, Addis Ababa, Ethiopia
| | - Amare Assefa Anara
- USAID Transform: Primary Health Care Activity, JSI Research & Training Institute, Inc. in Ethiopia, P.O. Box 1392 code 1110, Addis Ababa, Ethiopia
| | - Zelalem Yilma Emiru
- USAID Transform: Primary Health Care Activity, JSI Research & Training Institute, Inc. in Ethiopia, P.O. Box 1392 code 1110, Addis Ababa, Ethiopia
| | - Feyisa Serbessa Yadeta
- USAID Transform: Primary Health Care Activity, JSI Research & Training Institute, Inc. in Ethiopia, P.O. Box 1392 code 1110, Addis Ababa, Ethiopia
| | - Almaz Bekele Wami
- USAID Transform: Primary Health Care Activity, Pathfinder International, Addis Ababa, Ethiopia
| | - Mengistu Asnake Kibret
- USAID Transform: Primary Health Care Activity, Pathfinder International, Addis Ababa, Ethiopia
| | - Binyam Fekadu Desta
- USAID Transform: Primary Health Care Activity, JSI Research & Training Institute, Inc. in Ethiopia, P.O. Box 1392 code 1110, Addis Ababa, Ethiopia
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Prosen M. A systematic integrative literature review of the factors influencing the professionalization of midwifery in the last decade (2009-2019). Midwifery 2021; 106:103246. [PMID: 35007977 DOI: 10.1016/j.midw.2021.103246] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 09/03/2021] [Accepted: 12/26/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The professionalization of midwifery is not only important for midwives themselves, but for women and society in general since professionalism is associated with high-quality services and moral and ethical standards. AIM This systematic integrative literature review seeks to investigate the factors that have affected the professionalization of midwifery in the last decade (2009-2019). METHODS Systematic searches were conducted in EBSCO, PubMed, ScienceDirect, SAGE and the Web of Science Core Collection. Critical appraisal was conducted using the Mixed Methods Appraisal Tool (MMAT). The findings were synthesised through a thematic analysis. The PRISMA statement was used to guide the reporting. FINDINGS Analysis of the 20 studies included detected two main themes: professionalization barriers and professionalization opportunities. The first theme includes issues concerning power imbalance, social recognition, conflicting perspectives on childbirth, professional autonomy, work characteristics, midwifery associations, and regulation. The second theme includes opportunity issues related to woman-centred care, expansion of professional competency, interprofessional collaboration, and education. KEY CONCLUSIONS Over the last decade, the midwifery profession has faced several barriers that seem to be historically entrenched in the professionalization of midwifery, yet changes in the professionalization process are visible in the shift towards elements of the 'new professionalism' that is rising to the surface during this process. IMPLICATIONS FOR PRACTICE The findings suggest the socialisation process of midwifery candidates must focus on raising their self-awareness, self-esteem and confidence in their professional role; woman-centred care needs to be further promoted and implemented; and interprofessional collaboration should be addressed in educational programmes for all health professionals.
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Affiliation(s)
- Mirko Prosen
- University of Primorska, Faculty of Health Sciences, Polje 42, 6310 Izola, Slovenia.
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15
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Moncrieff G, Finlayson K, Cordey S, McCrimmon R, Harris C, Barreix M, Tunçalp Ö, Downe S. First and second trimester ultrasound in pregnancy: A systematic review and metasynthesis of the views and experiences of pregnant women, partners, and health workers. PLoS One 2021; 16:e0261096. [PMID: 34905561 PMCID: PMC8670688 DOI: 10.1371/journal.pone.0261096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/22/2021] [Indexed: 11/18/2022] Open
Abstract
Background The World Health Organization (WHO) recommends one ultrasound scan before 24 weeks gestation as part of routine antenatal care (WHO 2016). We explored influences on provision and uptake through views and experiences of pregnant women, partners, and health workers. Methods We undertook a systematic review (PROSPERO CRD42021230926). We derived summaries of findings and overarching themes using metasynthesis methods. We searched MEDLINE, CINAHL, PsycINFO, SocIndex, LILACS, and AIM (Nov 25th 2020) for qualitative studies reporting views and experiences of routine ultrasound provision to 24 weeks gestation, with no language or date restriction. After quality assessment, data were logged and analysed in Excel. We assessed confidence in the findings using Grade-CERQual. Findings From 7076 hits, we included 80 papers (1994–2020, 23 countries, 16 LICs/MICs, over 1500 participants). We identified 17 review findings, (moderate or high confidence: 14/17), and four themes: sociocultural influences and expectations; the power of visual technology; joy and devastation: consequences of ultrasound findings; the significance of relationship in the ultrasound encounter. Providing or receiving ultrasound was positive for most, reportedly increasing parental-fetal engagement. However, abnormal findings were often shocking. Some reported changing future reproductive decisions after equivocal results, even when the eventual diagnosis was positive. Attitudes and behaviours of sonographers influenced service user experience. Ultrasound providers expressed concern about making mistakes, recognising their need for education, training, and adequate time with women. Ultrasound sex determination influenced female feticide in some contexts, in others, termination was not socially acceptable. Overuse was noted to reduce clinical antenatal skills as well as the use and uptake of other forms of antenatal care. These factors influenced utility and equity of ultrasound in some settings. Conclusion Though antenatal ultrasound was largely seen as positive, long-term adverse psychological and reproductive consequences were reported for some. Gender inequity may be reinforced by female feticide following ultrasound in some contexts. Provider attitudes and behaviours, time to engage fully with service users, social norms, access to follow up, and the potential for overuse all need to be considered.
