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Jemal K, Ayana D, Tadesse F, Adefris M, Awol M, Tesema M, Dagne B, Abeje S, Bantie A, Butler M, Nwoke C, Kanyuka Z, Adams SJ, Mendez I. Implementation and evaluation of a pilot antenatal ultrasound imaging programme using tele-ultrasound in Ethiopia. J Telemed Telecare 2024; 30:1005-1016. [PMID: 35912493 PMCID: PMC11367800 DOI: 10.1177/1357633x221115746] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 07/06/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Ultrasound imaging is an important aspect of antenatal care, though access to antenatal ultrasound imaging is limited in many developing countries. The objective of this study was to evaluate a pilot programme which aimed to improve access to antenatal ultrasound for rural Ethiopians through enhanced training of healthcare providers (including midwives, nurses and clinical officers) with support remotely provided by obstetricians using a tele-ultrasound platform. METHODS Thirteen healthcare providers in the North Shoa Zone in Ethiopia completed training to enable them to perform antenatal ultrasound with the remote supervision of an obstetrician via a tele-ultrasound platform. Pregnant women attending an antenatal appointment at two facilities were offered an antenatal ultrasound exam performed by one of the healthcare providers. Image interpretations between obstetricians and healthcare providers were compared. Participants and healthcare providers were invited to complete a questionnaire regarding their experience with tele-ultrasound, and participants, healthcare providers and obstetricians were interviewed regarding their experience with the tele-ultrasound pilot programme. RESULTS 2795 pregnant women had an antenatal ultrasound exam. Of 100 exams randomly selected to assess concordance between healthcare providers' and obstetricians' image interpretations, concordance ranged from 79% to 100% for each parameter assessed. 99.4% of participants surveyed indicated that they would recommend antenatal ultrasound using tele-ultrasound to friends and family. Themes relating to participants' experiences of having a tele-ultrasound exam were reduced travel and cost, equivalence in quality of virtual care to in-person care and empowerment through diagnostic information. CONCLUSION Healthcare provider-performed antenatal ultrasound - supported by obstetricians via tele-ultrasound - showed high levels of concordance, was well-received by participants and provided rural Ethiopian women with enhanced access to antenatal imaging.
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Affiliation(s)
- Kemal Jemal
- Department of Nursing, College of Medicine and Health Sciences, Salale University, Fitche, Ethiopia
| | - Dereje Ayana
- Department of Medicine, College of Medicine and Health Sciences, Salale University, Fitche, Ethiopia
| | - Felagot Tadesse
- Department of Obstetrics and Gynecology, St Paul’s Hospital Millennium College, Addis Ababa, 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
| | - Megan Butler
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Chikezirim Nwoke
- Department of Sociology and Anthropology, Carleton University, Ottawa, Canada
| | - Zakhar Kanyuka
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - 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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Ssegujja E, Andipatin M. Translating lessons to reinforce national stillbirth response; multi-stakeholder perspectives regarding priorities and opportunities to deliver quality evidence-based interventions within a limited-resource context in Uganda. BMC Health Serv Res 2024; 24:715. [PMID: 38858756 PMCID: PMC11165756 DOI: 10.1186/s12913-024-11180-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 06/05/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND There is noted increase in attention towards implementation of evidence-based interventions in response to the stillbirth burden in low- and middle-income countries including Uganda. Recent results reporting some of the strategies adopted have tended to focus much attention towards their overall effect on the stillbirth burden. More is needed regarding stakeholder reflections on priorities and opportunities for delivering quality services within a limited resource setting like Uganda. This paper bridges this knowledge gap. METHODS Data collection occurred between March and June 2019 at the national level. Qualitative interviews were analysed using a thematic analysis technique. RESULTS Identified priorities included; a focus on supportive functions such as the referral system, attention to the demand side component of maternal health services, and improvements in the support supervision particularly focusing on empowering subnational level actors. The need to strengthen the learning for better implementation of strategies which are compatible with context was also reported. A comprehensive and favourable policy environment with the potential to direct implementation of strategies, harnessing the private sector contribution as well as the role of national level champions and patient advocates to amplify national stillbirth reduction efforts for continued visibility and impact were recommended. CONCLUSION Great potential exists within the current strategies to address the national stillbirth burden. However, priorities such as improving the supportive functions of MCH service delivery and attention to the demand side need to be pursued more for better service delivery with opportunities including a favourable policy environment primed to better serve the current strategies. This calls for dedicated efforts targeted at addressing gaps within the existing priorities and opportunities for better delivery of national strategies to address the stillbirth burden in Uganda.
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Affiliation(s)
- Eric Ssegujja
- Department of Health Policy Planning and Management, School of Public Health, College of Health Sciences, Makerere University, P.O. Box 7076, Kampala, Uganda.
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, Republic of South Africa.
| | - Michelle Andipatin
- Department of Psychology, University of the Western Cape, Cape Town, South Africa
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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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Kim C, Wagle K, Shrestha B, Bhatta S, Maharjan S, Dhakal L, Rizal R, Kristensen S. Perceptions of service providers, service recipients and female community health volunteers on a rural obstetric ultrasound program in rural Nepal: a qualitative study. BMC Pregnancy Childbirth 2023; 23:574. [PMID: 37563558 PMCID: PMC10413490 DOI: 10.1186/s12884-023-05876-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 07/26/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND In rural Nepal, where women face financial and geographic barriers in accessing ultrasound scans, the government initiated a Rural Obstetric Ultrasound Program (ROUSG) to train skilled birth attendants (SBAs) in rural birthing centers and expand access to routine ultrasound scans for local pregnant women. This study explores the perceived benefits and limitations of the training and implementation of this program. METHODS A qualitative study was conducted in 15 primary care facilities in Bhojpur and Dhading, two rural districts of Nepal. The research team conducted in-depth interviews with 15 trained SBAs and focus group discussions with 48 service recipients and 30 FCHVs to gain insight into their perceptions. All interviews and focus group discussions were recorded, reviewed, and manually coded into MS Excel. RESULTS Overall, our findings indicated that the ROUSG program was very well received among all our study participants, though critical gaps were identified, mostly during the training of the SBAs. These included insufficient guidance or practice opportunities during training and the challenges of implementing the mobile obstetric ultrasound service. Most importantly, though, our results suggest that the implementation of the ROUSG program increased access to prenatal care, earlier identification and referrals for abnormal scans, as well as reduced pregnancy-related stress. There was also a notable anecdotal increase in antenatal care utilization and institutional deliveries, as well as high satisfaction in both service providers and recipients. CONCLUSION Our findings highlighted that while the training component could use some strengthening with increased opportunities for supervised practice sessions and periodic refresher training after the initial 21-days, the program itself had the potential to fill crucial gaps in maternal and newborn care in rural Nepal, by expanding access not only to ROUSG services but also to other MNH services such as ANC and institutional deliveries. Our findings also support the use of ultrasound in areas with limited resources as a solution to identify potential complications at earlier stages of pregnancy and improve timely referrals, indicating the potential for reducing maternal and neonatal morbidities. This initial study supports further research into the role ROUSG can play in expanding critical MNH services in underserved areas and improving broader health outcomes through earlier identification of potential obstetric complications.
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Affiliation(s)
| | | | | | | | | | | | - Rajiv Rizal
- AMDA-Nepal, AMDA Hospital, Damak, Jhapa, Nepal
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Nyumwa P, Bula AK, Nyondo-Mipando AL. Perceptions on acceptability of the 2016 WHO ANC model among the pregnant women in Phalombe District, Malawi - a qualitative study using Theoretical Framework of Acceptability. BMC Pregnancy Childbirth 2023; 23:166. [PMID: 36906538 PMCID: PMC10007797 DOI: 10.1186/s12884-023-05497-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 03/06/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND The World Health Organization introduced a new model of care, 'The 2016 WHO ANC Model' to overcome challenges encountered during the implementation of the Focused Antenatal Care Approach. For any new intervention to achieve its objective, it must be widely accepted by both the deliverers and recipients. Malawi rolled out the model in 2019 without carrying out acceptability studies. The objective of this study was to explore the perceptions of pregnant women and health care workers on the acceptability of 2016 WHO's ANC model in Phalombe District, Malawi using the Theoretical Framework of Acceptability. METHODOLOGY We conducted a descriptive qualitative study between May and August 2021. The Theoretical Framework of Acceptability was used to guide the development of study objectives, data collection tools, and data analysis. We purposely conducted 21 in-depth interviews (IDIs) among pregnant women, postnatal mothers, a safe motherhood coordinator, and Antenatal care (ANC) clinic midwives, and two focus group discussions (FGDs) among Disease Control and Surveillance Assistants. All IDIs and FGDs were conducted in Chichewa, digitally recorded, and simultaneously transcribed and translated into English. Data was analysed manually using content analysis. RESULTS The model is acceptable among most pregnant women and they reckoned that it would help reduce maternal and neonatal deaths. Support from a husband, peers, and health care workers facilitated acceptability of the model while the increased number of ANC contacts which resulted in fatigue and increased transportation cost incurred by the women was a deterrent. CONCLUSION This study has shown that most pregnant women have accepted the model despite facing numerous challenges. Therefore, there is a need to strengthen the enabling factors and address the bottlenecks in the implementation of the model. Furthermore, the model should be widely publicised so that both intervention deliverers and recipients of care implement the model as intended. This will in turn help to achieve the model's aim of improving maternal and neonatal outcomes and creating a positive experience with health care among pregnant women and adolescent girls.
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Affiliation(s)
- Prince Nyumwa
- Department of Health Systems and Policy, School of Global and Public Health, Kamuzu University of Health Sciences, P/Bag 360 Blantyre 3, Blantyre, Malawi. .,Holy Family College of Nursing, P.O. Box 51224, Limbe, Malawi.
| | | | - Alinane Linda Nyondo-Mipando
- Department of Health Systems and Policy, School of Global and Public Health, Kamuzu University of Health Sciences, P/Bag 360 Blantyre 3, Blantyre, Malawi.,Maternal and Fetal Health Group, Malawi Liverpool Wellcome Programme, P.O Box 30096, Blantyre, Malawi
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Kurjak A, Medjedovic E, Stanojević M. Use and misuse of ultrasound in obstetrics with reference to developing countries. J Perinat Med 2023; 51:240-252. [PMID: 36302110 DOI: 10.1515/jpm-2022-0438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/04/2022] [Indexed: 11/15/2022]
Abstract
Maternal and neonatal health is one of the main global health challenges. Every day, approximately 800 women and 7,000 newborns die due to complications during pregnancy, delivery, and neonatal period. The leading causes of maternal death in sub-Saharan Africa are obstetric hemorrhage (28.8%), hypertensive disorders in pregnancy (22.1%), non-obstetric complications (18.8%), and pregnancy-related infections (11.5%). Diagnostic ultrasound examinations can be used in a variety of specific circumstances during pregnancy. Because adverse outcomes may also arise in low-risk pregnancies, it is assumed that routine ultrasound in all pregnancies will enable earlier detection and improved management of pregnancy complications. The World Health Organization (WHO) estimated in 1997 that 50% of developing countries had no access to ultrasound imaging, and available equipment was outdated or broken. Unfortunately, besides all the exceptional benefits of ultrasound in obstetrics, its inappropriate use and abuse are reported. Using ultrasound to view, take a picture, or determine the sex of a fetus without a medical indication can be considered ethically unjustifiable. Ultrasound assessment when indicated should be every woman's right in the new era. However, it is still only a privilege in some parts of the world. Investment in both equipment and human resources has been clearly shown to be cost-effective and should be an obligatory step in the improvement of health care. Well-developed health systems should guide developing countries, creating principles for the organization of the health system with an accent on the correct, legal, and ethical use of diagnostic ultrasound in pregnancy to avoid its misuse. The aim of the article is to present the importance of correct and appropriate use of ultrasound in obstetrics and gynecology with reference to developing countries.
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Affiliation(s)
- Asim Kurjak
- Department of Obstetrics and Gynecology, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Edin Medjedovic
- Clinic of Gynecology and Obstetrics, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.,Department of Gynecology, School of Medicine, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
| | - Milan Stanojević
- Department of Obstetrics and Gynecology, University Hospital "Sveti Duh", Zagreb, Croatia.,Neonatal Unit, Department of Obstetrics and Gynecology, Medical School University of Zagreb, Zagreb, Croatia
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Sakeah E, Bawah AA, Kuwolamo I, Anyorikeya M, Asuming PO, Aborigo RA. How different incentives influence reported motivation and perceptions of performance in Ghanaian community-based health planning and services zones. BMC Res Notes 2023; 16:17. [PMID: 36803880 PMCID: PMC9942281 DOI: 10.1186/s13104-023-06286-2] [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: 07/20/2022] [Accepted: 02/07/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Maternal mortality is still a burden worldwide, and Ghana's maternal and child mortalities are still high. Incentive schemes have been effective in improving health workers' performance thereby reducing maternal and child deaths. The efficiency of public health services in most developing countries has been linked to the provision of incentives. Thus, financial packages for Community Health Volunteers (CHVs) serve as enablers for them to be focused and committed to their work. However, the poor performance of CHVs is still a challenge in health service delivery in many developing countries. Although the reasons for these persistent problems are understood, we need to find out how to implement what works in the face of political will and financial constraints. This study assesses how different incentives influence reported motivation and perceptions of performance in Community-based Health Planning and Services Program (CHPS) zones in the Upper East region. METHODS A quasi-experimental study design with post-intervention measurement was used. Performance-based interventions were implemented for 1 year in the Upper East region. The different interventions were rolled out in 55 of 120 CHPS zones. The 55 CHPS zones were randomly assigned to four groups: three groups of 14 CHPS zones with the last group containing 13 CHPS zones. Several alternative types of financial and non-financial incentives as well as their sustainability were explored. The financial incentive was a small monthly performance-based Stipend. The non-financial incentives were: Community recognition; paying for National Health Insurance Scheme (NHIS) premiums and fees for CHV, one spouse, and up to two children below 18 years, and; quarterly performance-based Awards for best-performing CHVs. The four groups represent the four different incentive schemes. We conducted 31 In-depth interviews (IDIs) and 31 Focus Group Discussions (FGDs) with health professionals and community members. RESULTS Community members and the CHVs wanted the stipend as the first incentive but requested that it be increased from the current level. The Community Health Officers (CHOs) prioritized the Awards over the Stipend because they felt it was too small to generate the required motivation in the CHVs. The second incentive was the National Health Insurance Scheme (NHIS) registration. Community recognition was also considered by health professionals as effective in motiving CHVs and work support inputs and CHVs training helped in improving output. The various incentives have helped increase health education and facilitated the work of the volunteers leading to increased outputs: Household visits and Antenatal Care and Postnatal Care coverage improved. The incentives have also influenced the initiative of volunteers. Work support inputs were also regarded as motivators by CHVs, but the challenges with the incentives included the size of the stipend and delays in disbursement. CONCLUSION Incentives are effective in motivating CHVs to improve their performance, thereby improving access to and use of health services by community members. The Stipend, NHIS, Community recognition and Awards, and the work support inputs all appeared to be effective in improving CHVs' performance and outcomes. Therefore, if health professionals implement these financial and non-financial incentives, it could bring a positive impact on health service delivery and use. Also, building the capacities of CHVs and providing them with the necessary inputs could improve output.
