Summary OBJECTIVEOBJ ECTIVE To assess the clinical bene®t and ®nancial feasibility of an ultrasound service in a district hospital in Botswana.METHOD METHO D An ultrasound service was established in the study hospital. Clinical and ultrasound-aided diagnoses were compared in patients who met eligibility criteria laid down in an indication list. RESULTSRES ULTS We enrolled 2309 patients over 18 months. The most frequent indications for ultrasound were pregnancy-related diagnoses followed by gynaecological and hepato-biliary disorders. Ultrasound assistance improved case management in 696 cases (30%) and led to an immediate change in management in 151 patients. Ultrasound diagnosis was used as gold standard to assess the accuracy of the clinical diagnosis of incomplete abortion (sensitivity 24%; positive predictive value, PPV 66%), pelvic mass (sensitivity 53%; PPV 69%), ectopic pregnancy (sensitivity 75%; PPV 28%), and gall bladder stones (sensitivity 30%; PPV 32%).CONCLUSIONS CONCLUSIONS Ultrasound improved case management for a wide diversity of clinical problems encountered on district health care level. The service proved to be affordable for the Botswana health care system. keywords district health care, diagnostic ultrasound, quality of care, developing country, technology transfer correspondence Dr Hermann Bussmann, Botswana-Harvard Partnership for HIV Research and Education, P/Bag BO320