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Affiliation(s)
- Gill Moncrieff
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
- * E-mail:
| | - Kenneth Finlayson
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Sarah Cordey
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Rebekah McCrimmon
- School of Health and Community Studies, University of Central Lancashire, Preston, United Kingdom
| | - Catherine Harris
- Applied Health Research Hub, University of Central Lancashire, Preston, United Kingdom
| | - Maria Barreix
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Soo Downe
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
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Ultrasound at labour triage in eastern Uganda: A mixed methods study of patient perceptions of care and providers' implementation experience. PLoS One 2021; 16:e0259770. [PMID: 34767612 PMCID: PMC8589172 DOI: 10.1371/journal.pone.0259770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 10/26/2021] [Indexed: 11/19/2022] Open
Abstract
In settings where antenatal ultrasound is not offered routinely, ultrasound use when a woman first presents to the maternity ward for labour (i.e., triage) may be beneficial. This study investigated patients' perceptions of care and providers' experience with ultrasound implementation during labour triage at a district referral hospital (DH) and three primary health centers (HC) in eastern Uganda. This was a mixed methods study comprising questionnaires administered to women and key informant interviews among midwives pre- and post-ultrasound introduction. Bivariate analyses were conducted using chi-square tests. Qualitative themes were categorized as (1) workflow integration; (2) impact on clinical processes; (3) patient response to ultrasound; and (4) implementation barriers. A total of 731 and 815 women completed questionnaires from the HCs and DH, respectively. At the HC-level, triage quality of care, satisfaction and recommendation ratings increased with implementation of ultrasound. In contrast, satisfaction and recommendation ratings did not differ upon ultrasound introduction at the DH, whereas perceived triage quality of care increased. Most participants noted a perceived improvement in midwives' experience and knowledge upon introduction of ultrasound. Women who underwent a scan also reported diverse feelings, such as fear or worry about their delivery, fear of harm due to the ultrasound, or relief after knowing the baby's condition. For the midwives' perspective (n = 14), respondents noted that ultrasound led to more accurate diagnoses (e.g., fetal position, heart rate, multiple gestation) and improved decision-making. However, they noted health system barriers to ultrasound implementation, such as increased workload, not enough ultrasound-trained providers, and irregular electricity. While triage ultrasound in this context was seen as beneficial to mothers and useful in providers' clinical assessments, further investigation around provider-patient communication, system-level challenges, and fears or misconceptions among women are needed.
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Vinayak S, Temmerman M, Villeirs G, Brownie SM. A Curriculum Model for Multidisciplinary Training of Midwife Sonographers in a Low Resource Setting. J Multidiscip Healthc 2021; 14:2833-2844. [PMID: 34675531 PMCID: PMC8505681 DOI: 10.2147/jmdh.s331371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/08/2021] [Indexed: 11/23/2022] Open
Abstract
In many low-resource settings, less than 5% of pregnant women can access ultrasound during pregnancy. Thus, gestational age is often difficult to determine, multiple pregnancies are diagnosed late and foetal and pregnancy-related anomalies can go undetected. A pilot solution was designed beyond the traditional approach of increasing numbers of qualified radiologists, gynaecologists and sonographers. An innovative Human Resource for Health (HRH) task sharing, and maternal child health (MCH) workforce training and capacity building initiative was designed, involving development and testing of a curriculum to train midwife sonographers via a teleradiology innovation platform and a partnership between specialist radiologists, sonographers and midwives. The setting was a tertiary-level private university hospital in Nairobi with implementation in three outreach locations. Direct oversight, support and supervision of specialist radiologists and ultrasonographers effectively addressed issues of quality and safety across the 3-week training period and project implementation. Concepts from sociocultural learning theory informed an initial interactive e-learning module for each midwife at their respective site. Midwives were introduced to ultrasound equipment with a series of didactic and interactive lectures delivered by an expert sonographer at the tertiary hospital teaching site. Lectures were supported by hands-on practical experience, role modelling and mentoring over a four-week period. Assessments included both written examination and practical assessment with an exit examination requiring demonstration of competency in both written and practical format. Final confirmation of scanning accuracy was confirmed with post-delivery verification of results. The pilot was highly successful with an image interpretation accuracy of 99.63% for the midwives. Lessons from this initiative provides guidance in the curriculum development process along with a curriculum outline; pedagogical framework; teaching methods; assessment processes; credentialing; resourcing; and other considerations in scaling up the program. Importantly, the paper details processes for maintaining a high level of quality control and patient safety.