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Affiliation(s)
- Evelyn Sakeah
- School of Public Health, C.K. Tedam University of Technology and Applied Sciences, Navrongo, Ghana. .,Population/Public Health Department, Navrongo Health Research Centre, Navrongo, Ghana.
| | - Ayaga A. Bawah
- grid.8652.90000 0004 1937 1485Regional Institute for Population Studies, University of Ghana, Legon, Accra Ghana
| | - Irene Kuwolamo
- grid.415943.ePopulation/Public Health Department, Navrongo Health Research Centre, Navrongo, Ghana
| | - Maria Anyorikeya
- grid.415943.ePopulation/Public Health Department, Navrongo Health Research Centre, Navrongo, Ghana
| | - Patrick O. Asuming
- grid.8652.90000 0004 1937 1485Business School, University of Ghana, Legon, Accra Ghana
| | - Raymond Akawire Aborigo
- grid.415943.ePopulation/Public Health Department, Navrongo Health Research Centre, Navrongo, Ghana
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Institutionalization of limited obstetric ultrasound leading to increased antenatal, skilled delivery, and postnatal service utilization in three regions of Ethiopia: A pre-post study. PLoS One 2023; 18:e0281626. [PMID: 36791077 PMCID: PMC10045583 DOI: 10.1371/journal.pone.0281626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 01/29/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND A minimum of one ultrasound scan is recommended for all pregnant women before the 24th week of gestation. In Ethiopia, there is a shortage of skilled manpower to provide these services. Currently, trained mid-level providers are providing the services at the primary healthcare level. The aims of this study were to compare antenatal care 1 (ANC1), antenatal care 4 (ANC4), skilled birth attendance (SBA), and postnatal care (PNC) service utilization before and after institutionalizing Vscan limited obstetric ultrasounds at semi-urban health centers in Ethiopia. METHODS A pre and post intervention observational study was conducted to investigate maternal and neonatal health service utilization rates before and after institutionalizing Vscan limited obstetric ultrasound services, between July 2016 and June 2020. The data were extracted from 1st August- 31st December 2020. RESULTS The observed monthly increase on the mean rank of first ANC visits after the introduction of Vscan limited obstetric ultrasound services showed a statistically significant difference at KW-ANOVA H (3) = 17.09, P = 0.001. The mean rank of fourth ANC utilization showed a statistically significant difference at KW- ANOVA H (3) = 16.24, P = 0.001. The observed mean rank in skilled birth attendance (SBA) showed a statistically significant positive difference using KW-ANOVA H (3) = 23.6, P<0.001. The mean rank of increased utilization in postnatal care showed a statistically significant difference using KW-ANOVA H (3) = 17.79, P<0.001. CONCLUSION The introduction of limited obstetric ultrasound services by trained mid-level providers at the primary healthcare level was found to have improved the utilization of ANC, SBA, and postnatal care (PNC) services. It is recommended that the institutionalization of limited obstetric ultrasound services be scaled up and a further comparative study between facilities with and without ultrasound services be conducted to confirm causality and assess effects on maternal and perinatal outcomes.
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Awor S, Byanyima R, Abola B, Kiondo P, Orach CG, Ogwal-Okeng J, Kaye D, Nakimuli A. Prediction of stillbirth low resource setting in Northern Uganda. BMC Pregnancy Childbirth 2022; 22:855. [PMID: 36403017 PMCID: PMC9675255 DOI: 10.1186/s12884-022-05198-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/08/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Women of Afro-Caribbean and Asian origin are more at risk of stillbirths. However, there are limited tools built for risk-prediction models for stillbirth within sub-Saharan Africa. Therefore, we examined the predictors for stillbirth in low resource setting in Northern Uganda. METHODS Prospective cohort study at St. Mary's hospital Lacor in Northern Uganda. Using Yamane's 1967 formula for calculating sample size for cohort studies using finite population size, the required sample size was 379 mothers. We doubled the number (to > 758) to cater for loss to follow up, miscarriages, and clients opting out of the study during the follow-up period. Recruited 1,285 pregnant mothers at 16-24 weeks, excluded those with lethal congenital anomalies diagnosed on ultrasound. Their history, physical findings, blood tests and uterine artery Doppler indices were taken, and the mothers were encouraged to continue with routine prenatal care until the time for delivery. While in the delivery ward, they were followed up in labour until delivery by the research team. The primary outcome was stillbirth 24 + weeks with no signs of life. Built models in RStudio. Since the data was imbalanced with low stillbirth rate, used ROSE package to over-sample stillbirths and under-sample live-births to balance the data. We cross-validated the models with the ROSE-derived data using K (10)-fold cross-validation and obtained the area under curve (AUC) with accuracy, sensitivity and specificity. RESULTS The incidence of stillbirth was 2.5%. Predictors of stillbirth were history of abortion (aOR = 3.07, 95% CI 1.11-8.05, p = 0.0243), bilateral end-diastolic notch (aOR = 3.51, 95% CI 1.13-9.92, p = 0.0209), personal history of preeclampsia (aOR = 5.18, 95% CI 0.60-30.66, p = 0.0916), and haemoglobin 9.5 - 12.1 g/dL (aOR = 0.33, 95% CI 0.11-0.93, p = 0.0375). The models' AUC was 75.0% with 68.1% accuracy, 69.1% sensitivity and 67.1% specificity. CONCLUSION Risk factors for stillbirth include history of abortion and bilateral end-diastolic notch, while haemoglobin of 9.5-12.1 g/dL is protective.
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Affiliation(s)
- Silvia Awor
- Department of Obstetrics and Gynecology, Faculty of Medicine Gulu University, Gulu, Uganda.
| | - Rosemary Byanyima
- Mulago National Referral Hospital, and Teaching Hospital for Makerere University, P.O.Box 7051, Kampala, Uganda
| | - Benard Abola
- Department of Mathematics, Faculty of Science, Gulu University, P.O.Box 166, Gulu, Uganda
| | - Paul Kiondo
- Department of Obstetrics and Gynaecology, Makerere University, P.O.Box 7062, Kampala, Uganda
| | - Christopher Garimoi Orach
- Department of Community Health, School of Public Health, College of Health Sciences Makerere University, P.O.Box 7062, Kampala, Uganda
| | - Jasper Ogwal-Okeng
- Department of Pharmacology, School of Health Sciences, Lira University, P.O.Box 1035, Lira, Uganda
| | - Dan Kaye
- Department of Obstetrics and Gynaecology, Makerere University, P.O.Box 7062, Kampala, Uganda
| | - Annettee Nakimuli
- Department of Obstetrics and Gynaecology, Makerere University, P.O.Box 7062, Kampala, Uganda
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Yitbarek K, Tuji A, Alemayehu YK, Tadesse D, Tadele A, Tsegaye S, Abera Y, Abrar M, Ibrahim A, Esmael S, Belete M, Mohammed A, Shekabdulahi M, Olani H, Selamu A, Medhin G, Gerbaba MJ. Effect of USAID-funded obstetric ultrasound service interventions on maternal and perinatal health outcomes at primary healthcare facilities in Ethiopia: a propensity score matching analysis. BMJ Open 2022; 12:e065351. [PMID: 36220324 PMCID: PMC9558785 DOI: 10.1136/bmjopen-2022-065351] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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
OBJECTIVE A dimensional shift in the health service delivery in the primary healthcare setting is required to raise maternal and child well-being. This study aimed to evaluate the effect of US Agency for International Development-funded obstetric ultrasound service on maternal and perinatal health outcomes at Ethiopia's primary healthcare facilities. DESIGN We employed a quasi-experimental study design. SETTING The study was conducted in primary health centres located in four regions of Ethiopia. PARTICIPANTS We used 2 years' data of 1568 mothers from 13 intervention and 13 control primary health centres. Data were obtained from Vscan, antenatal care (ANC), delivery and postnatal care registers. INTERVENTION Use of portable obstetric ultrasound service during pregnancy. OUTCOME MEASURES The primary outcome variables include complete four ANC visits, referral during ANC, delivery in a health facility and having postnatal care and continuum of care. The secondary outcome variable was perinatal death. RESULTS With the kernel matching approach, we have found that having four or more ANC visits was decreased after the intervention (average treatment effect (ATE): -0.20; 95% CI: -0.23 to -0.09), and the rest of the indicators, including referral during ANC (ATE: 0.01; 95% CI: 0.15 to 0.34), institutional delivery (ATE: 0.24; 95% CI: 0.15 to 0.34) and postnatal care (ATE: 0.26; 95% CI: 0.10 to 0.37), were significantly raised because of the intervention. Similarly, we have found that perinatal death dropped considerably due to the intervention. CONCLUSION The findings show a consistent increase in maternal health service use because of the introduction of obstetric ultrasound services at the primary health centre level. Furthermore, early detection of complications and following referral for specialty care were found to be high. The consistent rise in maternal health service use indicators calls for additional trial to test the effect of obstetric ultrasound service in other locations of the country. Furthermore, evaluating the predictive values, sensitivity and specificity of the obstetric ultrasound service is important.
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Affiliation(s)
- Kiddus Yitbarek
- Department of Health Policy and Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Alemu Tuji
- USAID Transform Health in Developing Regions, Amref Health Africa, Addis Ababa, Ethiopia
| | - Yibeltal Kiflie Alemayehu
- Department of Health Policy and Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia
- MERQ Consultancy PLC, Addis Ababa, Ethiopia
| | - Derebe Tadesse
- USAID Transform Health in Developing Regions, Amref Health Africa, Addis Ababa, Ethiopia
| | - Afework Tadele
- Department of Population and Family Health, Jimma University, Jimma, Ethiopia
| | - Sentayehu Tsegaye
- USAID Transform Health in Developing Regions, Amref Health Africa, Addis Ababa, Ethiopia
| | - Yared Abera
- USAID Transform Health in Developing Regions, Amref Health Africa, Addis Ababa, Ethiopia
| | - Mohammed Abrar
- USAID Transform Health in Developing Regions, Amref Health Africa, Semera, Afar, Ethiopia
| | - Ahmed Ibrahim
- USAID Transform Health in Developing Regions, Amref Health Africa, Jigjiga, Somali, Ethiopia
| | - Salah Esmael
- USAID Transform Health in Developing Regions, Amref Health Africa, Asosa, Benishangul-gumuz, Ethiopia
| | - Mebrie Belete
- USAID Transform Health in Developing Regions, Amref Health Africa, Gambela, Ethiopia
| | - Abdella Mohammed
- USAID Transform Health in Developing Regions, Amref Health Africa, Semera, Afar, Ethiopia
| | - Muktar Shekabdulahi
- USAID Transform Health in Developing Regions, Amref Health Africa, Jigjiga, Somali, Ethiopia
| | - Hundessa Olani
- USAID Transform Health in Developing Regions, Amref Health Africa, Asosa, Benishangul-gumuz, Ethiopia
| | - Arab Selamu
- USAID Transform Health in Developing Regions, Amref Health Africa, Gambela, Ethiopia
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mulusew J Gerbaba
- Department of Epidemiology, Faculty of Public Health, Jimma University, Jimma, Ethiopia
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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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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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Whittington JR, Hughes DS, Rabie NZ, Ounpraseuth ST, Nembhard WN, Chauhan SP, Magann EF. Detection of Fetal Anomalies by Remotely Directed and Interpreted Ultrasound (Teleultrasound): A Randomized Noninferiority Trial. Am J Perinatol 2022; 39:113-119. [PMID: 34808687 DOI: 10.1055/s-0041-1739352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To determine the accuracy and reliability of remotely directed and interpreted ultrasound (teleultrasound) as compared with standard in-person ultrasound for the detection of fetal anomalies, and to determine participants' satisfaction with teleultrasound. STUDY DESIGN This was a single-center, randomized (1:1) noninferiority study. Individuals referred to the maternal-fetal medicine (MFM) ultrasound clinic were randomized to standard in-person ultrasound and counseling or teleultrasound and telemedicine counseling. The primary outcome was major fetal anomaly detection rate (sensitivity). All ultrasounds were performed by registered diagnostic medical sonographers and interpretations were done by a group of five MFM physicians. After teleultrasound was completed, the teleultrasound patients filled out a satisfaction survey using a Likert scale. Newborn data were obtained from the newborn record and statewide birth defect databases. RESULTS Of 300 individuals randomized in each group, 294 were analyzed in the remotely interpreted teleultrasound group and 291 were analyzed in the in-person ultrasound group. The sensitivity of sonographic detection of 28 anomalies was 82.14% in the control group and of 20 anomalies in the telemedicine group, it was 85.0%. The observed difference in sensitivity was 0.0286, much smaller than the proposed noninferiority limit of 0.05. Specificity, negative predictive value, positive predictive value, and accuracy were more than 94% for both groups. Patient satisfaction was more than 95% on all measures, and there were no significant differences in patient satisfaction based on maternal characteristics. CONCLUSION Teleultrasound is not inferior to standard in-person ultrasound for the detection of fetal anomalies. Teleultrasound was uniformly well received by patients, regardless of demographics. These key findings support the continued expansion of telemedicine services. KEY POINTS · For detection of major anomalies, teleultrasound is comparable to standard ultrasound.. · Teleultrasound was well accepted by patients.. · Teleultrasound use should be expanded..
