Effectiveness of advertising availability of prenatal ultrasound on uptake of antenatal care in rural Uganda: A cluster randomized trial

Abstract

In rural Uganda pregnant women often lack access to health services, do not attend antenatal care, and tend to utilize traditional healers/birth attendants. We hypothesized that receiving a message advertising that “you will be able to see your baby by ultrasound” would motivate rural Ugandan women who otherwise might use a traditional birth attendant to attend antenatal care, and that those women would subsequently be more satisfied with care. A cluster randomized trial was conducted across eight rural sub-counties in southwestern Uganda. Sub-counties were randomized to a control arm, with advertisement of antenatal care with no mention of portable obstetric ultrasound (four communities, n = 59), or an intervention arm, with advertisement of portable obstetric ultrasound. Advertisement of portable obstetric ultrasound was further divided into intervention A) word of mouth advertisement of portable obstetric ultrasound and antenatal care (one communitity, n = 16), B) radio advertisement of only antenatal care and word of mouth advertisement of antenatal care and portable obstetric ultrasound (one community, n = 7), or C) word of mouth + radio advertisement of both antenatal care and portable obstetric ultrasound (two communities, n = 75). The primary outcome was attendance to antenatal care. 159 women presented to antenatal care across eight sub-counties. The rate of attendance was 65.1 (per 1000 pregnant women, 95% CI 38.3–110.4) where portable obstetric ultrasound was advertised by radio and word of mouth, as compared to a rate of 11.1 (95% CI 6.1–20.1) in control communities (rate ratio 5.9, 95% CI 2.6–13.0, p<0.0001). Attendance was also improved in women who had previously seen a traditional healer (13.0, 95% CI 5.4–31.2) compared to control (1.5, 95% CI 0.5–5.0, rate ratio 8.7, 95% CI 2.0–38.1, p = 0.004). By advertising antenatal care and portable obstetric ultrasound by radio attendance was significantly improved. This study suggests that women can be motivated to attend antenatal care when offered the concrete incentive of seeing their baby.

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

“…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.…”

“…Four observational studies reporting on the utilisation of ANC demonstrated the association between the implementation of PoCUS services and ANC attendance . These studies used variable measures of outcome such as ANC attendance, service utilisation or the number of ANC interventions administered.…”

“…Cherniak et al . explored the relationship between advertising the availability of PoCUS and ANC attendance in a non‐blinded clustered randomised control trial.…”

Systematic review to identify proxy indicators to quantify the impact of eHealth tools on maternal and neonatal health outcomes in low-income and middle-income countries including Delphi consensus

“…114 Management of unintended pregnancy The better availability and implementation of the management of unintended pregnancy. Examples of a proxy indicator is medications for induced abortion (mifepristone and misoprostol).…”