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Affiliation(s)
- Sudhir Vinayak
- Department of Medical Imaging, Aga Khan University Hospital, Nairobi, Kenya
| | - Marleen Temmerman
- Department of Obstetrics & Gynaecology, Aga Khan University Hospital, Nairobi, Kenya.,Department of Obstetrics & Gynaecology, Ghent University, Ghent, Belgium
| | - Geert Villeirs
- Department of Diagnostics, Ghent University Hospital, Ghent, Belgium
| | - Sharon M Brownie
- School of Nursing, Midwifery and Public Health, University of Canberra, Canberra, ACT, Australia.,School of Medicine, Griffith University, Queensland, Australia.,Centre for Health and Social Practice, Wintec, Hamilton, New Zealand
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Ali S, Kabajaasi O, Kawooya MG, Byamugisha J, Zakus D, Papageorghiou AT, Klipstein-Grobusch K, Rijken MJ. Antenatal Doppler ultrasound implementation in a rural sub-Saharan African setting: exploring the perspectives of women and healthcare providers. Reprod Health 2021; 18:199. [PMID: 34620186 PMCID: PMC8499453 DOI: 10.1186/s12978-021-01233-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background The World Health Organization recommends research to evaluate the effects of a single third trimester Doppler ultrasound examination on preventable deaths in unselected-risk pregnancies, particularly in low- and middle-income countries (LMICs) where the evidence base is scarce. While evaluating such technologies, researchers often ignore women and health care provider perspectives. This study explored the views and experiences of women and healthcare providers regarding the use of advanced ultrasound technology to optimize the health of mothers and their babies in a rural community in mid-western Uganda. Methods We enrolled 53 mothers and 10 healthcare providers, and captured data on their perceptions, barriers, and facilitators to the use of Doppler ultrasound technology using focus group discussions, semi-structured interviews and observations. Using qualitative content analysis, we inductively coded the transcripts in ATLAS.ti 8.0, detecting emerging themes. Results Women were afraid that ultrasound would harm them or their fetuses and many of them had never seen an ultrasound scan. The majority of the women found their partners supportive to attend antenatal care and use ultrasound services. Healthcare providers in Kagadi Hospital were unfamiliar with Doppler technology and using it to guide clinical decisions. Other barriers to the implementation of Doppler ultrasound included shortage of trained local staff, insufficient equipment, long distance to and from the hospital, and frequent power cuts. Conclusions We found limited exposure to Doppler ultrasound technology among women and healthcare providers in mid-western Uganda. Engaging male partners may potentially influence the likelihood of accepting and using it to improve the health of women and their fetuses while wide spread myths and misconceptions about it may be changed by community engagement. Healthcare workers experienced difficulties in offering follow-up care to mothers detected with complications and Doppler ultrasound required a high level of training. While introducing advanced ultrasound machines to weak health systems, it is important to adequately train healthcare providers to avoid inappropriate interventions based on misinterpretation of the findings, consider where it is likely to be most beneficial, and embed it with realistic clinical practice guidelines. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01233-5. Globally, nearly three million babies are stillborn every year, but most especially in low- and middle-income countries like Uganda. One of the factors contributing to a high number of stillbirths in low-income countries is the difficulty in identifying complications and accessing high quality care during pregnancy. Although antenatal Doppler scans are being widely used to diagnose complications in high-risk pregnancies in developed countries, studies evaluating it in LMICs are needed before it is implemented on a wide scale. We engaged 53 mothers, eight health workers from a hospital and two healthcare managers from a local government in Uganda to attain their opinions about Doppler ultrasound. We found that spousal involvement may promote acceptance and use of ultrasound services. However, the health workers did not have adequate knowledge about Doppler technology and using it for the benefit of mothers and the mothers feared that ultrasound procedures might harm them or their unborn babies. Making matters worse, the hospital faced frequent power cuts that affected the use of the equipment. Further, mothers must cover a long distance to access the hospital and its services. To reduce the number of babies dying during pregnancy or a few days after birth in Uganda and similar low-resource settings using Doppler technology, it is essential to strengthen the health systems. Starting with the training of healthcare providers to equipping and stabilizing power supply in health facilities, and educating the public about critical health procedures to break myths and misconceptions.