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Affiliation(s)
- Julie R Whittington
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.,College of Public Health, Arkansas Center for Birth Defects Research and Prevention, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Dawn S Hughes
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Nader Z Rabie
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Songthip T Ounpraseuth
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Wendy N Nembhard
- College of Public Health, Arkansas Center for Birth Defects Research and Prevention, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas.,Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Suneet P Chauhan
- Department of Obstetrics and Gynecology, McGovern Medical School at UTHealth, Houston, Texas
| | - Everett F Magann
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.,College of Public Health, Arkansas Center for Birth Defects Research and Prevention, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Arunda MO, Agardh A, Asamoah BO. Determinants of continued maternal care seeking during pregnancy, birth and postnatal and associated neonatal survival outcomes in Kenya and Uganda: analysis of cross-sectional, demographic and health surveys data. BMJ Open 2021; 11:e054136. [PMID: 34903549 PMCID: PMC8672021 DOI: 10.1136/bmjopen-2021-054136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES To examine how maternal and sociodemographic factors determine continued care-seeking behaviour from pregnancy to postnatal period in Kenya and Uganda and to determine associated neonatal survival outcomes. DESIGN A population-based analysis of cross-sectional data using multinomial and binary logistic regressions. SETTING Countrywide, Kenya and Uganda. PARTICIPANTS Most recent live births of 24 502 mothers within 1-59 months prior to the 2014-2016 Demographic and Health Surveys. OUTCOMES Care-seeking continuum and neonatal mortality. RESULTS Overall, 57% of the mothers had four or more antenatal care (ANC) contacts, of which 73% and 41% had facility births and postnatal care (PNC), respectively. Maternal/paternal education versus no education was associated with continued care seeking in majority of care-seeking classes; relative risk ratios (RRRs) ranged from 2.1 to 8.0 (95% CI 1.1 to 16.3). Similarly, exposure to mass media was generally associated with continued care seekin; RRRs ranged from 1.8 to 3.2 (95% CI 1.2 to 5.4). Care-seeking tendency reduced if a husband made major maternal care-seeking decisions. Transportation problems and living in rural versus urban were largely associated with lower continued care use; RRR ranged from 0.4 to 0.7 (95% CI 0.3 to 0.9). The two lowest care-seeking categories with no ANC and no PNC indicated the highest odds for neonatal mortality (adjusted OR 4.2, 95% CI 1.6 to 10.9). 23% neonatal deaths were attributable to inadequate maternal care attendance. CONCLUSION Strategies such as mobile health specifically for promoting continued maternal care use up to postnatal could be integrated in the existing structures. Another strategy would be to develop and employ a brief standard questionnaire to determine a mother's continued care-seeking level during the first ANC visit and to use the information to close the care-seeking gaps. Strengthening the community health workers system to be an integral part of promoting continued care seeking could enhance care seeking as a stand-alone strategy or as a component of aforementioned suggested strategies.
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Affiliation(s)
- Malachi Ochieng Arunda
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Anette Agardh
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Benedict Oppong Asamoah
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
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Marini TJ, Weiss SL, Gupta A, Zhao YT, Baran TM, Garra B, Shafiq I, Oppenheimer DC, Egoavil MS, Ortega RL, Quinn RA, Kan J, Dozier AM, Tamayo L, Carlotto C, Castaneda B. Testing telediagnostic thyroid ultrasound in Peru: a new horizon in expanding access to imaging in rural and underserved areas. J Endocrinol Invest 2021; 44:2699-2708. [PMID: 33970434 PMCID: PMC8572222 DOI: 10.1007/s40618-021-01584-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/21/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE Thyroid ultrasound is a key tool in the evaluation of the thyroid, but billions of people around the world lack access to ultrasound imaging. In this study, we tested an asynchronous telediagnostic ultrasound system operated by individuals without prior ultrasound training which may be used to effectively evaluate the thyroid and improve access to imaging worldwide. METHODS The telediagnostic system in this study utilizes volume sweep imaging (VSI), an imaging technique in which the operator scans the target region with simple sweeps of the ultrasound probe based on external body landmarks. Sweeps are recorded and saved as video clips for later interpretation by an expert. Two operators without prior ultrasound experience underwent 8 h of training on the thyroid VSI protocol and the operation of the telemedicine platform. After training, the operators scanned patients at a health center in Lima. Telediagnostic examinations were sent to the United States for remote interpretation. Standard of care thyroid ultrasound was performed by an experienced radiologist at the time of VSI examination to serve as a reference standard. RESULTS Novice operators scanned 121 subjects with the thyroid VSI protocol. Of these exams, 88% were rated of excellent image quality showing complete or near complete thyroid visualization. There was 98.3% agreement on thyroid nodule presence between VSI teleultrasound and standard of care ultrasound (Cohen's kappa 0.91, P < 0.0001). VSI measured the thyroid size, on average, within 5 mm compared to standard of care. Readers of VSI were also able to effectively characterize thyroid nodules, and there was no significant difference in measurement of thyroid nodule size (P = 0.74) between VSI and standard of care. CONCLUSION Thyroid VSI telediagnostic ultrasound demonstrated both excellent visualization of the thyroid gland and agreement with standard of care thyroid ultrasound for nodules and thyroid size evaluation. This system could be deployed for evaluation of palpable thyroid abnormalities, nodule follow-up, and epidemiological studies to promote global health and improve the availability of diagnostic imaging in underserved communities.
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Affiliation(s)
- T J Marini
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - S L Weiss
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - A Gupta
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - Y T Zhao
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - T M Baran
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - B Garra
- Medical Imaging Ministries of the Americas, 10810 Lake Minneola Shores, Clermont, FL, 34711, USA
| | - I Shafiq
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - D C Oppenheimer
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - M S Egoavil
- Medical Innovation and Technology, Calle Los Libertadores 635, 15046, San Isidro, Peru
| | - R L Ortega
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - R A Quinn
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - J Kan
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - A M Dozier
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - L Tamayo
- Medical Innovation and Technology, Calle Los Libertadores 635, 15046, San Isidro, Peru
| | - C Carlotto
- Medical Innovation and Technology, Calle Los Libertadores 635, 15046, San Isidro, Peru
| | - B Castaneda
- Pontifica Universidad Catolica del Peru, Av. Universitaria 1801, 15088, San Miguel, Peru.
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Marini TJ, Weis JM, Baran TM, Kan J, Meng S, Yeo A, Zhao YT, Ambrosini R, Cleary S, Rubens D, Chess M, Castaneda B, Dozier A, O'Connor T, Garra B, Kaproth-Joslin K. Lung ultrasound volume sweep imaging for respiratory illness: a new horizon in expanding imaging access. BMJ Open Respir Res 2021; 8:8/1/e000919. [PMID: 34772730 PMCID: PMC8593737 DOI: 10.1136/bmjresp-2021-000919] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 10/19/2021] [Indexed: 12/12/2022] Open
Abstract
Background Respiratory illness is a leading cause of morbidity in adults and the number one cause of mortality in children, yet billions of people lack access to medical imaging to assist in its diagnosis. Although ultrasound is highly sensitive and specific for respiratory illness such as pneumonia, its deployment is limited by a lack of sonographers. As a solution, we tested a standardised lung ultrasound volume sweep imaging (VSI) protocol based solely on external body landmarks performed by individuals without prior ultrasound experience after brief training. Each step in the VSI protocol is saved as a video clip for later interpretation by a specialist. Methods Dyspneic hospitalised patients were scanned by ultrasound naive operators after 2 hours of training using the lung ultrasound VSI protocol. Separate blinded readers interpreted both lung ultrasound VSI examinations and standard of care chest radiographs to ascertain the diagnostic value of lung VSI considering chest X-ray as the reference standard. Comparison to clinical diagnosis as documented in the medical record and CT (when available) were also performed. Readers offered a final interpretation of normal, abnormal, or indeterminate/borderline for each VSI examination, chest X-ray, and CT. Results Operators scanned 102 subjects (0–89 years old) for analysis. Lung VSI showed a sensitivity of 93% and a specificity of 91% for an abnormal chest X-ray and a sensitivity of 100% and a specificity of 93% for a clinical diagnosis of pneumonia. When any cases with an indeterminate rating on chest X-ray or ultrasound were excluded (n=38), VSI lung ultrasound showed 92% agreement with chest X-ray (Cohen’s κ 0.83 (0.68 to 0.97, p<0.0001)). Among cases with CT (n=21), when any ultrasound with an indeterminate rating was excluded (n=3), there was 100% agreement with VSI. Conclusion Lung VSI performed by previously inexperienced ultrasound operators after brief training showed excellent agreement with chest X-ray and high sensitivity and specificity for a clinical diagnosis of pneumonia. Blinded readers were able to identify other respiratory diseases including pulmonary oedema and pleural effusion. Deployment of lung VSI could benefit the health of the global community.
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Affiliation(s)
| | | | | | - Jonah Kan
- University of Rochester School of Medicine and Dentistry, URMC, Rochester, NY, USA
| | - Steven Meng
- University of Rochester School of Medicine and Dentistry, URMC, Rochester, NY, USA
| | - Alex Yeo
- Department of Medicine, Boston University Medical Center, Boston, MA, USA
| | - Yu T Zhao
- Department of Imaging Sciences, URMC, Rochester, NY, USA
| | | | - Sean Cleary
- Department of Imaging Sciences, URMC, Rochester, NY, USA
| | - Deborah Rubens
- Department of Imaging Sciences, URMC, Rochester, NY, USA
| | - Mitchell Chess
- Department of Imaging Sciences, URMC, Rochester, NY, USA
| | - Benjamin Castaneda
- Departmento de Ingeniería, Pontificia Universidad Católica del Perú, Lima, Peru
| | - Ann Dozier
- Department of Public Health Sciences, URMC, Rochester, NY, USA
| | | | - Brian Garra
- Medical Imaging Ministries of the Americas, Clermont, FL, USA
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Horn D, Edwards E, Ssembatya R, DeStigter K, Dougherty A, Ehret D. Association between antenatal ultrasound findings and neonatal outcomes in rural Uganda: a secondary analysis. BMC Pregnancy Childbirth 2021; 21:756. [PMID: 34749679 PMCID: PMC8573986 DOI: 10.1186/s12884-021-04204-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 10/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although the use of prenatal ultrasound services has increased in low- income and lower middle-income countries, there has not been a concurrent improvement in perinatal mortality. It remains unknown whether individual ultrasound findings in this setting are associated with neonatal death or the need for resuscitation at delivery. If associations are identified by ultrasound, they could be used to inform the birth attendant and counsel the family regarding risk, potentially altering delivery preparedness in order to reduce neonatal mortality. METHODS This was a secondary analysis of data collected from a prospective cohort. Data was gathered at Nawanyago Health Centre III in Kamuli District, Uganda. Participants included pregnant women who received second and third trimester prenatal ultrasound scans and delivered at that center between July 2010 and August 2018. All ultrasounds were performed at Nawanyago and deliveries were attended solely by midwives or nurses. Predictor variables included the following ultrasound findings: fetal number, fetal presentation, and amniotic fluid volume. The primary outcome was bag-mask ventilation (BMV) of the neonate at delivery. The secondary outcome was stillbirth or neonatal death in the delivery room. RESULTS Primary outcome data was available for 1105 infants and secondary outcome data was available for 1098 infants. A total of 33 infants received BMV at delivery. The odds of receiving BMV at delivery was significantly increased if amniotic fluid volume was abnormal (OR 4.2, CI 1.2-14.9) and there were increased odds for multiple gestation (OR 1.9, CI 0.7-5.4) and for non-vertex fetal presentation (OR 1.4, CI 0.6-3.2) that were not statistically significant. Stillbirth or neonatal death in the delivery room was diagnosed for 20 infants. Multiple gestation (OR 4.7, CI 1.6-14.2) and abnormal amniotic fluid volume (OR 4.8, CI 1.0-22.1) increased the odds of stillbirth or neonatal death in the delivery room, though only multiple gestation was statistically significant. CONCLUSION Common findings that are easily identifiable on ultrasound in low- and lower middle-income countries are associated with adverse perinatal outcomes. Education could lead to improved delivery preparedness, with the potential to reduce perinatal mortality. This was a preliminary study; larger prospective studies are needed to confirm these findings.
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Affiliation(s)
- Delia Horn
- Pediatrics, The Larner College of Medicine at the University of Vermont, 89 Beaumont Avenue, Burlington, VT, 05405, USA.
| | - Erika Edwards
- The Larner College of Medicine at the University of Vermont, 89 Beaumont Avenue, Burlington, VT, 05405, USA
| | - Renny Ssembatya
- Imaging the World Africa, Plot 435, Naalya-Namugongo Road, Kampala, Uganda
| | - Kristen DeStigter
- Radiology, The Larner College of Medicine at the University of Vermont, 89 Beaumont Avenue, Burlington, VT, 05405, USA
| | - Anne Dougherty
- Obstetrics and Gynecology, The Larner College of Medicine at the University of Vermont, 89 Beaumont Avenue, Burlington, VT, 05405, USA
| | - Danielle Ehret
- Pediatrics, The Larner College of Medicine at the University of Vermont, 89 Beaumont Avenue, Burlington, VT, 05405, USA
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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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DeWyer A, Scheel A, Kamarembo J, Akech R, Asiimwe A, Beaton A, Bobson B, Canales L, DeStigter K, Kazi DS, Kwan GF, Longenecker CT, Lwabi P, Murali M, Ndagire E, Namuyonga J, Sarnacki R, Ssinabulya I, Okello E, Aliku T, Sable C. Establishment of a cardiac telehealth program to support cardiovascular diagnosis and care in a remote, resource-poor setting in Uganda. PLoS One 2021; 16:e0255918. [PMID: 34358281 PMCID: PMC8345851 DOI: 10.1371/journal.pone.0255918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/26/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION To address workforce shortages and expand access to care, we developed a telemedicine program incorporating existing infrastructure for delivery of cardiovascular care in Gulu, Northern Uganda. Our study had three objectives: 1) assess feasibility and clinical impact 2) evaluate patient/parent satisfaction and 3) estimate costs. METHODS All cardiology clinic visits during a two-year study period were included. All patients received an electrocardiogram and echocardiogram performed by a local nurse in Gulu which were stored and transmitted to the Uganda Heart Institute in the capital of Kampala for remote consultation by a cardiologist. Results were relayed to patients/families following cardiologist interpretation. The following telemedicine process was utilized: 1) clinical intake by nurse in Gulu; 2) ECG and echocardiography acquisition in Gulu; 3) echocardiography transmission to the Uganda Heart Institute in Kampala, Uganda; 4) remote telemedicine consultation by cardiologists in Kampala; and 5) communication of results to patients/families in Gulu. Clinical care and technical aspects were tracked. Diagnoses and recommendations were analyzed by age groups (0-5 years, 6-21 years, 22-50 years and > 50 years). A mixed methods approach involving interviews and surveys was used to assess patient satisfaction. Healthcare sector costs of telemedicine-based cardiovascular care were estimated using time-driven activity-based costing. RESULTS Normal studies made up 47%, 55%, 76% and 45% of 1,324 patients in the four age groups from youngest to oldest. Valvular heart disease (predominantly rheumatic heart disease) was the most common diagnosis in the older three age groups. Medications were prescribed to 31%, 31%, 24%, and 48% of patients in the four age groups. The median time for consultation was 7 days. A thematic analysis of focus group transcripts displayed an overall acceptance and appreciation for telemedicine, citing cost- and time-saving benefits. The cost of telemedicine was $29.48/visit. CONCLUSIONS Our data show that transmission and interpretation of echocardiograms from a remote clinic in northern Uganda is feasible, serves a population with a high burden of heart disease, has a significant impact on patient care, is favorably received by patients, and can be delivered at low cost. Further study is needed to better assess the impact relative to existing standards of care and cost effectiveness.
