Introduction Ultrasound imaging is an important aspect of antenatal care, though access to antenatal ultrasound imaging is limited in many developing countries. The objective of this study was to evaluate a pilot programme which aimed to improve access to antenatal ultrasound for rural Ethiopians through enhanced training of healthcare providers (including midwives, nurses and clinical officers) with support remotely provided by obstetricians using a tele-ultrasound platform. Methods Thirteen healthcare providers in the North Shoa Zone in Ethiopia completed training to enable them to perform antenatal ultrasound with the remote supervision of an obstetrician via a tele-ultrasound platform. Pregnant women attending an antenatal appointment at two facilities were offered an antenatal ultrasound exam performed by one of the healthcare providers. Image interpretations between obstetricians and healthcare providers were compared. Participants and healthcare providers were invited to complete a questionnaire regarding their experience with tele-ultrasound, and participants, healthcare providers and obstetricians were interviewed regarding their experience with the tele-ultrasound pilot programme. Results 2795 pregnant women had an antenatal ultrasound exam. Of 100 exams randomly selected to assess concordance between healthcare providers’ and obstetricians’ image interpretations, concordance ranged from 79% to 100% for each parameter assessed. 99.4% of participants surveyed indicated that they would recommend antenatal ultrasound using tele-ultrasound to friends and family. Themes relating to participants’ experiences of having a tele-ultrasound exam were reduced travel and cost, equivalence in quality of virtual care to in-person care and empowerment through diagnostic information. Conclusion Healthcare provider–performed antenatal ultrasound – supported by obstetricians via tele-ultrasound – showed high levels of concordance, was well-received by participants and provided rural Ethiopian women with enhanced access to antenatal imaging.

For decades, as evidenced in programming and research, the humanitarian community has recognised gender equality and equity as integral to effective programming and response. Drawing upon ninety-nine publications indexed on the Web of Science and Google Scholar, this paper explores available evidence on gender and crisis settings in Africa to synthesise and critically analyse what is being learned. We found that limited research and programming have explicitly aimed to have gender transformative impacts, and those that do fail to adequately declare or reflect on the biases and intricacies of aiming to transform social norms in complex sociocultural contexts. Additionally, this review examines the trend of the body of research, highlighting the affiliation of authors and the geographical areas of focus. Evidence shows that research in this area is dominated by scholars affiliated with institutions in the Global North, raising questions relating to knowledge production and epistemic injustice in Africa.

Within bilateral and multilateral funding circles, there has been a strong and growing emphasis on the importance of understanding and responding to gender inequalities in humanitarian settings. However, given the often-short funding cycles, among other operational challenges, there is limited scope to incorporate interventions that address the root causes and social norms underpinning gender inequalities, or other gender transformative interventions. In the context of the decade-long crisis in the Lake Chad Basin, fuelled by incursions from non-state armed groups (NSAGs), including Boko Haram, and the resultant protracted and chronic humanitarian crisis, this article examines Save the Children’s child nutrition programmes in northeast Nigeria. Taking an ethnographic approach focused on volunteer-driven peer support groups (mother-to-mother and father-to-father) that aim to increase knowledge on best practices for infant and child nutrition, we investigate whether these activities are transforming societal gender norms. While evidence shows an improved understanding and awareness of gender-positive roles by both men and women, restrictive gender norms remain prevalent, including among lead volunteers. We suggest the possibility of longer term shifts in power dynamics in the home and society at large as well as suggest how humanitarian response can better integrate gender transformative programming.