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Affiliation(s)
- Sam Ali
- Department of Research, Ernest Cook Ultrasound Research and Education Institute (ECUREI), Mengo Hospital, Sir Albert Cook Building, Albert Cook Road, P.O. Box 7161, Kampala, Uganda. .,School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda. .,Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | | | - Michael G Kawooya
- Department of Research, Ernest Cook Ultrasound Research and Education Institute (ECUREI), Mengo Hospital, Sir Albert Cook Building, Albert Cook Road, P.O. Box 7161, Kampala, Uganda
| | - Josaphat Byamugisha
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - David Zakus
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Aris T Papageorghiou
- Nuffield Department of Women's and Reproductive Health, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Marcus J Rijken
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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19
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Mogren I, Ntaganira J, Sengoma JPS, Holmlund S, Small R, Pham Thi L, Kidanto HL, Ngarina M, Bergström C, Edvardsson K. Maternal health care professionals' experiences and views on the use of obstetric ultrasound in Rwanda: A cross-sectional study. BMC Health Serv Res 2021; 21:789. [PMID: 34376210 PMCID: PMC8356395 DOI: 10.1186/s12913-021-06758-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/12/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This study, undertaken in Rwanda, aimed to investigate health professionals' experiences and views on the following topics: current clinical guidelines for ultrasound from second trimester at the clinic, regional and national levels, and adherence to clinical guidelines; medically indicated ultrasound examinations; non-medical use of ultrasound including ultrasounds on maternal request; commercialisation of ultrasound; the value of ultrasound in relation to other clinical examinations in pregnancy; and ultrasound and medicalisation of pregnancy. METHODS A cross-sectional design was adopted. Health professionals providing antenatal care and delivery services to pregnant women in 108 health facilities were invited to complete a survey, which was developed based on the results of earlier qualitative studies undertaken as part of the CROss Country Ultrasound Study (CROCUS). RESULTS Nine hundred and seven health professionals participated: obstetricians/gynecologists (3.2%,) other physicians (24.5%), midwives (29.7%) and nurses (42.7%). Few physicians reported the existence of clinical guidelines at clinic, regional or national levels in Rwanda, and guidelines were moderately adhered to. Three obstetric ultrasound examinations were considered medically indicated in an uncomplicated pregnancy. Most participants (73.0%) were positive about obstetric ultrasound examinations on maternal request. Commercialisation was not considered a problem, and the majority (88.5%) agreed that ultrasound had contributed to medicalisation of pregnancy. CONCLUSIONS Findings indicate that clinical guidelines for the use of obstetric ultrasound are limited in Rwanda. Non-medically indicated obstetric ultrasound was not considered a current problem at any level of the healthcare system. The positive attitude to obstetric ultrasound examinations on maternal request may contribute to further burden on a maternal health care system with limited resources. It is essential that limited obstetric ultrasound resources are allocated where they are most beneficial, and clearly stated medical indications would likely facilitate this.
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Affiliation(s)
- Ingrid Mogren
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, S-90187 Umeå, Sweden
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Joseph Ntaganira
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Jean Paul Semasaka Sengoma
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, S-90187 Umeå, Sweden
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Sophia Holmlund
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, S-90187 Umeå, Sweden
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Rhonda Small
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
- Department of Women’s and Children’s and Reproductive Health, Karolinska Institutet, Stockholm, Sweden
| | - Lan Pham Thi
- Department of Dermatology and Venereology, Hanoi Medical University, Hanoi, Vietnam
| | | | - Matilda Ngarina
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Cecilia Bergström
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, S-90187 Umeå, Sweden
| | - Kristina Edvardsson
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
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20
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Recker F, Weber E, Strizek B, Gembruch U, Westerway SC, Dietrich CF. Point-of-care ultrasound in obstetrics and gynecology. Arch Gynecol Obstet 2021; 303:871-876. [PMID: 33558990 PMCID: PMC7985120 DOI: 10.1007/s00404-021-05972-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/12/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The rapid technical development and portability of ultrasound systems over recent years has had a profound impact on the area of point-of-care-ultrasound (POCUS), both in general medicine and in obstetrics and gynecology. The use of POCUS enables the clinician to perform the ultrasound scan either at the medical office or the patient's bedside and used as an extension of the physical examination. Real-time images can immediately be correlated with the patient's symptoms, and any changes in a (critical) patient's condition can be more rapidly detected. POCUS IN OBGYN POCUS is also suitable for time-critical scenarios, and depending on the situation and its dynamics, the course and results of any therapy may be observed in real time. POCUS should be considered to be a routine extension of practice for most OB/GYN clinicians as it can give immediate answers to what could be life-threatening situations for the mother and/or baby. With its proven usefulness, the applications and use of POCUS should be incorporated in teaching programs for medical students, OBGYN residents and emergency physicians.
