Implementing an obstetric ultrasound training program in rural Africa

Greenwold, Natalie; Wallace, Sarah; Prost, A. E.; Jauniaux, Eric

doi:10.1016/j.ijgo.2013.09.018

Cited by 47 publications

(64 citation statements)

References 20 publications

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“…Trainees who completed the course took 3 written and 3 practical tests. In a study by Greenwold et al 1 to assess the feasibility and sustainability of a basic ultrasound training course in rural Africa, 9 nurses and clinical officers in Mozambique were trained in OB ultrasound in a course with 1 week of lectures and 7 weeks of hands-on training. Of the 1744 examinations performed by trainees, 804 were under supervision and 940 without supervision.…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies have suggested that the use of obstetrical (OB) ultrasound in low- and middle-income countries (LMIC) could improve OB management by aiding in identification of high-risk conditions 1, 2, 3, 4, 5. We are participating in a cluster-randomized clinical trial of OB ultrasound under the auspices of the Global Network for Women’s and Children’s Health Research 6 .…”

Section: Introductionmentioning

confidence: 99%

“…Trained health care workers could have an adjunctive role in ultrasound screening for high-risk OB conditions where access to care is limited. There have been several published studies on basic OB ultrasound training courses for health care workers in LMIC 1, 2, 3, 4, 8, 9, 10, 11. Although adequate performance after training is crucial,12, 13 reporting of quality control (QC) activities has been limited.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Focused Obstetric Ultrasound Examinations by Health Care Personnel in the Democratic Republic of Congo, Guatemala, Kenya, Pakistan, and Zambia

Nathan

Swanson

et al. 2017

Current Problems in Diagnostic Radiology

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Prior studies have suggested that obstetrical (OB) ultrasound in low- and middle-income countries has aided in detection of high-risk conditions, which in turn could improve OB management. We are participating in a cluster-randomized clinical trial of OB ultrasound, which is designed to assess the effect of basic OB ultrasound on maternal mortality, fetal mortality, neonatal mortality, and maternal near-miss in 5 low-income countries. We designed a 2-week course in basic OB ultrasound, followed by 12 weeks of oversight, to train health care professionals with no prior ultrasound experience to perform basic OB ultrasound to screen for high-risk pregnancies. All patients with high-risk pregnancies identified by the trainees were referred to higher-level health facilities where fully trained sonographers confirmed the diagnoses before any actions were taken. Although there have been several published studies on basic OB ultrasound training courses for health care workers in low- and middle-income countries, quality control reporting has been limited. The purpose of this study is to report on quality control results of these trainees. Health care workers trained in similar courses could have an adjunctive role in ultrasound screening for high-risk OB conditions where access to care is limited. After completion of the ultrasound course, 41 trainees in 5 countries performed 3801 ultrasound examinations during a 12-week pilot period. Each examination was reviewed by ultrasound trainers for errors in scanning parameters and errors in diagnosis, using predetermined criteria. Of the 32,480 images comprising the 3801 examinations, 94.8% were rated as satisfactory by the reviewers. There was 99.4% concordance between trainee and reviewer ultrasound diagnosis. The results suggest that trained health care workers could play a role in ultrasound screening for high-risk OB conditions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evaluation of Focused Obstetric Ultrasound Examinations by Health Care Personnel in the Democratic Republic of Congo, Guatemala, Kenya, Pakistan, and Zambia

Nathan

Swanson

et al. 2017

Current Problems in Diagnostic Radiology

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“…It has been argued that training in ultrasound should be directed towards midwives as well as physicians, as midwives provide most of the maternity care [42]. The effectiveness of training midwives in obstetric ultrasound has been evaluated as successful in several African countries [43–45]. In an intervention study conducted in Zambia, 17% of the scans performed by midwives resulted in a change in clinical decision making [43].…”

Section: Discussionmentioning

confidence: 99%

Improved maternity care if midwives learn to perform ultrasound: a qualitative study of Rwandan midwives’ experiences and views of obstetric ultrasound

