Screening Obstetric Ultrasound Training for a 5-Country Cluster Randomized Controlled Trial

Nathan, R.; Swanson, Jonathan O.; Marks, William; Goldsmith, Nicole; Vance, Cheryl; Sserwanga, Ntale Brian; Swanson, David L.; McClure, Elizabeth M; Franklin, Holly; Mirza, Waseem; Mwenechanya, Musaku; Muyodi, David; Figuero, Lester; Bolamba, Victor Lokomba; Goldenberg, Robert L.; Pineda, Irma Sayury

doi:10.1097/ruq.0000000000000096

Cited by 26 publications

(39 citation statements)

References 18 publications

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“…Other NGOs in Uganda are involved in training sonographers to use basic ultrasound techniques at community health centers (HCIIIs) to triage pregnant women with potential obstetric complications to district hospitals (20)(21)(22). Similarly, ITWA's efforts to train sonographers to characterize breast masses at the level of HCIIIs would not only help to downstage breast cancer, but also reduce the number of women travelling unnecessarily to referral hospitals for nonmalignant breast lumps.…”

Section: Performance Of Front-line Sonographers At Nawanyago Hciiimentioning

confidence: 99%

Pilot Study of a Resource-Appropriate Strategy for Downstaging Breast Cancer in Rural Uganda

Matovu¹,

Shadrack²,

Ssembatya³

et al. 2016

JGR

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Breast cancer incidence and mortality are rapidly increasing in low-and middle-income countries like Uganda. Shifting the proportion of women presenting with late-stage breast cancer to earlystage breast cancer (downstaging) at the time of diagnosis would substantially improve survival and efficient use of available resources. Imaging The World (ITW) conducted a pilot study in Uganda where trained village health teams (VHTs) promoted breast cancer awareness in the Kamuli District (Uganda). As a result, 212 women with self-detected lumps presented to the community health center level III (Nawanyago HCIII) for a clinical breast examination (CBE). Patients with masses on CBE were examined with breast ultrasound by a certified sonographer trained in breast imaging. Women with ultrasound-detected masses were referred to a regional health center for further evaluation. Of the 212 women, 44 (21%) had a palpable mass by CBE, 11 (28%) examined by ultrasound were recommended for biopsy, and four breast cancers were diagnosed. Providing ultrasound scanning at Nawanyago HCIII reduced the number of women travelling to the referral hospital by 75%. As a result of breast cancer awareness and ultrasound studies, we were able to diagnose breast cancer at an earlier stage than would be otherwise possible. This pilot project supports locally available breast ultrasound as a resource-appropriate strategy to downstage breast cancer in a low-income country. I S S N 2 3 7 2 -8 4 1 8 in large numbers of patients. Therefore, given the resources, the most resource-appropriate strategy seems to be downstaging through health awareness leading to increased rates of BSE and CBE.According to the Breast Health Global Initiative (BHGI) guidelines, resource-appropriate strategies to downstage breast cancer in Uganda should include increased breast health awareness, so women begin to practice BSE and present early to their providers after self-detecting a lump (9, 10). It is also important to train the providers in breast health to obtain appropriate history and physical examination including a proper CBE. Both BSE and CBE have the potential for a high false-positive rate and are, therefore, no longer recommended in countries where screening mammography is available (11-13). But, with one publically available mammography unit in the country, screening mammography is not a feasible option for most Ugandan women, particularly rural women. Ultrasound is more widely available, even in rural areas, and has the ability to characterize palpable masses detected by CBE as those requiring biopsy versus those that can safely be managed by imaging or clinical follow-up (14).In accordance with the World Health Organization's recommendations to reduce the global burden of breast cancer (15), Imaging The World (ITW) developed a resource-appropriate strategy to downstage breast cancer. ITW is a non-profit organization with a global team of volunteers who provide ultrasound training, equipment and technology in LMICs to improve and sustain health outcomes...

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Section: Performance Of Front-line Sonographers At Nawanyago Hciiimentioning

confidence: 99%

Pilot Study of a Resource-Appropriate Strategy for Downstaging Breast Cancer in Rural Uganda

Matovu¹,

Shadrack²,

Ssembatya³

et al. 2016

JGR

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“…Because trained sonographers were not available to staff the rural health centers in which the study ultrasounds were to be performed, the University of Washington’s Department of Radiology (UW) designed a 2-week course in basic OB ultrasound for health care professionals with no prior ultrasound experience 7 . This course was used to train 41 ultrasound-naïve health care workers (midwives, nurses, radiographers, and medical officers) in 5 LMIC countries to perform basic OB ultrasound to screen for high-risk pregnancies.…”

Section: Introductionmentioning

confidence: 99%

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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“…In concert with local sonographer trainers, UW then oversaw a quality assurance process including review of stored images of all ultrasound scans collected during a 3-month pilot period and 10%–20% of images collected throughout the study. Both the initial training and the quality assurance process are discussed in detail elsewhere 4 . In the DRC, Pakistan, and Zambia, the sonographers were based in the field and traveled to the health centers in their assigned clusters each day with the necessary equipment to perform ultrasound examinations.…”

Section: Introductionmentioning

confidence: 99%

Challenges of Implementing Antenatal Ultrasound Screening in a Rural Study Site: A Case Study From the Democratic Republic of the Congo

Swanson¹,

Lokangaka²,

Bauserman³

et al. 2017

Glob Health Sci Pract

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In the context of a well-resourced research project on obstetric ultrasound, we encountered major challenges, including security and maintenance of the equipment, electricity requirements, health systems integration, and a variety of other systems issues. We propose future ultrasound interventions have at minimum a functioning health system with skilled and motivated staff, access to a referral hospital capable of providing affordable and higher levels of care, and feasible transportation means.

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Screening Obstetric Ultrasound Training for a 5-Country Cluster Randomized Controlled Trial

Cited by 26 publications

References 18 publications

Pilot Study of a Resource-Appropriate Strategy for Downstaging Breast Cancer in Rural Uganda

Pilot Study of a Resource-Appropriate Strategy for Downstaging Breast Cancer in Rural Uganda

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

Challenges of Implementing Antenatal Ultrasound Screening in a Rural Study Site: A Case Study From the Democratic Republic of the Congo

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