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Affiliation(s)
- Florian Recker
- Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany.
| | - Eva Weber
- Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Brigitte Strizek
- Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | | | - Christoph F Dietrich
- Department for Internal Medicine, Clinic Beau-Site, Schänzlihalde 11, 3013, Bern, Switzerland
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21
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Messina MP, Piccioni MG, Petrella C, Vitali M, Greco A, Ralli M, Ceccanti M, Ferraguti G, Neri I, Ricchi A, Fiore M, D'Angelo A. Advanced midwifery practice: intrapartum ultrasonography to assess fetal head station and comparison with vaginal digital examination. Minerva Obstet Gynecol 2021; 73:253-260. [PMID: 33851805 DOI: 10.23736/s2724-606x.21.04687-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Vaginal digital examination is considered the gold standard to evaluate patients during labor and delivery. However, transperineal ultrasound has been suggested as an effective tool in determining fetal head station during labor. Angle of progression (AOP), head-perineal distance (HPD) and head-symphysis distance (HSD) are reliable parameters to assess fetal head station during labor. The study aims were to evaluate how midwives can use AOP, HSD, HPD to assess the accuracy of digital vaginal exploration limited to the fetal head station. METHODS Trained midwives for ultrasound analyses performed transperineal ultrasounds during the first stage of labor with 2D-convex probe in 62 pregnant women at term with a single fetus in cephalic presentation. Immediately before the intrapartum ultrasound, the birth attendant performed a digital examination to assess cervical dilatation and head station. The ultrasound scans were compared to the digital vaginal examination through the Tutschek's formula. RESULTS AOP was wider in women who delivered vaginally without any complication if compared to "complicated delivery" group. HPD and HSD were greater in women who underwent an operative vaginal delivery or caesarean section. The vaginal exploration accuracy was 34%, but when ±1 cm was considered as tolerated, the overall accuracy was 74.19%. CONCLUSIONS Midwives may include ultrasounds in their clinical practice after adequate training or under the supervision of an ultrasound professional as an adjunct tool during labor to evaluate its progress and prevent any deviation from physiology.
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Affiliation(s)
- Marisa P Messina
- Department of Gynecology, Obstetrics and Urology, Sapienza University, Rome, Italy
| | - Maria G Piccioni
- Department of Gynecology, Obstetrics and Urology, Sapienza University, Rome, Italy
| | - Carla Petrella
- Institute of Biochemistry and Cell Biology (IBBC-CNR), Rome, Italy
| | | | - Antonio Greco
- Department of Sense Organs, Sapienza University, Rome, Italy
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University, Rome, Italy
| | - Mauro Ceccanti
- SIFASD - Italian Society for the Study of Fetal Alcohol Spectrum Disorder, Rome, Italy
| | | | - Isabella Neri
- University of Modena and Reggio Emilia, Modena, Italy
| | - Alba Ricchi
- University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Fiore
- Institute of Biochemistry and Cell Biology (IBBC-CNR), Rome, Italy - marcofiore.roma @gmail.com.,Department of Sense Organs, Sapienza University, Rome, Italy
| | - Alessio D'Angelo
- Department of Gynecology, Obstetrics and Urology, Sapienza University, Rome, Italy
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22
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Luntsi G, Ugwu AC, Nkubli FB, Emmanuel R, Ochie K, Nwobi CI. Achieving universal access to obstetric ultrasound in resource constrained settings: A narrative review. Radiography (Lond) 2020; 27:709-715. [PMID: 33160820 DOI: 10.1016/j.radi.2020.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/30/2020] [Accepted: 10/13/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The potential benefits and challenges of achieving universal access to obstetric ultrasound services in resource constrained settings were reviewed, with a view to making some recommendations to address the huge burden of avoidable maternal and child morbidity and mortality. KEY FINDINGS In most resource-poor settings of the world, antenatal ultrasound is available only to a privileged few in urban centres, while the majority of the population living in rural areas have little or no access to diagnostic imaging services. There is also the extreme shortage of sonographers and doctors with specialist training in sonography. A comprehensive regulation must be put in place to achieve maximum benefits and to ensure quality assurance; appropriate use and application of ethics and training must be comprehensive. CONCLUSION Ultrasound service provision, in resource-scarce settings, has the potential to improve access and quality of health care services in areas like the point of care ultrasound service provision and in the fields of obstetrics and gynaecology. A comprehensive regulation must be put in place to achieve maximum benefits and to ensure quality assurance. IMPLICATIONS FOR PRACTICE Making ultrasound technology available and affordable in resource scare settings has the potential to improve access to diagnostic imaging services and reduce avoidable maternal and child death in resource constrained settings.
