Training in Ultrasound to Determine Gestational Age in Low- and Middle- Income Countries: A Systematic Review

Viner, Alexandra; Okolo, Isioma; Norman, Jane E.; Stock, Sarah; Reynolds, Rebecca M.

doi:10.3389/fgwh.2022.854198

Cited by 4 publications

(2 citation statements)

References 62 publications

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“…Access to support from an ultrasound expert for ongoing mentoring and training and access to ultrasound education and/or training were also frequently cited as barriers. As ultrasound education and training of LMIC healthcare providers have increased, it remains unclear what constitutes optimal training, including type, scope, duration, frequency, and quality assurance, among other factors 8,11,[26][27][28][29][30][31][32][33][34] .…”

Section: Discussionmentioning

confidence: 99%

A survey of barriers and facilitators to ultrasound use in low- and middle-income countries

Ginsburg

Liddy

Khazaneh

et al. 2023

Sci Rep

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Point-of-care ultrasound has the potential to help inform assessment, diagnosis, and management of illness in low- and middle-income countries (LMIC). To better understand current ultrasound use, barriers and facilitators to use, and perceptions and practices in LMIC, we conducted an anonymous online global survey targeting healthcare providers training and using ultrasound in LMIC. A total of 241 respondents representing 62 countries participated and most were physicians working in publicly-funded urban tertiary hospitals in LMIC. Most had received ultrasound training (78%), reported expertise (65%) and confidence (90%) in ultrasound use, and had access to ultrasound (88%), utilizing ultrasound most commonly for procedures and for evaluations of lungs, heart, and trauma. Access to an ultrasound machine was reported as both the top barrier (17%) and top facilitator (53%); other common barriers included access to education and training, cost, and competition for use and other common facilitators included access to a probe, gel, and electricity, and acceptance by healthcare providers, administrators, and patients. Most (80%) noted ultrasound access was important and 96% agreed that ultrasound improves quality of care and patient outcomes. Improving access to low-cost ultrasound equipment is critical to increasing ultrasound use among those who are trained.

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Section: Discussionmentioning

confidence: 99%

A survey of barriers and facilitators to ultrasound use in low- and middle-income countries

Ginsburg

Liddy

Khazaneh

et al. 2023

Sci Rep

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“…HCWs were confident that they would be able to perform the procedure if given adequate training, but their views on the desired nature and duration of the training were varied. Other studies have evaluated combinations of didactics courses, hands-on instruction, supervised scanning, and lectures [ 31 , 32 ]. The duration of training for obstetric point-of-care studies in one review [ 31 ] ranged from 3 days to 3 months.…”

Section: Discussionmentioning

confidence: 99%

Acceptability and Feasibility of a Low-Cost Device for Gestational Age Assessment in a Low-Resource Setting: Qualitative Study

Koech,

Musitia,

Mwashigadi

et al. 2022

JMIR Hum Factors

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Background Ultrasound for gestational age (GA) assessment is not routinely available in resource-constrained settings, particularly in rural and remote locations. The TraCer device combines a handheld wireless ultrasound probe and a tablet with artificial intelligence (AI)-enabled software that obtains GA from videos of the fetal head by automated measurements of the fetal transcerebellar diameter and head circumference. Objective The aim of this study was to assess the perceptions of pregnant women, their families, and health care workers regarding the feasibility and acceptability of the TraCer device in an appropriate setting. Methods A descriptive study using qualitative methods was conducted in two public health facilities in Kilifi county in coastal Kenya prior to introduction of the new technology. Study participants were shown a video role-play of the use of TraCer at a typical antenatal clinic visit. Data were collected through 6 focus group discussions (N=52) and 18 in-depth interviews. Results Overall, TraCer was found to be highly acceptable to women, their families, and health care workers, and its implementation at health care facilities was considered to be feasible. Its introduction was predicted to reduce anxiety regarding fetal well-being, increase antenatal care attendance, increase confidence by women in their care providers, as well as save time and cost by reducing unnecessary referrals. TraCer was felt to increase the self-image of health care workers and reduce time spent providing antenatal care. Some participants expressed hesitancy toward the new technology, indicating the need to test its performance over time before full acceptance by some users. The preferred cadre of health care professionals to use the device were antenatal clinic nurses. Important implementation considerations included adequate staff training and the need to ensure sustainability and consistency of the service. Misconceptions were common, with a tendency to overestimate the diagnostic capability, and expectations that it would provide complete reassurance of fetal and maternal well-being and not primarily the GA. Conclusions This study shows a positive attitude toward TraCer and highlights the potential role of this innovation that uses AI-enabled automation to assess GA. Clarity of messaging about the tool and its role in pregnancy is essential to address misconceptions and prevent misuse. Further research on clinical validation and related usability and safety evaluations are recommended.

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Use and misuse of ultrasound in obstetrics with reference to developing countries

Kurjak

Medjedović

Stanojević

2022

Journal of Perinatal Medicine

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Maternal and neonatal health is one of the main global health challenges. Every day, approximately 800 women and 7,000 newborns die due to complications during pregnancy, delivery, and neonatal period. The leading causes of maternal death in sub-Saharan Africa are obstetric hemorrhage (28.8%), hypertensive disorders in pregnancy (22.1%), non-obstetric complications (18.8%), and pregnancy-related infections (11.5%). Diagnostic ultrasound examinations can be used in a variety of specific circumstances during pregnancy. Because adverse outcomes may also arise in low-risk pregnancies, it is assumed that routine ultrasound in all pregnancies will enable earlier detection and improved management of pregnancy complications. The World Health Organization (WHO) estimated in 1997 that 50% of developing countries had no access to ultrasound imaging, and available equipment was outdated or broken. Unfortunately, besides all the exceptional benefits of ultrasound in obstetrics, its inappropriate use and abuse are reported. Using ultrasound to view, take a picture, or determine the sex of a fetus without a medical indication can be considered ethically unjustifiable. Ultrasound assessment when indicated should be every woman’s right in the new era. However, it is still only a privilege in some parts of the world. Investment in both equipment and human resources has been clearly shown to be cost-effective and should be an obligatory step in the improvement of health care. Well-developed health systems should guide developing countries, creating principles for the organization of the health system with an accent on the correct, legal, and ethical use of diagnostic ultrasound in pregnancy to avoid its misuse. The aim of the article is to present the importance of correct and appropriate use of ultrasound in obstetrics and gynecology with reference to developing countries.

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Training in Ultrasound to Determine Gestational Age in Low- and Middle- Income Countries: A Systematic Review

Cited by 4 publications

References 62 publications

A survey of barriers and facilitators to ultrasound use in low- and middle-income countries

A survey of barriers and facilitators to ultrasound use in low- and middle-income countries

Acceptability and Feasibility of a Low-Cost Device for Gestational Age Assessment in a Low-Resource Setting: Qualitative Study

Use and misuse of ultrasound in obstetrics with reference to developing countries

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