Community survey on awareness and use of obstetric ultrasonography in rural Sarlahi District, Nepal

Abstract

Objective To assess levels of awareness and use of obstetric ultrasonography in rural Nepal. Methods Between March 2014 and March 2015, a cross-sectional survey was conducted among married women aged 15–40 years residing in rural Sarlahi District, Nepal, regarding their knowledge and use of obstetric ultrasonography during their most recent pregnancy. Regression analyses were used to identify reproductive health, socioeconomic, and other characteristics that increased the likelihood of undergoing an obstetric ultrasonographic examination. Results Among 6182 women, 1630 (26.4%) had undergone obstetric ultrasonography during their most recent pregnancy, of whom 1011 (62.0%) received only one examination. Odds of receiving an ultrasonographic examination were higher among women with higher education than among those with none (≥11 years’ education: adjusted odds ratio [aOR] 10.28, 95% confidence interval [CI] 5.55–19.04), and among women whose husbands had higher education than among those with husbands with none (≥11 years’ education: aOR 1.99, 95% CI 1.47–2.69). Odds were lower among women younger than 18 years than among those aged 18–34 years (aOR 0.72, 95% confidence interval 0.59–0.90). Conclusion Utilization of obstetric ultrasonography in rural Nepal was very limited. The health community should actively work toward researching the potential health impact of obstetric ultrasonography in low-resource settings, while addressing limitations such as cost and misuse.

Obstetric ultrasound use in low and middle income countries: a narrative review

“…In the same study, 2.6% of respondents had ever requested fetal sex determination and when the female sex of the fetus was disclosed, over 63% of them were aborted [ 9 , 41 ]. In a study in Nepal, 6.8% of surveyed pregnant women received ultrasound exams for fetal sex determination despite it being unlawful [ 42 ]. The study also found that compared to women who had at least one live born son prior to the recent pregnancy, women with no live born sons and three or more live born daughters had 1.55 higher odds of receiving an ultrasound exam, which may suggest use for fetal sex determination [ 42 ].…”

“…In a study in Nepal, 6.8% of surveyed pregnant women received ultrasound exams for fetal sex determination despite it being unlawful [ 42 ]. The study also found that compared to women who had at least one live born son prior to the recent pregnancy, women with no live born sons and three or more live born daughters had 1.55 higher odds of receiving an ultrasound exam, which may suggest use for fetal sex determination [ 42 ]. Other popular reasons for determining fetal sex were reported to be curiosity and preparation for the baby [ 43 , 44 ].…”

Perceptions, careseeking, and experiences pertaining to non-cephalic births in rural Sarlahi District, Nepal: a qualitative study

“…The high risk associated with malpresentation underlies the value of tertiary care, but the impracticality of the recommendation shone through the experiences of numerous women. Some facilities in this area abide by a blanket referral protocol for non-cephalic presentation as reported elsewhere [ 14 ] and hinted by interviewees, but the arduousness of completing that referral puts into question the clinical value. Both lower-level clinicians and families face the reality of the risk associated with the lower capacity available in greater proximity and the risk associated with the journey for tertiary care, without a guarantee of timely and high quality care.…”

“…This issue also applies to the value of diagnostics. Most women interviewed for the study were unaware of the condition prior to delivery, which was triangulated through quantitative data [ 14 ]. Ultrasonography is the only gold standard method of detecting non-cephalic presentation prior to delivery, and access and utilization are sparse in low-resource settings.…”

“…Ultrasonography is the only gold standard method of detecting non-cephalic presentation prior to delivery, and access and utilization are sparse in low-resource settings. In our study area, only about a quarter of women received an obstetric ultrasound exam during their most recent pregnancy [ 14 ]. While early diagnosis could translate to earlier care-seeking, the distance barrier and the possibility of poor care still remain and ultrasonography also has high associated cost.…”