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Affiliation(s)
- G Luntsi
- Department of Medical Radiography, Faculty of Allied Health Sciences, College of Medical Sciences, University of Maiduguri, Borno State, Nigeria.
| | - A C Ugwu
- Department of Radiography and Radiological Sciences, Faculty of Health Sciences, Nnamdi Azikiwe University Awka, Anambra State, Nigeria
| | - F B Nkubli
- Department of Medical Radiography, Faculty of Allied Health Sciences, College of Medical Sciences, University of Maiduguri, Borno State, Nigeria
| | - R Emmanuel
- Department of Medical Radiography, Faculty of Allied Health Sciences, College of Medical Sciences, Bayero University Kano, Kano State, Nigeria
| | - K Ochie
- Department of Radiography and Radiological Sciences, Faculty of Health Sciences, University of Nigeria, Enugu Campus, Enugu State, Nigeria
| | - C I Nwobi
- Department of Medical Radiography, Faculty of Allied Health Sciences, College of Medical Sciences, University of Maiduguri, Borno State, Nigeria
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23
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Holmlund S, Lan PT, Edvardsson K, Phuc HD, Ntaganira J, Small R, Kidanto H, Ngarina M, Mogren I. Health professionals' experiences and views on obstetric ultrasound in Vietnam: a regional, cross-sectional study. BMJ Open 2019; 9:e031761. [PMID: 31548354 PMCID: PMC6773349 DOI: 10.1136/bmjopen-2019-031761] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Obstetric ultrasound is an important part of antenatal care in Vietnam, although there are great differences in access to antenatal care and ultrasound services across the country. The aim of this study was to explore Vietnamese health professionals' experiences and views of obstetric ultrasound in relation to clinical management, resources and skills. DESIGN A cross-sectional questionnaire study was performed as part of the CROss Country UltraSound study. SETTING Health facilities (n=29) in urban, semiurban and rural areas of Hanoi region in Vietnam. PARTICIPANTS Participants were 289 obstetricians/gynaecologists and 535 midwives. RESULTS A majority (88%) of participants agreed that 'every woman should undergo ultrasound examination' during pregnancy to determine gestational age. Participants reported an average of six ultrasound examinations as medically indicated during an uncomplicated pregnancy. Access to ultrasound at participants' workplaces was reported as always available regardless of health facility level. Most participants performing ultrasound reported high-level skills for fetal heart rate examination (70%), whereas few (23%) reported being skilled in examination of the anatomy of the fetal heart. Insufficient ultrasound training leading to suboptimal pregnancy management was reported by 37% of all participants. 'Better quality of ultrasound machines', 'more physicians trained in ultrasound' and 'more training for health professionals currently performing ultrasound' were reported as ways to improve the utilisation of ultrasound. CONCLUSIONS Obstetric ultrasound is used as an integral part of antenatal care at all selected health facility levels in the region of Hanoi, and access was reported as high. However, reports of insufficient ultrasound training resulting in suboptimal pregnancy management indicate a need for additional training of ultrasound operators to improve utilisation of ultrasound.
