Ultrasound in Africa: what can really be done?

Abstract

Today we are living in a globalized world in which information on what is happening in one part of the world is easily communicated to other parts of the world. This happens thanks to advancement in science and technology. One area where technology has made the greatest impact is heath care provision. Ultrasound technology is now playing a critical role in health care provision particularly in Obstetrics and Gynaecology. This has significantly assisted in provision of quality health care to pregnant women and their unborn infants and in reducing maternal and neonatal morbidity and mortality in the developed world. Africa the continent with greatest health care challenges and with the highest maternal and neonatal mortalities is yet to fully utilize this important tech nology. The need for this technology is great as the conditions requiring its application abound. The effective application of Ultrasound however faces serious challenges in Africa. To successfully entrench Ultrasound in quality Obstetrics and Gynaecology care various approaches must be adopted to overcome the challenges. The aim of this paper is to identify the benefits and the challenges inimical to the application Ultrasound in Obstetrics and Gynecology in Africa.It also examines what needs to be done to achieve better application of Ultrasound in Obstetrics and Gynecology.

Diagnostic Accuracy of Neonatal Assessment for Gestational Age Determination: A Systematic Review

“…Maternal recall of last menstrual period (LMP) is often unavailable or unreliable, particularly in populations with high rates of maternal illiteracy. 4,5 The shortage of health care providers in LMIC, currently estimated at 7.9 million, 6 contributes to poor coverage of antenatal care. In sub-Saharan Africa and Southeast Asia, fewer than onethird of mothers in households in the poorest quintile receive at least 1 antenatal care visit.…”

“…8,9 Moreover, access to ultrasonography is low, with <7% of pregnant women having access to ultrasound in rural sub-Saharan Africa. 4 Traditional sonography in late pregnancy is notably inaccurate for determining GA (±4 weeks). 10,11 Clinical assessment of newborn maturity has long been used as a proxy to estimate GA after birth (Table 1).…”

Accessible Personal Ultrasound Training Simulator

“…Additionally, sonography is widely considered to be a sustainable radiology modality for low‐ and middle‐income countries because of its portability, durability, and relatively low cost to purchase and operate. Yet the vast majority of providers in these countries have received less training than World Health Organization standards (3–6 months’ directed education and performance of 300–500 studies) . In one survey of providers (N = 138) from 44 low‐ and middle‐income countries, lack of training (60%) was the most commonly cited barrier to the use of sonography, followed by cost (50%), difficulty maintaining ultrasound machines (47%), and lack of equipment (46%) .…”

“…Yet the vast majority of providers in these countries have received less training than World Health Organization standards (3-6 months' directed education and performance of 300-500 studies). 21,22 In one survey of providers (N = 138) from 44 lowand middle-income countries, lack of training (60%)…”

Opportunities and Challenges in Realizing Universal Access to Obstetric Ultrasound in Sub-Saharan Africa

“…As the clinical value of sonography is well established, efforts now need to be geared towards making obstetric ultrasound part of comprehensive antenatal care. With current technological developments in equipment quality and increasing access to smaller devices and mobile data/telemetry links that enable provision of services in remote locations together with the phenomenal reduction in costs, it should be possible for sonography to be made available in all primary health care settings [5][6][7]. Indeed, we have deployed midwives trained to undertake antenatal scans using portable devices in settings remote from our hospital with image telemetry transmitted using cheap mobile phone technology with encouraging results (personal communications).…”