Experiences of midwives on Vscan limited obstetric ultrasound use: a qualitative exploratory study

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.

Feasibility and effects of the Mimba Yangu (My Pregnancy) project in improving routine prenatal ultrasound by nurses-midwives in rural Kenya: A before-after study

“…27,31 Midwives from a study in Ethiopia expressed that ultrasound creating an image of the baby facilitated their communication with pregnant women. 32 In LMIC, routine obstetric ultrasound imaging at primary health care level is not a standard operation procedure. Often ultrasound during pregnancy is only available in urban settings, limited to private facilities and delivered by radiologists.…”

Institutionalization of limited obstetric ultrasound leading to increased antenatal, skilled delivery, and postnatal service utilization in three regions of Ethiopia: A pre-post study

“…The institutionalization of portable ultrasound innovation service is an invaluable asset in semi-urban or rural health centers where most perinatal and antenatal care of pregnant women are administered. These mothers usually lack access to better services available in referral health facilities, which are usually located in big cities, and decline lifesaving services due to fear of associated costs like transport, meals, accommodation, and consultation fee of traditional ultrasound machines [ 31 , 35 ].…”

“…Vscan ultrasound machines with seed supplies were provided to each of the targeted 100 health centers after successfully providing basic limited ultrasound classroom and practical hands-on training for 10 days. The trainees were 219 mid-level healthcare providers who lacked knowledge and skills on the technology [ 31 ]. In addition, the training was supplemented with three sessions of monthly coaching, each lasting for two days, and the provision of virtual real-time feedback.…”

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

“…The knowledge and skill building activity was executed through a 10-day classroom basic limited obstetric ultrasound training supplemented with experiential learning events under supervision of Gynecologist/Obstetricians and Radiologists. In addition, three sessions of objective structured clinical examination (OSCE) followed by onsite and offsite mentoring/coaching sessions were facilitated [30]. A competent certified mid-level health professional can operate ultrasound machines and identify normal pregnancy, first trimester pregnancy and complications, fetal dating and measurements, second and third trimester pregnancy and complications.…”