Assessing the utility of ultrasound in Liberia

Abstract

Sub-Saharan Africa has sparse imaging capacity, and data on ultrasound (US) use is limited. We collected prospective data on consecutive patients undergoing US to assess disease spectrum and US utility in Liberia. A total of 102 patients were prospectively enrolled. Average age was 33 years (0-84), 80% were female. US indications were: 53% Obstetrics/Gynecology (OB/GYN) (24% gynecologic, 17% second/third trimester, 12% first trimester), 14% hepatobiliary, 10% intraperitoneal/intrathoracic fluid, 8% cardiac, 5% focused assessment of sonography in trauma, and 4% renal. US changed management in 62% of cases. Greatest impact was in first trimester OB (86%), FAST (83%), ECHO (80%), and second/third trimester OB (77%). US changed management in 47% of right upper quadrant and 33% of gynecologic studies. Curvilinear probe addressed over 80% of need. The primary role for US in developing countries is in management of obstetrics, with a secondary role for traumatic and a-traumatic abdominal processes. Most needs can be met with the curvilinear probe. Training should begin with obstetrics and should be a primary focus for curriculum.

Review: indications for ultrasound use in low‐ and middle‐income countries

“…(Table 1) Four articles documented the use of ultrasound by medical volunteers on missions in Ghana, Liberia, Mexico and Gambia (Kobal et al. 2004a,b; Kotlyar & Moore 2008; Spencer & Adler 2008).…”

“…Of the expert opinion articles, 4 (33%) were from sub-Saharan Africa and 9 (75%) from high-income countries. (Table 1) Four articles documented the use of ultrasound by medical volunteers on missions in Ghana, Liberia, Mexico and Gambia (Kobal et al 2004a,b;Kotlyar & Moore 2008;Spencer & Adler 2008).…”

“…The use of FAST as an important adjunct in trauma care has been documented in articles from South Africa, Liberia, Rwanda and Peru (Kotlyar & Moore 2008; Shah et al. 2009; Crouch et al.…”

Review article: Use of ultrasound in the developing world

“…The greatest impact on patient management was seen with first trimester obstetric ultrasound, followed by FAST, cardiac and second/third trimester ultrasound exams; the smallest impact was seen in RUQ and gynecologic studies [3]. …”

Evaluation of an Obstetric Ultrasound Curriculum for Midwives in Liberia

“…The needs in low‐ and middle‐income countries are varied, however. A prior investigation in Liberia demonstrated that bedside ultrasound may have the most impact in obstetric care 5 . A South African study in 2013 found that point‐of‐care ultrasound was widely used in the emergent clinical setting and that the ultrasound modalities most commonly used did reflect the local burden of disease.…”