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Affiliation(s)
- Alyssa DeWyer
- Virginia Tech Carilion School of Medicine, Roanoke, VA, United States of America
| | - Amy Scheel
- Emory University School of Medicine, Atlanta, GA, United States of America
| | | | - Rose Akech
- Gulu Regional Referral Hospital, Gulu, Uganda
| | | | - Andrea Beaton
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States of America
- The University of Cincinnati School of Medicine, Cincinnati, OH, United States of America
| | | | - Lesley Canales
- Children’s National Hospital, Washington, DC, United States of America
| | - Kristen DeStigter
- University of Vermont Medical Center, Burlington, VT, United States of America
| | - Dhruv S. Kazi
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Cardiovascular Medicine Section, Department of Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Gene F. Kwan
- Boston University School of Medicine, Boston, MA, United States of America
| | - Chris T. Longenecker
- Case Western Reserve University School of Medicine, Cleveland, OH, United States of America
- University Hospitals Harrington Heart & Vascular Institute, Cleveland, OH, United States of America
| | | | - Meghna Murali
- Children’s National Hospital, Washington, DC, United States of America
| | | | | | - Rachel Sarnacki
- Children’s National Hospital, Washington, DC, United States of America
| | | | | | | | - Craig Sable
- Children’s National Hospital, Washington, DC, United States of America
- George Washington School of Medicine, Washington, DC, United States of America
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21
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Kimambo D, Kennedy S, Kifai E, Kailembo N, Eichberg C, Markosky S, Shah I, Powers E, Zwerner P, Dorman SE, Janabi M, Bayer R. Feasibility of point-of-care cardiac ultrasound performed by clinicians at health centers in Tanzania. BMC Cardiovasc Disord 2021; 21:239. [PMID: 33980177 PMCID: PMC8117304 DOI: 10.1186/s12872-021-02045-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Point-of-care cardiac ultrasound (cardiac POCUS) has potential to become a useful tool for improving cardiovascular care in Tanzania. We conducted a pilot program to train clinicians at peripheral health centers to obtain and interpret focused cardiac POCUS examinations using a hand-held portable device. METHODS Over a 5-day period, didactic and experiential methods were used to train clinicians to conduct a pre-specified scanning protocol and recognize key pathologies. Pre- and post-training knowledge and post-training image acquisition competency were assessed. In their usual clinical practices, trainees then scanned patients with cardiovascular signs/symptoms, recorded a pre-specified set of images for each scan, and documented their interpretation as to presence or absence of key pathologies on a case report form. A cardiologist subsequently reviewed all images, graded them for image quality, and then documented their interpretation of key pathologies in a blinded fashion; the cardiologist interpretation was considered the gold standard. RESULTS 8 trainees (6 Clinical Officers, 1 Assistant Medical Officer, and 1 Medical Doctor) initiated and completed the training. Trainees subsequently performed a total of 429 cardiac POCUS examinations in their clinical practices over a 9 week period. Stratified by trainee, the median percent of images that were of sufficient quality to be interpretable was 76.7% (range 18.0-94.2%). For five of eight trainees, 75% or more of images were interpretable. For detection of pre-specified key pathologies, kappa statistics for agreement between trainee and cardiologist ranged from - 0.03 (no agreement) for detection of pericardial effusion to 0.42 (moderate agreement) for detection of tricuspid valve regurgitation. Mean kappa values across the key pathologies varied by trainee from 0 (no agreement) to 0.32 (fair agreement). CONCLUSIONS The 5-day training program was sufficient to train most clinicians to obtain basic cardiac images but not to accurately interpret them. Proficiency in image interpretation may require a more intensive training program.
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Affiliation(s)
| | - Samuel Kennedy
- Medical University of South Carolina, 135 Rutledge Avenue, Room 1207, Charleston, SC, 29425, USA
| | | | - Neema Kailembo
- Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Christie Eichberg
- Medical University of South Carolina, 135 Rutledge Avenue, Room 1207, Charleston, SC, 29425, USA
| | - Sarah Markosky
- Medical University of South Carolina, 135 Rutledge Avenue, Room 1207, Charleston, SC, 29425, USA
| | - Ishan Shah
- Medical University of South Carolina, 135 Rutledge Avenue, Room 1207, Charleston, SC, 29425, USA
| | - Eric Powers
- Medical University of South Carolina, 135 Rutledge Avenue, Room 1207, Charleston, SC, 29425, USA
| | - Peter Zwerner
- Medical University of South Carolina, 135 Rutledge Avenue, Room 1207, Charleston, SC, 29425, USA
| | - Susan E Dorman
- Medical University of South Carolina, 135 Rutledge Avenue, Room 1207, Charleston, SC, 29425, USA.
| | - Mohamed Janabi
- Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Richard Bayer
- Medical University of South Carolina, 135 Rutledge Avenue, Room 1207, Charleston, SC, 29425, USA
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22
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Toscano M, Marini TJ, Drennan K, Baran TM, Kan J, Garra B, Dozier AM, Ortega RL, Quinn RA, Zhao YT, Egoavil MS, Tamayo L, Carlotto C, Castaneda B. Testing telediagnostic obstetric ultrasound in Peru: a new horizon in expanding access to prenatal ultrasound. BMC Pregnancy Childbirth 2021; 21:328. [PMID: 33902496 PMCID: PMC8074497 DOI: 10.1186/s12884-021-03720-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/15/2021] [Indexed: 12/19/2022] Open
Abstract
Background Ninety-four percent of all maternal deaths occur in low- and middle-income countries, and the majority are preventable. Access to quality Obstetric ultrasound can identify some complications leading to maternal and neonatal/perinatal mortality or morbidity and may allow timely referral to higher-resource centers. However, there are significant global inequalities in access to imaging and many challenges to deploying ultrasound to rural areas. In this study, we tested a novel, innovative Obstetric telediagnostic ultrasound system in which the imaging acquisitions are obtained by an operator without prior ultrasound experience using simple scan protocols based only on external body landmarks and uploaded using low-bandwidth internet for asynchronous remote interpretation by an off-site specialist. Methods This is a single-center pilot study. A nurse and care technician underwent 8 h of training on the telediagnostic system. Subsequently, 126 patients (68 second trimester and 58 third trimester) were recruited at a health center in Lima, Peru and scanned by these ultrasound-naïve operators. The imaging acquisitions were uploaded by the telemedicine platform and interpreted remotely in the United States. Comparison of telediagnostic imaging was made to a concurrently performed standard of care ultrasound obtained and interpreted by an experienced attending radiologist. Cohen’s Kappa was used to test agreement between categorical variables. Intraclass correlation and Bland-Altman plots were used to test agreement between continuous variables. Results Obstetric ultrasound telediagnosis showed excellent agreement with standard of care ultrasound allowing the identification of number of fetuses (100% agreement), fetal presentation (95.8% agreement, κ =0.78 (p < 0.0001)), placental location (85.6% agreement, κ =0.74 (p < 0.0001)), and assessment of normal/abnormal amniotic fluid volume (99.2% agreement) with sensitivity and specificity > 95% for all variables. Intraclass correlation was good or excellent for all fetal biometric measurements (0.81–0.95). The majority (88.5%) of second trimester ultrasound exam biometry measurements produced dating within 14 days of standard of care ultrasound. Conclusion This Obstetric ultrasound telediagnostic system is a promising means to increase access to diagnostic Obstetric ultrasound in low-resource settings. The telediagnostic system demonstrated excellent agreement with standard of care ultrasound. Fetal biometric measurements were acceptable for use in the detection of gross discrepancies in fetal size requiring further follow up. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03720-w.
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Affiliation(s)
- Marika Toscano
- Department of Obstetrics & Gynecology, Division of Maternal/Fetal Medicine, University of Rochester Medical Center, 601 Elmwood Ave, Box 668, Rochester, NY, 14642, USA.
| | - Thomas J Marini
- Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - Kathryn Drennan
- Department of Obstetrics & Gynecology, Division of Maternal/Fetal Medicine, University of Rochester Medical Center, 601 Elmwood Ave, Box 668, Rochester, NY, 14642, USA
| | - Timothy M Baran
- Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - Jonah Kan
- University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Box 607, Rochester, NY, 14642, USA
| | - Brian Garra
- Medical Imaging Ministries of the Americas, 10810 Lake Minneola Shores, Clermont, FL, 34711, USA
| | - Ann M Dozier
- Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd., Rochester, NY, 14642, USA
| | - Rafael L Ortega
- University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Box 607, Rochester, NY, 14642, USA
| | - Rosemary A Quinn
- University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Box 607, Rochester, NY, 14642, USA
| | - Yu T Zhao
- University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Box 607, Rochester, NY, 14642, USA
| | - Miguel S Egoavil
- Medical Innovation and Technology, Calle Los Libertadores 635, 15046, San Isidro, Peru
| | - Lorena Tamayo
- Medical Innovation and Technology, Calle Los Libertadores 635, 15046, San Isidro, Peru
| | - Claudia Carlotto
- Medical Innovation and Technology, Calle Los Libertadores 635, 15046, San Isidro, Peru
| | - Benjamin Castaneda
- Departament of Academic Engineering, Division of Electric Engineering, Pontificia Universidad Catolica del Peru, Av. Universitaria 1801, 15088, San Miguel, Peru
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23
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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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24
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Dougherty A, Kasten M, DeSarno M, Badger G, Streeter M, Jones DC, Sussman B, DeStigter K. Validation of a Telemedicine Quality Assurance Method for Point-of-Care Obstetric Ultrasound Used in Low-Resource Settings. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:529-540. [PMID: 32770709 DOI: 10.1002/jum.15429] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/28/2020] [Accepted: 06/04/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES A remote quality assurance and improvement protocol for point-of-care obstetric ultrasound in low-resource areas was validated against the standard of care for obstetric ultrasound in the United States. METHODS Compressed movie clip ultrasound images (obstetric sweep protocol) obtained by minimally trained personnel were read and interpreted by physicians with training in obstetric ultrasound. Observed findings were compared among readers and between each reader and the gold standard ultrasound scan report. Descriptive statistics were used for the analysis. RESULTS The agreements among readers and between readers and the gold standard, for the anterior and posterior variables of the placental location were excellent, with Cohen κ values of 0.81 to 0.88 and 0.77 to 0.9, respectively. Cohen κ values were slight or slight/fair for other placental locations (left, right, fundal, and low), and the sensitivity and specificity ranged widely. The agreement among readers and between readers and the gold standard for fetal number comparisons was also excellent, with Cohen κ values ranging from 0.82 to 1, sensitivity from 0.83 to 1, and specificity from 0.99 to 1. The agreement among readers for fetal presentation comparisons, according to the Cohen κ, ranged from 0.79 to 0.85 and between readers and the gold standard had values of 0.43 to 0.49. For biometric parameters and estimated gestational age calculations based on these parameters, inter-reader reliability ranged from 0.79 to 0.85 for all parameters except femur length. Greater than 94% of obstetric sweep protocol ultrasound ages were within 7 days of the corresponding gold standard age. CONCLUSIONS Movie clip ultrasound images provided adequate information for remote readers to reliably determine the placental location, fetal number, fetal presentation, and pregnancy dating.
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Affiliation(s)
- Anne Dougherty
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | | | - Michael DeSarno
- Department of Medical Biostatistics and Bioinformatics, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - Gary Badger
- Department of Medical Biostatistics and Bioinformatics, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - Mary Streeter
- Department of Radiology, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - David C Jones
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - Betsy Sussman
- Department of Radiology, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - Kristen DeStigter
- Department of Radiology, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
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25
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Marini TJ, Oppenheimer DC, Baran TM, Rubens DJ, Toscano M, Drennan K, Garra B, Miele FR, Garra G, Noone SJ, Tamayo L, Carlotto C, Trujillo L, Waks E, Garra K, Egoavil MS, Berrospi J, Castaneda B. New Ultrasound Telediagnostic System for Low-Resource Areas: Pilot Results From Peru. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:583-595. [PMID: 32798267 DOI: 10.1002/jum.15420] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/21/2020] [Accepted: 06/22/2020] [Indexed: 05/26/2023]
Abstract
Billions of people around the world lack access to diagnostic imaging. To address this issue, we piloted a comprehensive ultrasound telediagnostic system, which uses ultrasound volume sweep imaging (VSI) acquisitions capable of being performed by operators without prior traditional ultrasound training and new telemedicine software capable of sending imaging acquisitions asynchronously over low Internet bandwidth for remote interpretation. The telediagnostic system was tested with obstetric, right upper quadrant abdominal, and thyroid volume sweep imaging protocols in Peru. Scans obtained by operators without prior ultrasound experience were sent for remote interpretation by specialists using the telemedicine platform. Scans obtained allowed visualization of the target region in 96% of cases with diagnostic imaging quality. This telediagnostic system shows promise in improving health care disparities in the developing world.
