Addressing Obstetrical Challenges at 12 Rural Ugandan Health Facilities: Findings from an International Ultrasound and Skills Development Training for Midwives in Uganda

Abstract

Background:Like much of Sub-Saharan Africa, Uganda is facing significant maternal and fetal health challenges. Despite the fact that the majority of the Uganda population is rural and the major obstetrical care provider is the midwife, there is a lack of data in the literature regarding rural health facilities’ and midwives’ knowledge of ultrasound technology and perspectives on important maternal health issues such as deficiencies in prenatal services.Methodology:A survey of the current antenatal diagnostic and management capabilities of midwives at 12 rural Ugandan health facilities was performed as part of an international program initiated to provide ultrasound machines and formal training in their use to midwives at antenatal care clinics.Results:The survey revealed that the majority of pregnant women attend less than the recommended minimum of four antenatal care visits. There were significant knowledge deficits in many prenatal conditions that require ultrasound for early diagnosis, such as placenta previa and macrosomia. The cost of providing ultrasound machines and formal training to 12 midwives was $6,888 per powered rural health facility and $8,288 for non-powered rural health facilities in which solar power was required to maintain ultrasound.Conclusions and Global Health Implications:In order to more successfully meet Millennium Development Goal 4 (reduce child mortality), 5 (improve maternal health) and 6 (combat HIV) through decreasing maternal to child transmission of HIV, the primary healthcare provider, which is the midwife in Uganda, must be competent at the diagnosis and management of a wide spectrum of obstetrical challenges. A trained ultrasound-based approach to obstetrical care is a cost effective method to take on these goals.

Exploring the availability and impact of antenatal point‐of‐care ultrasound services in rural and remote communities: A scoping review

“…The initial search yielded 3863 original results; however, 17 studies remained for inclusion after screening, as per the study protocol (see Figure ). Majority of the results were observational studies, with 7 prospective cohort studies, 3 cross‐sectional studies and 1 retrospective data analysis . Other study designs included a non‐blinded clustered randomised control trial, a pre‐post survey, a randomised control trial, a blinded investigational study, a field action report and a survey followed by a pilot project …”

“…Africa was the region with the largest volume of literature, with 11 studies identified . Common themes explored included the utilisation of ANC, clinical knowledge and skills and patient outcomes.…”

“…Five observational studies from Africa reporting on PoCUS training were identified . These studies investigated the current clinical skills and/or outcomes of introducing antenatal PoCUS training and services in rural clinics.…”

“…Kinnevey et al . used a cross‐sectional design to investigate the cost of providing 12 midwives from different rural Ugandan health facilities with PoCUS equipment and a 6‐week antenatal PoCUS training programme.…”

“…used a cross‐sectional design to investigate the cost of providing 12 midwives from different rural Ugandan health facilities with PoCUS equipment and a 6‐week antenatal PoCUS training programme. The total cost of equipping a powered rural facility was $6888 USD ($3669 for training and $3219 for a Mindray DP‐10) and a non‐powered site was $8288, as additional costs were required to maintain the service using solar power . A pre‐training self‐assessment survey was administered to assess the prior ultrasound knowledge of the midwives and the nature of their clinics .…”