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Affiliation(s)
- Sophia Holmlund
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - Pham Thi Lan
- Department of Dermatology and Venereology, Hanoi Medical University, Hanoi, Vietnam
| | - Kristina Edvardsson
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Ho Dang Phuc
- Department of Probability and Mathematical Statistics, Institute of Mathematics, Vietnam Academy of Science and Technology, Hanoi, Vietnam
| | - Joseph Ntaganira
- School of Public Health, University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda
| | - Rhonda Small
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
- Department of Women's and Children's and Reproductive Health, Karolinska Institutet, Stockholm, Sweden
| | - Hussein Kidanto
- Department of Obstetrics and Gynecology, Aga Khan University - Tanzania, Dar es Salaam, Tanzania
| | - Matilda Ngarina
- Department of Obstetrics and Gynecology, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Ingrid Mogren
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
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Hitimana R, Lindholm L, Mogren I, Krantz G, Nzayirambaho M, Sengoma JPS, Pulkki-Brännström AM. Incremental cost and health gains of the 2016 WHO antenatal care recommendations for Rwanda: results from expert elicitation. Health Res Policy Syst 2019; 17:36. [PMID: 30953520 PMCID: PMC6451275 DOI: 10.1186/s12961-019-0439-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 03/13/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES High-quality evidence of effectiveness and cost-effectiveness is rarely available and relevant for health policy decisions in low-resource settings. In such situations, innovative approaches are needed to generate locally relevant evidence. This study aims to inform decision-making on antenatal care (ANC) recommendations in Rwanda by estimating the incremental cost-effectiveness of the recent (2016) WHO antenatal care recommendations compared to current practice in Rwanda. METHODS Two health outcome scenarios (optimistic, pessimistic) in terms of expected maternal and perinatal mortality reduction were constructed using expert elicitation with gynaecologists/obstetricians currently practicing in Rwanda. Three costing scenarios were constructed from the societal perspective over a 1-year period. The two main inputs to the cost analyses were a Monte Carlo simulation of the distribution of ANC attendance for a hypothetical cohort of 373,679 women and unit cost estimation of the new recommendations using data from a recent primary costing study of current ANC practice in Rwanda. Results were reported in 2015 USD and compared with the 2015 Rwandan per-capita gross domestic product (US$ 697). RESULTS Incremental health gains were estimated as 162,509 life-years saved (LYS) in the optimistic scenario and 65,366 LYS in the pessimistic scenario. Incremental cost ranged between $5.8 and $11 million (an increase of 42% and 79%, respectively, compared to current practice) across the costing scenarios. In the optimistic outcome scenario, incremental cost per LYS ranged between $36 (for low ANC attendance) and $67 (high ANC attendance), while in the pessimistic outcome scenario, it ranged between $90 (low ANC attendance) and $168 (high ANC attendance) per LYS. Incremental cost effectiveness was below the GDP-based thresholds in all six scenarios. DISCUSSION Implementing the new WHO ANC recommendations in Rwanda would likely be very cost-effective; however, the additional resource requirements are substantial. This study demonstrates how expert elicitation combined with other data can provide an affordable source of locally relevant evidence for health policy decisions in low-resource settings.
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Affiliation(s)
- Regis Hitimana
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Lars Lindholm
- Department of Epidemiology and Global Health, Umeå University, SE 901 87 Umeå, Sweden
| | - Ingrid Mogren
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, 901 87 Umeå, Sweden
| | - Gunilla Krantz
- Department of Public Health and Community Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Manasse Nzayirambaho
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Jean-Paul Semasaka Sengoma
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, 901 87 Umeå, Sweden
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Westerway SC. Comparing the effectiveness of training course formats for point-of-care ultrasound in the third trimester of pregnancy. Australas J Ultrasound Med 2019; 22:45-50. [PMID: 34760536 PMCID: PMC8411680 DOI: 10.1002/ajum.12125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The availability of obstetric point-of-care ultrasound (PoCUS) services has been shown to improve pregnancy outcomes in regional and remote areas both in Australia and around the world. There is an increasing demand for efficient, cost-effective PoCUS courses for monitoring the fetus in the third trimester of pregnancy. AIM To compare the effectiveness of targeted PoCUS courses provided for health professionals that assess the fetus during the third trimester of pregnancy. METHOD The skill-teaching curriculum and competency outcomes of six obstetric PoCUS courses were compared. There were 55 learners with no prior ultrasound experience including 23 with English as a second language. Course duration ranged from 4 to 18 h, didactic lecture time up to 6 h and practical scanning sessions of 3-12 h. Learner/tutor ratio varied from 1:1 to 6:1. All courses included the teaching of knobology, image optimisation and probe manipulation. Practical sessions included supervised scanning of ultrasound phantoms and scanning women in the third trimester of pregnancy. The teaching outcomes that were assessed included image optimisation, determination of fetal lie, fetal heart rate, measuring the single deepest pocket of amniotic fluid, identifying the placental position and basic fetal biometry. The same pre- and post-course multiple choice test and course evaluation forms were used for every programme. RESULTS All participants achieved the limited course objectives, regardless of the differences in the course formats. CONCLUSION This study confirms that obstetric PoCUS courses can provide the initial basic knowledge and scanning skills required to perform limited scope third-trimester scanning.