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Affiliation(s)
- Thomas J Marini
- Department of Imaging Sciences, University of Rochester, and University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, New York, USA
| | - Daniel C Oppenheimer
- Department of Imaging Sciences, University of Rochester, and University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, New York, USA
| | - Timothy M Baran
- Department of Imaging Sciences, University of Rochester, and University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, New York, USA
| | - Deborah J Rubens
- Department of Imaging Sciences, University of Rochester, and University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, New York, USA
| | - Marika Toscano
- Department of Obstetrics and Gynecology, University of Rochester, and University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, New York, USA
| | - Kathryn Drennan
- Department of Obstetrics and Gynecology, University of Rochester, and University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, New York, USA
| | - Brian Garra
- Medical Imaging Ministries of the Americas, Clermont, Florida, USA
| | - Frank R Miele
- Medical Imaging Ministries of the Americas, Clermont, Florida, USA
| | - Gail Garra
- Medical Imaging Ministries of the Americas, Clermont, Florida, USA
| | | | | | | | | | - Erin Waks
- Medical Imaging Ministries of the Americas, Clermont, Florida, USA
| | - Katie Garra
- Medical Imaging Ministries of the Americas, Clermont, Florida, USA
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26
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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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27
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Perception of Ghanaian Primigravidas Undergoing Their First Antenatal Ultrasonography in Cape Coast. Radiol Res Pract 2020; 2020:4589120. [PMID: 33149949 PMCID: PMC7603634 DOI: 10.1155/2020/4589120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 11/22/2022] Open
Abstract
Ultrasound scans have become an essential requirement of pregnancy care in countries with developed health services and increasingly being used in medical practice in Ghana as well. The aim of this study was to find out the perception of primigravidas experiencing antenatal ultrasonography for the first time in Cape Coast. This was a descriptive, prospective study which employed the use of a questionnaire to obtain data from 384 consented respondents, who were primigravidas experiencing antenatal ultrasonography for the first time in three selected public health facilities in Cape Coast Metropolis over a six-month period. Sociodemographic data, reasons for undergoing antenatal ultrasound, their expectations, knowledge in fetal abnormalities, and suggestions to help improve their future experiences were collected. The data were analyzed using SPSS software, version 20.0 (SPSS Inc., Chicago, IL, USA). Out of a total number of 384 respondents, 87.8% of them knew about what ultrasound is used for. 87.5% scanned because a doctor or midwife requested for the scan whilst 53.9% scanned to check for fetal abnormalities. 98.4% indicated that ultrasound scanning has positive effects on pregnancy outcome. An expensive service was stated as a negative reason that would influence the decision to undergo the examination next time; nonetheless, 90.4% would recommend it to other women and suggested showing the fetus on monitor while scanning and providing accurate findings would make their future experiences better. The perception of the primigravidas was largely positive. Checking for fetal abnormalities was a major reason for the scans, although their knowledge in specific fetal abnormalities was low. They expected to know the fetal sex, but that was not a major reason for scanning. Showing them the monitor was the most frequent suggestion to make future experience better.
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28
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Wong HY, Marcu LG, Bezak E, Parange NA. Review of Health Economics of Point-of-Care Testing Worldwide and Its Efficacy of Implementation in the Primary Health Care Setting in Remote Australia. Risk Manag Healthc Policy 2020; 13:379-386. [PMID: 32440241 PMCID: PMC7212773 DOI: 10.2147/rmhp.s247774] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/20/2020] [Indexed: 11/30/2022] Open
Abstract
There are important differences concerning health outcomes between the Australian population living in rural/remote regions and the urban population. Health care provision in remote areas, particularly in regions with a low number of inhabitants, is not without challenges. Aboriginal, rural and remote communities are therefore affected, as they face various obstacles in accessing health services, owing to geographical settings, difficulties in transportation to nearby hospitals, limited or inexistent local qualified personnel. The implementation of point-of-care testing could be a plausible solution to these challenges, as various point-of-care services that have been successfully put into action worldwide indicate towards positive clinical outcomes. Point-of-care units have a real potential in reducing morbidity and mortality in all population groups. This article aims to review the published literature on point-of-care testing around the world, with a focus on health economics and the feasibility of its implementation in Australian rural and remote regions.
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Affiliation(s)
- Hoi Yan Wong
- Division of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| | - Loredana G Marcu
- Faculty of Informatics & Science, University of Oradea, Oradea 410087, Romania.,Cancer Research Institute and School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia
| | - Eva Bezak
- Division of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia.,Cancer Research Institute and School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia.,Department of Physics, University of Adelaide, Adelaide, SA 5005, Australia
| | - Nayana Anupam Parange
- Division of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia.,Cancer Research Institute and School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia
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29
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Britton N, Miller MA, Safadi S, Siegel A, Levine AR, McCurdy MT. Tele-Ultrasound in Resource-Limited Settings: A Systematic Review. Front Public Health 2019; 7:244. [PMID: 31552212 PMCID: PMC6738135 DOI: 10.3389/fpubh.2019.00244] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 08/13/2019] [Indexed: 01/21/2023] Open
Abstract
Background: Telemedicine, or healthcare delivery from a distance, has evolved over the past 50 years and helped alter health care delivery to patients around the globe. Its integration into numerous domains has permitted high quality care that transcends obstacles of geographic distance, lack of access to health care providers, and cost. Ultrasound is an effective diagnostic tool and its application within telemedicine (“tele-ultrasound”) has advanced substantially in recent years, particularly in high-income settings. However, the utility of tele-ultrasound in resource-limited settings is less firmly established. Objective: To determine whether remote tele-ultrasound is a feasible, accurate, and care-altering imaging tool in resource-limited settings. Data Sources: PubMed, MEDLINE, and Embase. Study Eligibility Criteria: Twelve original articles met the following eligibility criteria: full manuscript available, written in English, including a direct patient-care intervention, performed in a resource-limited setting, images sent to a remote expert reader for interpretation and feedback, contained objective data on the impact of tele-ultrasound. Study Appraisal and Synthesis Methods: Abstracts were independently screened by two authors against inclusion criteria for full-text review. Any discrepancies were settled by a senior author. Data was extracted from each study using a modified Cochrane Consumers and Communication Review Group's data extraction template. Study bias was evaluated using the ROBINS-I tool. Results: The study results reflect the diverse applications of tele-ultrasound in low-resource settings. Africa was the most common study location. The specialties of cardiology and obstetrics comprised most studies. Two studies primarily relied on smartphones for image recording and transmission. Real-time, rather than asynchronous, tele-ultrasound image interpretation occurred in five of the 12 studies. The most common outcome measures were image quality, telemedicine system requirements, diagnostic accuracy, and changes in clinical management. Limitations: The studies included were of poor quality with a dearth of randomized control trials and with significant between study heterogeneity which resulted in incomplete data and made cross study comparison difficult. Conclusions and Implications of Key Findings: Low-quality evidence suggests that ultrasound images acquired in resource-limited settings and transmitted using a telemedical platform to an expert interpreter are of satisfactory quality and value for clinical diagnosis and management.
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Affiliation(s)
- Noel Britton
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States
| | - Michael A Miller
- University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Sami Safadi
- University of Maryland School of Medicine, Baltimore, MD, United States
| | - Ariel Siegel
- University of Maryland School of Medicine, Baltimore, MD, United States
| | - Andrea R Levine
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States.,University of Maryland School of Medicine, Baltimore, MD, United States
| | - Michael T McCurdy
- University of Maryland School of Medicine, Baltimore, MD, United States
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30
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Salinaro JR, McNally PJ, Nickenig Vissoci JR, Ellestad SC, Nelson B, Broder JS. A prospective blinded comparison of second trimester fetal measurements by expert and novice readers using low-cost novice-acquired 3D volumetric ultrasound. J Matern Fetal Neonatal Med 2019; 34:1805-1813. [PMID: 31352874 DOI: 10.1080/14767058.2019.1649390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
RATIONALE AND OBJECTIVES Two-dimensional (2D) ultrasound (US) is operator dependent, requiring operator skill and experience to selectively identify and record planes of interest for subsequent interpretation. This limits the utility of US in settings in which expert sonographers are unavailable. Three-dimensional (3D) US acquisition of an anatomic target, which enables reconstruction of any plane through the acquired volume, might reduce operator dependence by providing any desired image plane for interpretation, without identification of target planes of interest at the time of acquisition. We applied a low-cost 3DUS technology because of the wider potential application compared with dedicated 3DUS systems. We chose second trimester fetal biometric parameters for study because of their importance in maternal-fetal health globally. We hypothesized that expert and novice interpretations of novice-acquired 3D volumes would not differ from each other nor from expert measurements of expert-acquired 2D images, the clinical reference standard. MATERIALS AND METHODS This was a prospective, blinded, observational study. Expert sonographers blinded to 3DUS volumes acquired 2DUS images of second trimester fetuses from 32 subjects, and expert readers performed interpretation, during usual care. A novice sonographer blinded to other clinical data acquired oriented 3DUS image volumes of the same subjects on the same date. Expert readers blinded to other data assessed placental location (PL), fetal presentation (FP), and amniotic fluid volume (AFV) in novice-acquired 3D volumes. Novice and expert raters blinded to other data independently measured biparietal diameter (BPD), humerus length (HL), and femur length (FL) for each fetus from novice-acquired 3D volumes. Corresponding gestational age (GA) estimates were calculated. Inter-rater reliability of measurements and GAs (expert 3D versus expert 2D, novice 3D versus expert 2D, and expert 3D versus novice 3D) were assessed by intraclass correlation coefficient (ICC). Mean inter-rater measurement differences were analyzed using one-way ANOVA. RESULTS 3D volume acquisition and reconstruction required mean 30.4 s (±5.7) and 70.0 s (±24.0), respectively. PL, FP, and AFV were evaluated from volumes for all subjects; mean time for evaluation was 16 s (±0.0). PL, FP, and AFV could be evaluated for all subjects. At least one biometric measurement was possible for 31 subjects (97%). Agreement between rater pairs for a composite of all measures was excellent (ICCs ≥ 0.95), and for individual measures was good to excellent (ICCs ≥ 0.75). Inter-rater differences were not significant (p > .05). CONCLUSIONS Expert and novice interpretations of novice-acquired 3DUS volumes of second trimester fetuses provided reliable biometric measures compared with expert interpretation of expert-acquired 2DUS images. 3DUS volume acquisition with a low-cost system may reduce operator dependence of ultrasound.
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Affiliation(s)
| | | | - Joao R Nickenig Vissoci
- Division of Emergency Medicine, Department of Surgery, School of Medicine, Duke University, Durham, NC, USA
| | - Sarah C Ellestad
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, School of Medicine, Duke University, Durham, NC, USA
| | - Brian Nelson
- Division of Emergency Medicine, Department of Surgery, School of Medicine, Duke University, Durham, NC, USA
| | - Joshua S Broder
- Division of Emergency Medicine, Department of Surgery, School of Medicine, Duke University, Durham, NC, USA
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31
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Swanson JO, Nathan RO, Swanson DL, Perez KM, Bresnahan BW, Mirza W, Goldenberg RL. Use of ultrasound and mHealth to improve perinatal outcomes in low and middle income countries. Semin Perinatol 2019; 43:267-272. [PMID: 31003635 DOI: 10.1053/j.semperi.2019.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The explosion of mobile health and portable obstetric ultrasound interventions in low- and middle-income countries (LMIC) reflects the optimism that technology can help reduce persistently high rates of maternal and neonatal mortality and morbidity in these settings. While these technology-driven interventions have had success in improving aspects of antenatal and perinatal care, they have not clearly demonstrated reductions in mortality. The expanding synergy between mobile health (mHealth) and ultrasound technology shows promise to enhance care, but it will likely take combining these technological advances with system-wide approaches that also address referral patterns and infrastructure barriers to improve outcomes.
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Affiliation(s)
- Jonathan O Swanson
- Department of Radiology, University of Washington, UW Mailbox 357115, 1959 NE Pacific Street, Seattle, WA 98195, USA.
| | - Robert O Nathan
- Department of Radiology, University of Washington, UW Mailbox 357115, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - David L Swanson
- Department of Radiology, University of Washington, UW Mailbox 357115, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - Krystle M Perez
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Brian W Bresnahan
- Department of Radiology, University of Washington, UW Mailbox 357115, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - Waseem Mirza
- Department of Radiology, Aga Khan University, Karachi, Pakistan
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
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32
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Marini TJ, Castaneda B, Baran T, O'Connor TP, Garra B, Tamayo L, Zambrano M, Carlotto C, Trujillo L, Kaproth-Joslin KA. Lung Ultrasound Volume Sweep Imaging for Pneumonia Detection in Rural Areas: Piloting Training in Rural Peru. J Clin Imaging Sci 2019; 9:35. [PMID: 31538033 PMCID: PMC6737249 DOI: 10.25259/jcis_29_2019] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 05/21/2019] [Indexed: 01/19/2023] Open
Abstract
Objective: Pneumonia is the leading cause of pediatric mortality worldwide among children 0–5 years old. Lung ultrasound can be used to diagnose pneumonia in rural areas as it is a portable and relatively economic imaging modality with ~95% sensitivity and specificity for pneumonia in children. Lack of trained sonographers is the current limiting factor to its deployment in rural areas. In this study, we piloted training of a volume sweep imaging (VSI) ultrasound protocol for pneumonia detection in Peru with rural health workers. VSI may be taught to individuals with limited medical/ultrasound experience as it requires minimal anatomical knowledge and technical skill. In VSI, the target organ is imaged with a series of sweeps and arcs of the ultrasound probe in relation to external body landmarks. Methods: Rural health workers in Peru were trained on a VSI ultrasound protocol for pneumonia detection. Subjects were given a brief didactic session followed by hands-on practice with the protocol. Each attempt was timed and mistakes were recorded. Participants performed the protocol until they demonstrated two mistake-free attempts. Results: It took participants a median number of three attempts (range 1–6) to perform the VSI protocol correctly. Time to mastery took 51.4 ± 17.7 min. There were no significant differences among doctors, nurses, and technicians in total training time (P = 0.43) or number of attempts to success (P = 0.72). Trainee age was not found to be significantly correlated with training time (P = 0.50) or number of attempts to success (P = 0.40). Conclusion: Rural health workers learned a VSI protocol for pneumonia detection with relative ease in a short amount of time. Future studies should investigate the clinical efficacy of this VSI protocol for pneumonia detection. Key Message: A volume sweep imaging (VSI) protocol for pneumonia detection can be taught with minimal difficulty to rural health workers without prior ultrasound experience. No difference was found in training performance related to education level or age. VSI involves no significant knowledge of anatomy or technical skill.