Holmlund

Ntaganira

Edvardsson

et al. 2017

Global Health Action

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Background: Obstetric ultrasound has become an indispensable part of antenatal care worldwide. Although the use of ultrasound has shown benefits in the reduction of maternal and foetal morbidity and mortality, it has also raised many ethical challenges. Because of insufficient numbers of midwives in Rwanda, uncomplicated pregnancy care is usually provided by nurses in local health centres. Obstetric ultrasound is generally performed by physicians at higher levels of healthcare, where midwives are also more likely to be employed. Objectives: To explore Rwandan midwives’ experiences and views of the role of obstetric ultrasound in relation to clinical management, including ethical aspects. Methods: A qualitative study design was employed. Six focus group discussions were held in 2015 with 23 midwives working in maternity care in rural and urban areas of Rwanda, as part of the CROss Country Ultrasound Study (CROCUS). Results: Obstetric ultrasound was experienced as playing a very important role in clinical management of pregnant women, but participants emphasised that it should not overshadow other clinical examinations. The unequal distribution of ultrasound services throughout Rwanda was considered a challenge, and access was described as low, especially in rural areas. To increase the quality of maternity care, some advocated strongly for midwives to be trained in ultrasound and for physicians to receive additional training. In general, pregnant women were perceived both as requesting more ultrasound examinations than they received, and as not being satisfied with an antenatal consultation if ultrasound was not performed. Conclusions: Obstetric ultrasound plays a significant role in maternity care in Rwanda. Increasing demand for ultrasound examinations from pregnant women needs to be balanced with medical indication and health benefits. Training of midwives to perform obstetric ultrasound and further training for physicians would help to address access to ultrasound for greater numbers of women across Rwanda. RESPONSIBLE EDITOR Virgilio Mariano Salazar Torres, Karolinska Institute, Sweden

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“…However, several studies found psychological benefit for mothers and increased facility utilization associated with obstetric ultrasounds performed during prenatal care [26-28]. Additionally, clinical competence of paraprofessionals (e.g., midwives, paramedics) to perform obstetric ultrasound [29-34] with a relatively short training period has been shown [35,36]. However, the optimal training regimen to reach competency has not been determined.…”

Section: Introductionmentioning

confidence: 99%

First look: a cluster-randomized trial of ultrasound to improve pregnancy outcomes in low income country settings

McClure

Nathan

Saleem

et al. 2014

BMC Pregnancy Childbirth

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BackgroundIn high-resource settings, obstetric ultrasound is a standard component of prenatal care used to identify pregnancy complications and to establish an accurate gestational age in order to improve obstetric care. Whether or not ultrasound use will improve care and ultimately pregnancy outcomes in low-resource settings is unknown.Methods/DesignThis multi-country cluster randomized trial will assess the impact of antenatal ultrasound screening performed by health care staff on a composite outcome consisting of maternal mortality and maternal near-miss, stillbirth and neonatal mortality in low-resource community settings. The trial will utilize an existing research infrastructure, the Global Network for Women’s and Children’s Health Research with sites in Pakistan, Kenya, Zambia, Democratic Republic of Congo and Guatemala. A maternal and newborn health registry in defined geographic areas which documents all pregnancies and their outcomes to 6 weeks post-delivery will provide population-based rates of maternal mortality and morbidity, stillbirth, neonatal mortality and morbidity, and health care utilization for study clusters. A total of 58 study clusters each with a health center and about 500 births per year will be randomized (29 intervention and 29 control). The intervention includes training of health workers (e.g., nurses, midwives, clinical officers) to perform ultrasound examinations during antenatal care, generally at 18–22 and at 32–36 weeks for each subject. Women who are identified as having a complication of pregnancy will be referred to a hospital for appropriate care. Finally, the intervention includes community sensitization activities to inform women and their families of the availability of ultrasound at the antenatal care clinic and training in emergency obstetric and neonatal care at referral facilities.DiscussionIn summary, our trial will evaluate whether introduction of ultrasound during antenatal care improves pregnancy outcomes in rural, low-resource settings. The intervention includes training for ultrasound-naïve providers in basic obstetric ultrasonography and then enabling these trainees to use ultrasound to screen for pregnancy complications in primary antenatal care clinics and to refer appropriately.Trial registrationClinicaltrials.gov (NCT # 01990625)

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Implementing an obstetric ultrasound training program in rural Africa

Cited by 47 publications

References 20 publications

Evaluation of Focused Obstetric Ultrasound Examinations by Health Care Personnel in the Democratic Republic of Congo, Guatemala, Kenya, Pakistan, and Zambia

Evaluation of Focused Obstetric Ultrasound Examinations by Health Care Personnel in the Democratic Republic of Congo, Guatemala, Kenya, Pakistan, and Zambia

Improved maternity care if midwives learn to perform ultrasound: a qualitative study of Rwandan midwives’ experiences and views of obstetric ultrasound

First look: a cluster-randomized trial of ultrasound to improve pregnancy outcomes in low income country settings

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