Contribution of portable obstetric ultrasound service innovation in averting maternal and neonatal morbidities and mortalities at semi-urban health centers of Ethiopia: a retrospective facility-based study
Abstract:Background
The maternal and neonatal mortalities in Ethiopia are high. To achieve the Sustainable Development Goals, innovations in ultrasound scanning and surveillance activities have been implemented at health centers for over 2 years. This study aims to estimate the contribution of obstetric ultrasound services on averted maternal and neonatal morbidities and mortalities in Ethiopia.
Methods
A retrospective facility-based cross-sectional study d… Show more
“…Consequently, the mother could use a better service to raise the well-being of her child. Despite of the fact that there are pieces of evidence that reported it does not have an effect on maternal or child health outcomes,33 34 obstetric ultrasound service resulted in a dimensional change to safe motherhood and better child well-being 24 35…”
ObjectiveA 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.DesignWe employed a quasi-experimental study design.SettingThe study was conducted in primary health centres located in four regions of Ethiopia.ParticipantsWe 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.InterventionUse of portable obstetric ultrasound service during pregnancy.Outcome measuresThe 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.ResultsWith 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.ConclusionThe 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.
“…Consequently, the mother could use a better service to raise the well-being of her child. Despite of the fact that there are pieces of evidence that reported it does not have an effect on maternal or child health outcomes,33 34 obstetric ultrasound service resulted in a dimensional change to safe motherhood and better child well-being 24 35…”
ObjectiveA 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.DesignWe employed a quasi-experimental study design.SettingThe study was conducted in primary health centres located in four regions of Ethiopia.ParticipantsWe 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.InterventionUse of portable obstetric ultrasound service during pregnancy.Outcome measuresThe 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.ResultsWith 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.ConclusionThe 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.
“…The results of this study reveal an increased and statistically significant difference in first and fourth ANC service utilization. Increased coverage of ANC with ultrasound scanning services at twelve weeks of pregnancy helps to identify high risk health conditions including congenital anomalies, ectopic pregnancies, and abortion [ 6 , 25 ]. In addition, ANC4 helps to determine other life-threatening conditions in women and neonates which includes mal-presentations, multiple fetuses, abnormalities in sizes of fetuses for gestational age, abnormal placentation, and antepartum hemorrhage [ 6 , 25 ].…”
Section: Discussionmentioning
confidence: 99%
“…Increased coverage of ANC with ultrasound scanning services at twelve weeks of pregnancy helps to identify high risk health conditions including congenital anomalies, ectopic pregnancies, and abortion [ 6 , 25 ]. In addition, ANC4 helps to determine other life-threatening conditions in women and neonates which includes mal-presentations, multiple fetuses, abnormalities in sizes of fetuses for gestational age, abnormal placentation, and antepartum hemorrhage [ 6 , 25 ]. Hence, providing comprehensive ANC services contributes to the reduction of preventable maternal and neonatal deaths.…”
Section: Discussionmentioning
confidence: 99%
“…Similarly, the institutionalization of limited obstetric ultrasound services at semi urban or rural health centers has increased utilization of SBA and PNC services at time of delivery and immediately after to forty five days. Increased SBA and PNC services improve diagnoses and management of post-partum hemorrhage and very low birthweight cases ultimately curbing deaths of mothers and neonates, respectively [ 25 ]. These findings are also in alignment with studies conducted in other settings.…”
Section: Discussionmentioning
confidence: 99%
“…Studies have documented improvements in maternal and neonatal health service utilization and favorable pregnancy outcomes for both mother and baby as well as improvements in quality of services in remote places around the world, as a result of availing obstetric point of care ultrasound services [13][14][15][16][17][18][19][20][21][22][23][24][25][26]. The United States Agency for International Development (USAID) Transform: Primary Health Care project institutionalized antenatal limited obstetric ultrasound services in 100 health centers in Ethiopia.…”
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.
ObjectiveThe purpose of this exploratory study was to assess healthcare providers’ perspectives on maternity care following the introduction of ultrasound services in the area.DesignThe qualitative descriptive study.Study settingThis 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.ParticipantsThe 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.ResultsWe 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.ConclusionUltrasound 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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