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Affiliation(s)
- Thomas J Marini
- Departments of Imaging Sciences, University of Rochester, Rochester, New York, United States
| | - Benjamin Castaneda
- Department of Engineering, Pontifical Catholic University of Peru, Lima, Peru
| | - Timothy Baran
- Departments of Imaging Sciences, University of Rochester, Rochester, New York, United States
| | - Timothy P O'Connor
- Departments of Emergency Medicine, University of Rochester, Rochester, New York, United States
| | - Brian Garra
- Medical Imaging Ministries of the Americas, Clermont, Florida, United States
| | - Lorena Tamayo
- Medical Innovation and Technology, San Isidrio, Peru
| | - Maria Zambrano
- Touro College of Osteopathic Medicine, Middletown, New York, United States
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33
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Beaton A, Okello E, Scheel A, DeWyer A, Ssembatya R, Baaka O, Namisanvu H, Njeri A, Matovu A, Namagembe I, Mccarter R, Carapetis J, Destigter K, Sable C. Impact of heart disease on maternal, fetal and neonatal outcomes in a low-resource setting. Heart 2019; 105:755-760. [PMID: 30415203 PMCID: PMC11181686 DOI: 10.1136/heartjnl-2018-313810] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 10/04/2018] [Accepted: 10/06/2018] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The burden of pre-existing cardiovascular disease and the contribution to adverse pregnancy outcomes are not robustly quantified, particularly in low-income countries. We aimed to determine both the prevalence of maternal heart disease through active case finding and its attributable risk to adverse pregnancy outcomes. METHODS We conducted a 24-month prospective longitudinal investigation in three Ugandan health centres, using echocardiography for active case finding during antenatal care. Women with and without heart disease were followed to 6 weeks post partum to determine pregnancy outcomes. Prevalence of heart disease was calculated. Per cent attributable risk estimates were generated for maternal, fetal and neonatal mortality. RESULTS Screening echocardiography was performed in 3506 women. The prevalence of heart disease was 17 per 1000 women (95% CI 13 to 21); 15 per 1000 was rheumatic heart disease. Only 3.4% of women (2/58) had prior diagnosis. Cardiovascular complications occurred in 51% of women with heart disease, most commonly heart failure. Per cent attributable risk of heart disease on maternal mortality was 88.6% in the exposed population and 10.8% in the overall population. Population attributable risk of heart disease on fetal death was 1.1% and 6.0% for neonatal mortality CONCLUSIONS: Occult maternal heart disease may be responsible for a substantial proportion of adverse pregnancy outcomes in low-resource settings. Rheumatic heart disease is, by far, the most common condition, urging global prioritisation of this neglected cardiovascular disease.
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Affiliation(s)
- Andrea Beaton
- Children’s National Medical Center, Cincinnati, Ohio, USA
| | | | - Amy Scheel
- Children’s National Medical Center, Cincinnati, Ohio, USA
| | - Alyssa DeWyer
- Children’s National Medical Center, Cincinnati, Ohio, USA
| | | | | | | | - Angela Njeri
- Imaging the World Africa, Kampala, Uganda
- Mubende Regional Referral Hospital, Mubende, Uganda
| | | | - Imelda Namagembe
- Mulago National Referral Hospital, Kampala, Uganda
- Telethon Kids Institute, Nedlands, Western Australia, Australia
| | | | | | | | - Craig Sable
- Children’s National Medical Center, Cincinnati, Ohio, USA
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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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35
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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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Schlemmer HP, Bittencourt LK, D’Anastasi M, Domingues R, Khong PL, Lockhat Z, Muellner A, Reiser MF, Schilsky RL, Hricak H. Global Challenges for Cancer Imaging. J Glob Oncol 2018; 4:1-10. [PMID: 30241164 PMCID: PMC6180759 DOI: 10.1200/jgo.17.00036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Imaging plays many essential roles in nearly all aspects of high-quality cancer care. However, challenges to the delivery of optimal cancer imaging in both developing and advanced countries are manifold. Developing countries typically face dramatic shortages of both imaging equipment and general radiologists, and efforts to improve cancer imaging in these countries are often complicated by poor infrastructure, cultural barriers, and other obstacles. In advanced countries, on the other hand, although imaging equipment and general radiologists are typically accessible, the complexity of oncologic imaging and the need for subspecialists in the field are largely unrecognized; as a result, training opportunities are lacking, and there is a shortage of radiologists with the necessary subspecialty expertise to provide optimal cancer care and participate in advanced clinical research. This article is intended to raise awareness of these challenges and catalyze further efforts to address them. Some promising strategies and ongoing efforts are reviewed, and some specific actions are proposed.
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Affiliation(s)
- Heinz-Peter Schlemmer
- Heinz-Peter Schlemmer, German Cancer Research Center,
Heidelberg; Melvin D’Anastasi and Maximilian F.
Reiser, Ludwig-Maximilians-University Hospital, Munich, Germany;
Leonardo K. Bittencourt, Fluminense Federal University,
Niterói; Leonardo K. Bittencourt and Romeu
Domingues, Clínica de Diagnóstico por Imagem
(CDPI/Dasa), Rio de Janeiro, Brazil; Pek-Lan Khong, University of
Hong Kong, Queen Mary Hospital, Hong Kong, China; Zarina Lockhat,
University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa;
Ada Muellner and Hedvig Hricak, Memorial Sloan
Kettering Cancer Center, New York, NY; and Richard L. Schilsky,
American Society of Clinical Oncology, Alexandria, VA
| | - Leonardo K. Bittencourt
- Heinz-Peter Schlemmer, German Cancer Research Center,
Heidelberg; Melvin D’Anastasi and Maximilian F.
Reiser, Ludwig-Maximilians-University Hospital, Munich, Germany;
Leonardo K. Bittencourt, Fluminense Federal University,
Niterói; Leonardo K. Bittencourt and Romeu
Domingues, Clínica de Diagnóstico por Imagem
(CDPI/Dasa), Rio de Janeiro, Brazil; Pek-Lan Khong, University of
Hong Kong, Queen Mary Hospital, Hong Kong, China; Zarina Lockhat,
University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa;
Ada Muellner and Hedvig Hricak, Memorial Sloan
Kettering Cancer Center, New York, NY; and Richard L. Schilsky,
American Society of Clinical Oncology, Alexandria, VA
| | - Melvin D’Anastasi
- Heinz-Peter Schlemmer, German Cancer Research Center,
Heidelberg; Melvin D’Anastasi and Maximilian F.
Reiser, Ludwig-Maximilians-University Hospital, Munich, Germany;
Leonardo K. Bittencourt, Fluminense Federal University,
Niterói; Leonardo K. Bittencourt and Romeu
Domingues, Clínica de Diagnóstico por Imagem
(CDPI/Dasa), Rio de Janeiro, Brazil; Pek-Lan Khong, University of
Hong Kong, Queen Mary Hospital, Hong Kong, China; Zarina Lockhat,
University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa;
Ada Muellner and Hedvig Hricak, Memorial Sloan
Kettering Cancer Center, New York, NY; and Richard L. Schilsky,
American Society of Clinical Oncology, Alexandria, VA
| | - Romeu Domingues
- Heinz-Peter Schlemmer, German Cancer Research Center,
Heidelberg; Melvin D’Anastasi and Maximilian F.
Reiser, Ludwig-Maximilians-University Hospital, Munich, Germany;
Leonardo K. Bittencourt, Fluminense Federal University,
Niterói; Leonardo K. Bittencourt and Romeu
Domingues, Clínica de Diagnóstico por Imagem
(CDPI/Dasa), Rio de Janeiro, Brazil; Pek-Lan Khong, University of
Hong Kong, Queen Mary Hospital, Hong Kong, China; Zarina Lockhat,
University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa;
Ada Muellner and Hedvig Hricak, Memorial Sloan
Kettering Cancer Center, New York, NY; and Richard L. Schilsky,
American Society of Clinical Oncology, Alexandria, VA
| | - Pek-Lan Khong
- Heinz-Peter Schlemmer, German Cancer Research Center,
Heidelberg; Melvin D’Anastasi and Maximilian F.
Reiser, Ludwig-Maximilians-University Hospital, Munich, Germany;
Leonardo K. Bittencourt, Fluminense Federal University,
Niterói; Leonardo K. Bittencourt and Romeu
Domingues, Clínica de Diagnóstico por Imagem
(CDPI/Dasa), Rio de Janeiro, Brazil; Pek-Lan Khong, University of
Hong Kong, Queen Mary Hospital, Hong Kong, China; Zarina Lockhat,
University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa;
Ada Muellner and Hedvig Hricak, Memorial Sloan
Kettering Cancer Center, New York, NY; and Richard L. Schilsky,
American Society of Clinical Oncology, Alexandria, VA
| | - Zarina Lockhat
- Heinz-Peter Schlemmer, German Cancer Research Center,
Heidelberg; Melvin D’Anastasi and Maximilian F.
Reiser, Ludwig-Maximilians-University Hospital, Munich, Germany;
Leonardo K. Bittencourt, Fluminense Federal University,
Niterói; Leonardo K. Bittencourt and Romeu
Domingues, Clínica de Diagnóstico por Imagem
(CDPI/Dasa), Rio de Janeiro, Brazil; Pek-Lan Khong, University of
Hong Kong, Queen Mary Hospital, Hong Kong, China; Zarina Lockhat,
University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa;
Ada Muellner and Hedvig Hricak, Memorial Sloan
Kettering Cancer Center, New York, NY; and Richard L. Schilsky,
American Society of Clinical Oncology, Alexandria, VA
| | - Ada Muellner
- Heinz-Peter Schlemmer, German Cancer Research Center,
Heidelberg; Melvin D’Anastasi and Maximilian F.
Reiser, Ludwig-Maximilians-University Hospital, Munich, Germany;
Leonardo K. Bittencourt, Fluminense Federal University,
Niterói; Leonardo K. Bittencourt and Romeu
Domingues, Clínica de Diagnóstico por Imagem
(CDPI/Dasa), Rio de Janeiro, Brazil; Pek-Lan Khong, University of
Hong Kong, Queen Mary Hospital, Hong Kong, China; Zarina Lockhat,
University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa;
Ada Muellner and Hedvig Hricak, Memorial Sloan
Kettering Cancer Center, New York, NY; and Richard L. Schilsky,
American Society of Clinical Oncology, Alexandria, VA
| | - Maximilian F. Reiser
- Heinz-Peter Schlemmer, German Cancer Research Center,
Heidelberg; Melvin D’Anastasi and Maximilian F.
Reiser, Ludwig-Maximilians-University Hospital, Munich, Germany;
Leonardo K. Bittencourt, Fluminense Federal University,
Niterói; Leonardo K. Bittencourt and Romeu
Domingues, Clínica de Diagnóstico por Imagem
(CDPI/Dasa), Rio de Janeiro, Brazil; Pek-Lan Khong, University of
Hong Kong, Queen Mary Hospital, Hong Kong, China; Zarina Lockhat,
University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa;
Ada Muellner and Hedvig Hricak, Memorial Sloan
Kettering Cancer Center, New York, NY; and Richard L. Schilsky,
American Society of Clinical Oncology, Alexandria, VA
| | - Richard L. Schilsky
- Heinz-Peter Schlemmer, German Cancer Research Center,
Heidelberg; Melvin D’Anastasi and Maximilian F.
Reiser, Ludwig-Maximilians-University Hospital, Munich, Germany;
Leonardo K. Bittencourt, Fluminense Federal University,
Niterói; Leonardo K. Bittencourt and Romeu
Domingues, Clínica de Diagnóstico por Imagem
(CDPI/Dasa), Rio de Janeiro, Brazil; Pek-Lan Khong, University of
Hong Kong, Queen Mary Hospital, Hong Kong, China; Zarina Lockhat,
University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa;
Ada Muellner and Hedvig Hricak, Memorial Sloan
Kettering Cancer Center, New York, NY; and Richard L. Schilsky,
American Society of Clinical Oncology, Alexandria, VA
| | - Hedvig Hricak
- Heinz-Peter Schlemmer, German Cancer Research Center,
Heidelberg; Melvin D’Anastasi and Maximilian F.
Reiser, Ludwig-Maximilians-University Hospital, Munich, Germany;
Leonardo K. Bittencourt, Fluminense Federal University,
Niterói; Leonardo K. Bittencourt and Romeu
Domingues, Clínica de Diagnóstico por Imagem
(CDPI/Dasa), Rio de Janeiro, Brazil; Pek-Lan Khong, University of
Hong Kong, Queen Mary Hospital, Hong Kong, China; Zarina Lockhat,
University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa;
Ada Muellner and Hedvig Hricak, Memorial Sloan
Kettering Cancer Center, New York, NY; and Richard L. Schilsky,
American Society of Clinical Oncology, Alexandria, VA
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Exploring the prevalence of high-risk obstetric conditions diagnosed by point-of-care ultrasound evaluation in a rural Ugandan population: a cohort study. ACTA ACUST UNITED AC 2018. [DOI: 10.1097/grh.0000000000000020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kim ET, Singh K, Moran A, Armbruster D, Kozuki N. Obstetric ultrasound use in low and middle income countries: a narrative review. Reprod Health 2018; 15:129. [PMID: 30029609 PMCID: PMC6053827 DOI: 10.1186/s12978-018-0571-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/13/2018] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Although growing, evidence on the impact, access, utility, effectiveness, and cost-benefit of obstetric ultrasound in resource-constrained settings is still somewhat limited. Hence, questions around the purpose and the intended benefit as well as potential challenges across various domains must be carefully reviewed prior to implementation and scale-up of obstetric ultrasound technology in low-and middle-income countries (LMICs). MAIN BODY This narrative review discusses these issues for those trying to implement or scale-up ultrasound technology in LMICs. Issues addressed in this review include health personnel capacity, maintenance, cost, overuse and misuse of ultrasound, miscommunication between the providers and patients, patient diagnosis and care management, health outcomes, patient perceptions and concerns about fetal sex determination. CONCLUSION As cost of obstetric ultrasound becomes more affordable in LMICs, it is essential to assess the benefits, trade-offs and potential drawbacks of large-scale implementation. Additionally, there is a need to more clearly identify the capabilities and the limitations of ultrasound, particularly within the context of limited training of providers, to ensure that the purpose for which an ultrasound is intended is actually feasible. We found evidence of obstetric uses of ultrasound improving patient management. However, there was evidence that ultrasound use is not associated with reducing maternal, perinatal or neonatal mortality. Patients in various studies reported to have both positive and negative perceptions and experiences related to ultrasound and lastly, illegal use of ultrasound for determining fetal sex was raised as a concern.