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Affiliation(s)
- Susan Campbell Westerway
- School of Dentistry & Health SciencesCharles Sturt UniversityWagga WaggaNew South WalesAustralia
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26
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Holmlund S, Ntaganira J, Edvardsson K, Lan PT, Semasaka Sengoma JP, Lesio Kidanto H, Ngarina M, Small R, Mogren I. Health professionals' experiences and views on obstetric ultrasound in Rwanda: A cross-sectional study. PLoS One 2018; 13:e0208387. [PMID: 30513102 PMCID: PMC6279039 DOI: 10.1371/journal.pone.0208387] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 11/14/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Implementation of ultrasound in antenatal care (ANC) in low-income countries has been shown to increase pregnant women's compliance with ANC visits, and facilitate detection of high-risk pregnancies. In Rwanda, as in other low-income countries, access to ultrasound has increased significantly, but lack of training is often a barrier to its use. The aim of this study was to investigate Rwandan health professionals' experiences and views of obstetric ultrasound in relation to clinical management, resources and skills. METHODS A cross-sectional questionnaire study was undertaken between November 2016 and March 2017, as part of the CROss Country UltraSound Study (CROCUS). Data were collected at 108 health facilities located in both rural and urban areas of Rwanda, including provincial, referral, district and private hospitals as well as health centres. Participants were obstetricians (n = 29), other physicians (n = 222), midwives (n = 269) and nurses (n = 387). RESULTS Obstetricians/gynecologists/other physicians commonly performed ultrasound examinations but their self-rated skill levels implied insufficient training. Access to ultrasound when needed was reported as common in hospitals, but available to a very limited extent in health centres. The vast majority of participants, independent of health profession, agreed that maternity care would improve if midwives learned to perform basic ultrasound examinations. CONCLUSIONS Barriers to provision of high quality ultrasound services include variable access to ultrasound depending on health facility level and insufficient skills of ultrasound operators. Physicians in general need more training to perform ultrasound examinations. Implementation of a general dating ultrasound examination seems to be a relevant goal as most health professionals agree that pregnant woman would benefit from this service. To further improve maternity care services, the possibility of educating midwives to perform ultrasound examinations should be further explored.
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Affiliation(s)
- Sophia Holmlund
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - Joseph Ntaganira
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Kristina Edvardsson
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Pham Thi Lan
- Department of Dermatology and Venereology, Hanoi Medical University, Hanoi, Vietnam
| | - Jean Paul Semasaka Sengoma
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Hussein Lesio Kidanto
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Matilda Ngarina
- Department of Obstetrics and Gynecology, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Rhonda Small
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
- Department of Women’s and Children’s and Reproductive Health, Karolinska Institutet, Stockholm, Sweden
| | - Ingrid Mogren
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
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Fullerton J, Butler M, Aman C, Reid T. Global competencies for midwives: external cephalic version; ultrasonography, and tobacco cessation intervention. Women Birth 2018; 32:e413-e420. [PMID: 30174206 DOI: 10.1016/j.wombi.2018.08.166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/17/2018] [Accepted: 08/21/2018] [Indexed: 11/16/2022]
Abstract
PROBLEM AND BACKGROUND The International Confederation of Midwives (ICM) conducts regular updates to the Essential Competencies for Basic Midwifery Practice to determine the introduction or retention of items in the global scope of midwifery practice guidance document. AIM This article presents the review process that underpinned the deliberation about three specific clinical practices: external cephalic version, prenatal ultrasonography, and tobacco cessation interventions that occurred during the 2016-2017 global update study. METHODS A brief outline of the research methodology used in the 2016-2017 study is provided. Literature summaries about safety and effectiveness of three clinical skills are offered. Data addressing global and regional variations in support of each practice and final disposition of the items are documented. FINDINGS External cephalic version did not receive sufficient document support for inclusion in the initial list of items to be tested in the study. Prenatal ultrasonography was supported as an advanced (76.6%) or country-specific (18.8%) skill that midwives could acquire, to promote wider global access for pregnant women. Midwives' participation in tobacco cessation counselling was supported (≥85%) in each of ICM's regions. Knowledge about World Health Organization recommendations for nicotine replacement therapy was endorsed as an additional (62.4%) or country-specific (29.3%) skill. DISCUSSION AND CONCLUSION The current evidence of safety of midwives performing external cephalic version led to the recommendation that it be considered in the next document update. Conflicting views of midwives' role in acquiring skills to conduct prenatal ultrasound were evident. There was strong support for participation in smoking cessation counselling, but knowledge of World Health Organization recommendations was not highly endorsed.
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Affiliation(s)
| | - Michelle Butler
- Faculty of Science and Health, Dublin City University, Glasnevin, Dublin 9, Ireland.
| | - Cheryl Aman
- Midwifery Program, Department of Family Practice, University of British Columbia, Vancouver, BC, Canada.
| | - Tobi Reid
- Midwifery Program, Department of Family Practice, University of British Columbia, Vancouver, BC, Canada.
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