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Affiliation(s)
- Eunsoo Timothy Kim
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC 27516 USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Carolina Square, Suite 210, 123 West Franklin St, Chapel Hill, NC 27516 USA
| | - Kavita Singh
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC 27516 USA
- MEASURE Evaluation, Carolina Population Center, University of North Carolina at Chapel Hill, Carolina Square, Suite 330, 123 West Franklin St, Chapel Hill, NC 27516 USA
| | - Allisyn Moran
- US Agency for International Development, 1300 Pennsylvania Avenue, NW, Washington, DC 20523 USA
| | - Deborah Armbruster
- US Agency for International Development, 1300 Pennsylvania Avenue, NW, Washington, DC 20523 USA
| | - Naoko Kozuki
- International Rescue Committee, 1730 M St. NW Suite 505, Washington, DC 20036 USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205 USA
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Edoh T, Pawar PA, Kora AD. Evaluation of Telemedicine Systems User Satisfaction in Developing Countries. INTERNATIONAL JOURNAL OF E-HEALTH AND MEDICAL COMMUNICATIONS 2018. [DOI: 10.4018/ijehmc.2018070104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article describes how in developing countries, the work on regulatory aspects of telemedicine systems and applications is still in infancy. During our literature review and on-site research in Sub-Saharan Africa, we could not point out any work on measuring the quality of service (QoS) and quality of experience (QoE or QoX) provided by the telemedicine systems, thus making it impossible to measure the overall level of system user satisfaction in Sub-Saharan Africa. Therefore, we conducted a qualitative and quantitative study to measure network QoS performance and end-user QoE perception of telemedicine systems using publicly accessible conversation tool Skype in Mali and Senegal. The results show that about 75% of the users were satisfied with the quality of teleconsultation service provided and 60% of the users have good impression on the network performance. Based on obtained results, we propose KPIs such as global QoS for measuring QoS and propose a mathematical formula to predict the corresponding QoE, since there exists a relationship between QoS and QoE.
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Affiliation(s)
| | | | - Ahmed Dooguy Kora
- Ecole Superieure Multinationale de Telecommunications, Dakar Liberté, Senegal
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Ahmadzia H, Cigna S, Namagembe I, Macri C, Galerneau F, Magriples U. Teaching obstetric ultrasound at Mulago Hospital - Kampala, Uganda. Afr Health Sci 2018; 18:166-171. [PMID: 29977270 PMCID: PMC6016987 DOI: 10.4314/ahs.v18i1.21] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Mulago Hospital is a high volume referral hospital under the Makerere University School of Medicine and Health Sciences. Basic obstetric ultrasound is a useful skill that can aid patient care. Objectives The purpose of the study was to assess the effectiveness of an intervention implemented to teach basic ultrasound skills to medical students and house officers at Mulago Hosptial, Kampala, Uganda. Methods Forty participants, including medical students, junior house officers (JHOs), and senior house officers (SHOs) were enrolled in the study. A didactic and practical hands-on teaching session was evaluated using a pre- and post-test that was administered to all participants. Results Participants included 12 medical students, 23 JHOs, and 5 SHOs. A significant difference in pre- and post-test scores was demonstrated in the medical students and JHOs (34% to 76%, p <0.0001) and this was retained when the results were stratified into the basic definitions and practical sections of the survey (33% to 71%, p<0.0001). The scores for the senior house officers had a mean increase of 2.3 points. Conclusion This original teaching intervention is an effective method to improve knowledge and skills for medical students and house officers at Mulago Hospital in the area of basic obstetric ultrasound.
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Affiliation(s)
- Homa Ahmadzia
- The George Washington University Medical Faculty Associates, Department of Obstetrics and Gynecology, 2150 Pennsylvania Avenue NW, Room 6A 412, Washington, DC 20037
- Yale University, New Haven, CT
| | - Sarah Cigna
- The George Washington University Medical Faculty Associates, Department of Obstetrics and Gynecology, 2150 Pennsylvania Avenue NW, Room 6A 412, Washington, DC 20037
| | | | - Charles Macri
- The George Washington University Medical Faculty Associates, Department of Obstetrics and Gynecology, 2150 Pennsylvania Avenue NW, Room 6A 412, Washington, DC 20037
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Åhman A, Edvardsson K, Lesio Kidanto H, Ngarina M, Small R, Mogren I. 'Without ultrasound you can't reach the best decision' - Midwives' experiences and views of the role of ultrasound in maternity care in Dar Es Salaam, Tanzania. SEXUAL & REPRODUCTIVE HEALTHCARE 2017; 15:28-34. [PMID: 29389498 DOI: 10.1016/j.srhc.2017.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 11/17/2017] [Accepted: 11/20/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To explore Tanzanian midwives' experiences and views of the role of obstetric ultrasound in relation to clinical management of pregnancy, and in situations where maternal and fetal health interests conflict. METHOD In 2015, five focus group discussions were conducted with midwives (N = 31) at three public referral hospitals in the Dar es Salaam region as part of the CROss Country Ultrasound Study (CROCUS). RESULTS Ultrasound was described as decisive for proper management of pregnancy complications. Midwives noted an increasing interest in ultrasound among pregnant women. However, concerns were expressed about the lack of ultrasound equipment and staff capable of skilful operation. Further, counselling regarding medical management was perceived as difficult due to low levels of education among pregnant women. CONCLUSION Ultrasound has an important role in management of pregnancy complications. However, lack of equipment and shortage of skilled healthcare professionals seem to hamper use of obstetric ultrasound in this particular low-resource setting. Increased availability of obstetric ultrasound seems warranted, but further investments need to be balanced with advanced clinical skills' training as barriers, including power outages and lack of functioning equipment, are likely to continue to limit the provision of pregnancy ultrasound in this setting.
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Affiliation(s)
- Annika Åhman
- Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Sweden.
| | - Kristina Edvardsson
- Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Sweden; Judith Lumley Centre, La Trobe University, Melbourne, Australia.
| | - Hussein Lesio Kidanto
- Reproductive, Maternal and Child Health, Ministry of Health, Social Welfare, Gender, Children and Elderly Affairs, Dar es Salaam, Tanzania; Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Sweden.
| | - Matilda Ngarina
- Muhimbili National Hospital, Department of Obstetrics and Gynaecology, Dar es Salaam, Tanzania.
| | - Rhonda Small
- Judith Lumley Centre, La Trobe University, Melbourne, Australia.
| | - Ingrid Mogren
- Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Sweden.
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Dickerson LK, Rositch AF, Lucas S, Harvey SC. Pilot Educational Intervention and Feasibility Assessment of Breast Ultrasound in Rural South Africa. J Glob Oncol 2017; 3:502-508. [PMID: 29094089 PMCID: PMC5646899 DOI: 10.1200/jgo.2016.008086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Breast cancer is the leading cause of cancer death in women worldwide, with high mortality in low- and middle-income countries because of a lack of detection, diagnosis, and treatment. With mammography unavailable, ultrasound offers an alternative for downstaging. The literature reports successful training in various domains, but a focus on the breast is novel. We assessed the feasibility (knowledge acquisition, perceived usefulness, and self-efficacy) of breast ultrasound training for nonphysician providers. METHODS Training was implemented for 12 providers at Hlokomela Clinic in Hoedspruit, South Africa, over 3 weeks. Didactic presentations and example cases were followed by a presurvey and test (n = 12). All providers received hands-on training with nurses as models; five providers trained with patients. A post-test (n = 12) assessed knowledge acquisition and a postsurvey (n = 10) assessed perceived program usefulness and provider self-efficacy. RESULTS The pre- to post-test averages improved by 68% in total and in four competencies (foundational knowledge, descriptive categories, benign v malignant, and lesion identification). On the postsurvey, providers expressed that ultrasound could significantly influence breast cancer detection (9.1 out of 10), treatment (7.9 out of 10), and survival (8.7 out of 10) in their community and endorsed moderate confidence in their scanning (6.3 out of 10) and interpreting abilities (5.6 out of 10). CONCLUSION Our research supports the feasibility of breast ultrasound training as part of a breast education program in low- and middle-income countries. Pre- and post-test results and observed proficiency indicate that training nonphysician providers is achievable; postsurvey responses indicate program acceptance, community-based ownership, and provider self-efficacy with ultrasound. Future work may show that breast ultrasound is viable for early detection where mammography is unavailable.
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Affiliation(s)
- Lindsay K. Dickerson
- Lindsay K. Dickerson, Johns Hopkins University School of Medicine; Anne F. Rositch, Johns Hopkins Bloomberg School of Public Health; Susan C. Harvey, Johns Hopkins Medical Institutions, Baltimore, MD; and Susan Lucas, Chris Hani Baragwanath Academic Hospital, University of Witwatersrand School of Medicine, Johannesburg, South Africa
| | - Anne F. Rositch
- Lindsay K. Dickerson, Johns Hopkins University School of Medicine; Anne F. Rositch, Johns Hopkins Bloomberg School of Public Health; Susan C. Harvey, Johns Hopkins Medical Institutions, Baltimore, MD; and Susan Lucas, Chris Hani Baragwanath Academic Hospital, University of Witwatersrand School of Medicine, Johannesburg, South Africa
| | - Susan Lucas
- Lindsay K. Dickerson, Johns Hopkins University School of Medicine; Anne F. Rositch, Johns Hopkins Bloomberg School of Public Health; Susan C. Harvey, Johns Hopkins Medical Institutions, Baltimore, MD; and Susan Lucas, Chris Hani Baragwanath Academic Hospital, University of Witwatersrand School of Medicine, Johannesburg, South Africa
| | - Susan C. Harvey
- Lindsay K. Dickerson, Johns Hopkins University School of Medicine; Anne F. Rositch, Johns Hopkins Bloomberg School of Public Health; Susan C. Harvey, Johns Hopkins Medical Institutions, Baltimore, MD; and Susan Lucas, Chris Hani Baragwanath Academic Hospital, University of Witwatersrand School of Medicine, Johannesburg, South Africa
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Ferrer J, Chaumont T, Trujillo L, Fernandez I, Guerrero J, Stewart P, Garra G, Campos MF, Garra K, Stephens N, Harley C, Jacobo S, Waks E, Miele F, Garra B, Castaneda B. New tele-diagnostic model using volume sweep imaging for rural areas. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:2622-2625. [PMID: 29060437 DOI: 10.1109/embc.2017.8037395] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Advances in information and communications technologies provide a new opportunity to improve the access to healthcare in remote rural areas (RA) where there is a lack of infrastructure and medical experts. This paper implements a new model for tele-ultrasound (US) based on volumetric sweep imaging protocols specially designed for the acquisition of US. Non-physician health personnel from the RA are trained on the use of these protocols in a few days. The operator utilizes the medical box (MB), a specially designed telecommunication system, to guide, compress, encrypt and transmit the US sweeps through the cloud to the radiologist who performs the diagnosis remotely. The report is automatically sent back to the MB. The system was able to send US volumetric images with poor connectivity conditions in 6 minutes on average. These results of implementing this tele-ultrasound model in RAs are encouraging and support future validations.
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Haider SJA, diFlorio-Alexander R, Lam DH, Cho JY, Sohn JH, Harris R. Prospective Comparison of Diagnostic Accuracy Between Point-of-Care and Conventional Ultrasound in a General Diagnostic Department: Implications for Resource-Limited Settings. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1453-1460. [PMID: 28339133 DOI: 10.7863/ultra.16.06084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 09/29/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To compare the diagnostic accuracy of hand-held point-of-care (POC) versus conventional sonography in a general diagnostic setting with the intention to inform medical providers or clinicians on the rational use of POC ultrasound in resource limited settings. METHODS Over 3 months in 2010, 47 patients were prospectively enrolled at a single academic center to obtain 54 clinical conventional ultrasound examinations and 54 study-only POC ultrasound examinations. Indications were 48% abdominal, 26% retroperitoneal, and 24% obstetrical. Nine blinded readers (sonographers, residents, and attending radiologists) sequentially assigned diagnoses to POC and then conventional studies, yielding 476 interpreted study pairs. Diagnostic accuracy was obtained by comparing POC and conventional diagnoses to a reference diagnosis established by the unblinded, senior author. Analysis was stratified by study type, body mass index (BMI), diagnostic confidence, and image quality. RESULTS The mean diagnostic accuracy of conventional sonography was 84% compared with 74% for POC (P < .001). This difference was constant regardless of reader, exam type, or BMI. The sensitivity and specificity to detect abnormalities with conventional was 85 and 83%, compared with 75 and 68% for POC. The POC sonography demonstrated greater variability in image quality and diagnostic confidence, and this accounted for lower diagnostic accuracy. When image quality and diagnostic confidence were similar between POC and conventional examinations, there was no difference in accuracy. CONCLUSIONS Point-of-care was nearly as accurate as conventional sonography for basic, focused examinations. Observed differences in accuracy were attributed to greater variation in POC image quality.
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Affiliation(s)
- Steffen J A Haider
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | | | - David H Lam
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Joo Y Cho
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Jae Ho Sohn
- Department of Radiology & Biomedical Imaging, University of California San Francisco Medical Center, San Francisco, California, USA
| | - Robert Harris
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- Human Resources and Health Program, Centre Hospitalier Universitaire, Kigali, Rwanda, Africa
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45
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Henwood PC, Mackenzie DC, Liteplo AS, Rempell JS, Murray AF, Leo MM, Dukundane D, Dean AJ, Rulisa S, Noble VE. Point-of-Care Ultrasound Use, Accuracy, and Impact on Clinical Decision Making in Rwanda Hospitals. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1189-1194. [PMID: 28258591 DOI: 10.7863/ultra.16.05073] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 08/29/2016] [Indexed: 05/24/2023]
Abstract
OBJECTIVES Few studies of point-of-care ultrasound training and use in low resource settings have reported the impact of examinations on clinical management or the longer-term quality of trainee-performed studies. We characterized the long-term effect of a point-of-care ultrasound program on clinical decision making, and evaluated the quality of clinician-performed ultrasound studies. METHODS We conducted point-of-care ultrasound training for physicians from Rwandan hospitals. Physicians then used point-of-care ultrasound and recorded their findings, interpretation, and effects on patient management. Data were collected for 6 months. Trainee studies were reviewed for image quality and accuracy. RESULTS Fifteen participants documented 1158 ultrasounds; 590 studies (50.9%) had matched images and interpretations for review. Abdominal ultrasound for free fluid was the most frequently performed application. The mean image quality score was 2.36 (95% confidence interval, 2.28-2.44). Overall sensitivity and specificity for trainee-performed examinations was 94 and 98%. Point-of-care ultrasound use most commonly changed medications administered (42.4%) and disposition (30%). CONCLUSIONS A point-of-care ultrasound training intervention in a low-resource setting resulted in high numbers of diagnostic-quality studies over long-term follow-up. Ultrasound use routinely changed clinical decision making.
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Affiliation(s)
- Patricia C Henwood
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - David C Mackenzie
- Department of Emergency Medicine, Maine Medical Center, Portland, Maine, USA
| | - Andrew S Liteplo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joshua S Rempell
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Alice F Murray
- Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Megan M Leo
- Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Damas Dukundane
- University Teaching Hospital of Kigali (CHUK), Kigali, Rwanda
| | - Anthony J Dean
- Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stephen Rulisa
- University Teaching Hospital of Kigali (CHUK), Kigali, Rwanda
| | - Vicki E Noble
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Cherniak W, Anguyo G, Meaney C, Yuan Kong L, Malhame I, Pace R, Sodhi S, Silverman M. Effectiveness of advertising availability of prenatal ultrasound on uptake of antenatal care in rural Uganda: A cluster randomized trial. PLoS One 2017; 12:e0175440. [PMID: 28403187 PMCID: PMC5389838 DOI: 10.1371/journal.pone.0175440] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 03/26/2017] [Indexed: 11/18/2022] Open
Abstract
In rural Uganda pregnant women often lack access to health services, do not attend antenatal care, and tend to utilize traditional healers/birth attendants. We hypothesized that receiving a message advertising that "you will be able to see your baby by ultrasound" would motivate rural Ugandan women who otherwise might use a traditional birth attendant to attend antenatal care, and that those women would subsequently be more satisfied with care. A cluster randomized trial was conducted across eight rural sub-counties in southwestern Uganda. Sub-counties were randomized to a control arm, with advertisement of antenatal care with no mention of portable obstetric ultrasound (four communities, n = 59), or an intervention arm, with advertisement of portable obstetric ultrasound. Advertisement of portable obstetric ultrasound was further divided into intervention A) word of mouth advertisement of portable obstetric ultrasound and antenatal care (one communitity, n = 16), B) radio advertisement of only antenatal care and word of mouth advertisement of antenatal care and portable obstetric ultrasound (one community, n = 7), or C) word of mouth + radio advertisement of both antenatal care and portable obstetric ultrasound (two communities, n = 75). The primary outcome was attendance to antenatal care. 159 women presented to antenatal care across eight sub-counties. The rate of attendance was 65.1 (per 1000 pregnant women, 95% CI 38.3-110.4) where portable obstetric ultrasound was advertised by radio and word of mouth, as compared to a rate of 11.1 (95% CI 6.1-20.1) in control communities (rate ratio 5.9, 95% CI 2.6-13.0, p<0.0001). Attendance was also improved in women who had previously seen a traditional healer (13.0, 95% CI 5.4-31.2) compared to control (1.5, 95% CI 0.5-5.0, rate ratio 8.7, 95% CI 2.0-38.1, p = 0.004). By advertising antenatal care and portable obstetric ultrasound by radio attendance was significantly improved. This study suggests that women can be motivated to attend antenatal care when offered the concrete incentive of seeing their baby.
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Affiliation(s)
- William Cherniak
- Department of Family and Community Medicine, Division of Emergency Medicine, The Markham-Stouffville Hospital, University of Toronto, Toronto, Canada
- Bridge to Health Medical and Dental, Toronto, Canada
- * E-mail:
| | - Geoffrey Anguyo
- Kigezi Healthcare Foundation, and Mbarara University of Science and Technology, Kabale, Uganda
| | - Christopher Meaney
- Department of Family and Community Medicine, Division of Emergency Medicine, The Markham-Stouffville Hospital, University of Toronto, Toronto, Canada
| | - Ling Yuan Kong
- Bridge to Health Medical and Dental, Toronto, Canada
- Department of Internal Medicine, McGill University, Montreal, Canada
| | - Isabelle Malhame
- Bridge to Health Medical and Dental, Toronto, Canada
- Department of Internal Medicine, McGill University, Montreal, Canada
| | - Romina Pace
- Bridge to Health Medical and Dental, Toronto, Canada
- Department of Internal Medicine, McGill University, Montreal, Canada
| | - Sumeet Sodhi
- Department of Family and Community Medicine, Division of Emergency Medicine, The Markham-Stouffville Hospital, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Michael Silverman
- Bridge to Health Medical and Dental, Toronto, Canada
- Division of Infectious Diseases, Western University, London, Canada
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47
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Swanson JO, Plotner D, Franklin HL, Swanson DL, Lokomba Bolamba V, Lokangaka A, Sayury Pineda I, Figueroa L, Garces A, Muyodi D, Esamai F, Kanaiza N, Mirza W, Naqvi F, Saleem S, Mwenechanya M, Chiwila M, Hamsumonde D, McClure EM, Goldenberg RL, Nathan RO. Web-Based Quality Assurance Process Drives Improvements in Obstetric Ultrasound in 5 Low- and Middle-Income Countries. GLOBAL HEALTH: SCIENCE AND PRACTICE 2016; 4:675-683. [PMID: 28031304 PMCID: PMC5199182 DOI: 10.9745/ghsp-d-16-00156] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 11/01/2016] [Indexed: 11/15/2022]
Abstract
High quality is important in medical imaging, yet in many geographic areas, highly skilled sonographers are in short supply. Advances in Internet capacity along with the development of reliable portable ultrasounds have created an opportunity to provide centralized remote quality assurance (QA) for ultrasound exams performed at rural sites worldwide. We sought to harness these advances by developing a web-based tool to facilitate QA activities for newly trained sonographers who were taking part in a cluster randomized trial investigating the role of limited obstetric ultrasound to improve pregnancy outcomes in 5 low- and middle-income countries. We were challenged by connectivity issues, by country-specific needs for website usability, and by the overall need for a high-throughput system. After systematically addressing these needs, the resulting QA website helped drive ultrasound quality improvement across all 5 countries. It now offers the potential for adoption by future ultrasound- or imaging-based global health initiatives.
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Affiliation(s)
| | | | | | | | | | - Adrien Lokangaka
- University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Irma Sayury Pineda
- Instituto de Nutrición de Centroamérica y Panamá (INCAP), Guatemala City, Guatemala
| | - Lester Figueroa
- Instituto de Nutrición de Centroamérica y Panamá (INCAP), Guatemala City, Guatemala
| | - Ana Garces
- Instituto de Nutrición de Centroamérica y Panamá (INCAP), Guatemala City, Guatemala
| | - David Muyodi
- Moi University School of Medicine, Eldoret, Kenya
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48
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Lopes EL, Beaton AZ, Nascimento BR, Tompsett A, Dos Santos JP, Perlman L, Diamantino AC, Oliveira KK, Oliveira CM, Nunes MDCP, Bonisson L, Ribeiro AL, Sable C. Telehealth solutions to enable global collaboration in rheumatic heart disease screening. J Telemed Telecare 2016; 24:101-109. [PMID: 27815494 DOI: 10.1177/1357633x16677902] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The global burden of rheumatic heart disease is nearly 33 million people. Telemedicine, using cloud-server technology, provides an ideal solution for sharing images performed by non-physicians with cardiologists who are experts in rheumatic heart disease. Objective We describe our experience in using telemedicine to support a large rheumatic heart disease outreach screening programme in the Brazilian state of Minas Gerais. Methods The Programa de Rastreamento da Valvopatia Reumática (PROVAR) is a prospective cross-sectional study aimed at gathering epidemiological data on the burden of rheumatic heart disease in Minas Gerais and testing of a non-expert, telemedicine-supported model of outreach rheumatic heart disease screening. The primary goal is to enable expert support of remote rheumatic heart disease outreach through cloud-based sharing of echocardiographic images between Minas Gerais and Washington. Secondary goals include (a) developing and sharing online training modules for non-physicians in echocardiography performance and interpretation and (b) utilising a secure web-based system to share clinical and research data. Results PROVAR included 4615 studies that were performed by non-experts at 21 schools and shared via cloud-telemedicine technology. Latent rheumatic heart disease was found in 251 subjects (4.2% of subjects: 3.7% borderline and 0.5% definite disease). Of the studies, 50% were preformed on full functional echocardiography machines and transmitted via Digital Imaging and Communications in Medicine (DICOM) and 50% were performed on handheld echocardiography machines and transferred via a secure Dropbox connection. The average time between study performance date and interpretation was 10 days. There was 100% success in initial image transfer. Less than 1% of studies performed by non-experts could not be interpreted. Discussion A sustainable, low-cost telehealth model, using task-shifting with non-medical personal in low and middle income countries can improve access to echocardiography for rheumatic heart disease.
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Affiliation(s)
- Eduardo Lv Lopes
- 1 Faculdade de Medicina da Universidade Federal de Minas Gerais, Brazil
| | | | | | | | | | | | | | | | - Cassio M Oliveira
- 1 Faculdade de Medicina da Universidade Federal de Minas Gerais, Brazil
| | | | - Leonardo Bonisson
- 1 Faculdade de Medicina da Universidade Federal de Minas Gerais, Brazil
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49
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Edvardsson K, Ntaganira J, Åhman A, Sengoma JPS, Small R, Mogren I. Physicians' experiences and views on the role of obstetric ultrasound in rural and urban Rwanda: a qualitative study. Trop Med Int Health 2016; 21:895-906. [DOI: 10.1111/tmi.12718] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Kristina Edvardsson
- Department of Clinical Sciences; Obstetrics and Gynecology; Umeå University; Umeå Sweden
- Judith Lumley Centre; La Trobe University; Melbourne Australia
| | - Joseph Ntaganira
- College of Medicine and Health Sciences; School of Public Health; University of Rwanda; Kigali Rwanda
| | - Annika Åhman
- Department of Clinical Sciences; Obstetrics and Gynecology; Umeå University; Umeå Sweden
| | - Jean Paul Semasaka Sengoma
- Department of Clinical Sciences; Obstetrics and Gynecology; Umeå University; Umeå Sweden
- College of Medicine and Health Sciences; School of Public Health; University of Rwanda; Kigali Rwanda
| | - Rhonda Small
- Judith Lumley Centre; La Trobe University; Melbourne Australia
| | - Ingrid Mogren
- Department of Clinical Sciences; Obstetrics and Gynecology; Umeå University; Umeå Sweden
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Kinnevey C, Kawooya M, Tumwesigye T, Douglas D, Sams S. Addressing Obstetrical Challenges at 12 Rural Ugandan Health Facilities: Findings from an International Ultrasound and Skills Development Training for Midwives in Uganda. Int J MCH AIDS 2016; 5:46-52. [PMID: 28058192 PMCID: PMC5187639 DOI: 10.21106/ijma.106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Like much of Sub-Saharan Africa, Uganda is facing significant maternal and fetal health challenges. Despite the fact that the majority of the Uganda population is rural and the major obstetrical care provider is the midwife, there is a lack of data in the literature regarding rural health facilities' and midwives' knowledge of ultrasound technology and perspectives on important maternal health issues such as deficiencies in prenatal services. METHODOLOGY A survey of the current antenatal diagnostic and management capabilities of midwives at 12 rural Ugandan health facilities was performed as part of an international program initiated to provide ultrasound machines and formal training in their use to midwives at antenatal care clinics. RESULTS The survey revealed that the majority of pregnant women attend less than the recommended minimum of four antenatal care visits. There were significant knowledge deficits in many prenatal conditions that require ultrasound for early diagnosis, such as placenta previa and macrosomia. The cost of providing ultrasound machines and formal training to 12 midwives was $6,888 per powered rural health facility and $8,288 for non-powered rural health facilities in which solar power was required to maintain ultrasound. CONCLUSIONS AND GLOBAL HEALTH IMPLICATIONS In order to more successfully meet Millennium Development Goal 4 (reduce child mortality), 5 (improve maternal health) and 6 (combat HIV) through decreasing maternal to child transmission of HIV, the primary healthcare provider, which is the midwife in Uganda, must be competent at the diagnosis and management of a wide spectrum of obstetrical challenges. A trained ultrasound-based approach to obstetrical care is a cost effective method to take on these goals.
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Affiliation(s)
- Christina Kinnevey
- Sutter Health Family Medicine, AAFP Family Medicine Leads Emerging Leader Scholar, 2030 Sutter Place, Suite 2000, Davis, CA 95616, USA
| | - Michael Kawooya
- Ernest Cook Ultrasound Research and Education Institute (ECUREI), Mengo Hospital, Albert Cook Building, Albert Cook Road, P. O. BOX 7161, Kampala, UGANDA
| | - Tonny Tumwesigye
- Uganda Protestant Medical Bureau (UPMB), Plot 877 Balintuma Rd, Mengo, P. O Box 4127, Kampala, UGANDA
| | - David Douglas
- Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Sarah Sams
- Grant Family Medicine Residency Program, 285 East State Street Suite 670 Columbus, OH 43215, USA
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