Feasibility of an ultrasound service on district health care level in Botswana

Bussmann, Hermann; Koen, Emy; Arhin‐Tenkorang, Dyna; Munyadzwe, Grace; Troeger, Jochen

doi:10.1046/j.1365-3156.2001.00807.x

Cited by 29 publications

(30 citation statements)

References 19 publications

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“…Although accurate gestational age assessment is not a problem unique to resource-poor settings [3–5], there is lower availability of US dating for women in these settings [6–8]. Owing to the sheer numbers of births and economics in developing countries, the LMP remains to be the most widespread predictor of gestational age [9,10].…”

Section: Introductionmentioning

confidence: 99%

Estimation of gestational age from fundal height: a solution for resource-poor settings

White

Lee

Stepniewska

et al. 2011

J. R. Soc. Interface.

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Many women in resource-poor settings lack access to reliable gestational age assessment because they do not know their last menstrual period; there is no ultrasound (US) and methods of newborn gestational age dating are not practised by birth attendants. A bespoke multiple-measures model was developed to predict the expected date of delivery determined by US. The results are compared with both a linear and a nonlinear model. Prospectively collected early US and serial symphysis-pubis fundal height (SFH) data were used in the models. The data were collected from Karen and Burmese women attending antenatal care on the Thai–Burmese border. The multiple-measures model performed best, resulting in a range of accuracy depending on the number of SFH measures recorded per mother (for example six SFH measurements resulted in a prediction accuracy of ±2 weeks). SFH remains the proxy for gestational age in much of the resource-poor world. While more accurate measures should be encouraged, we demonstrate that a formula that incorporates at least three SFH measures from an individual mother and the slopes between them provide a significant increase in the accuracy of prediction compared with the linear and nonlinear formulae also using multiple SFH measures.

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Section: Introductionmentioning

confidence: 99%

Estimation of gestational age from fundal height: a solution for resource-poor settings

White

Lee

Stepniewska

et al. 2011

J. R. Soc. Interface.

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“…If implemented on a broader scale, ultrasound would assist physicians and other healthcare workers in making more appropriate treatment decisions instead of having to use the ‘treat first, think later’ approach, thus having the potential to save precious time and resources. Ultrasound has been shown to be a useful and financially affordable adjunct to clinical diagnosis in a wide variety of pathologies at the district healthcare level 23 . Abdominal ultrasound should be introduced into clinical algorithms for the diagnosis of EPTB.…”

Section: Discussionmentioning

confidence: 99%

Abdominal tuberculosis: sonographic diagnosis and treatment response in HIV-positive adults in rural South Africa

Heller

Goblirsch

Wallrauch

et al. 2010

International Journal of Infectious Diseases

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SummaryObjectiveTo investigate the diagnostic value of abdominal ultrasound in HIV-positive inpatients in a rural African setting.MethodsThis was a prospective case series over 3 months of adult HIV-positive patients with symptoms suggestive of abdominal tuberculosis (TB). Diagnostic ultrasound was performed for all patients: sonographic criteria included abdominal lymph node enlargement (>1.5 cm) and focal splenic lesions; ascites was a supportive finding. Further diagnostic studies, e.g., aspiration or biopsy were not routinely performed. TB treatment was initiated on the basis of clinical and sonographic features. The patients were contacted after 4 months to evaluate the clinical outcome.ResultsOne hundred and eighty adult HIV-positive patients were screened; 30 (16.7%) showed sonographic signs of abdominal TB. The median CD4 count was 78 cells/mm3. Presenting symptoms were weight loss (86.7%), abdominal pain (76.7%), and diarrhea (60%). Abdominal lymph node enlargement was the diagnostic finding in almost all cases (96.7%); hypoechoic lesions of the spleen were seen in 50% and ascites in 73.3%. Follow-up information was available for 25 patients: 24% had died and the remaining 76% reported symptomatic improvement and weight gain.ConclusionsCharacteristic sonographic features of abdominal TB are common in HIV-infected inpatients in a rural African setting. Ultrasound should be introduced into clinical algorithms for the diagnosis of extrapulmonary TB.

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“…Diagnostic ultrasound is feasible in the rural health care setting in African countries and can improve case management in many clinical problems 12,13. It has to be noted that ultrasound is a highly operator-dependent tool.…”

mentioning

confidence: 99%

Short Course for Focused Assessment with Sonography for Human Immunodeficiency Virus/Tuberculosis: Preliminary Results in a Rural Setting in South Africa with High Prevalence of Human Immunodeficiency Virus and Tuberculosis

Heller¹,

Wallrauch²,

Lessells³

et al. 2010

The American Society of Tropical Medicine and Hygiene

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In Africa, human immunodeficiency virus (HIV)–associated extrapulmonary tuberculosis (TB) is common and poses diagnostic difficulties. Ultrasound is useful to find suggestive signs such as effusions or abdominal lymphadenopathy. Because trained radiologists are scarce in resource-poor settings, even this simple and relatively inexpensive diagnostic tool is frequently unavailable to patients in district hospitals in sub-Saharan Africa. We developed a focused protocol for assessment with sonography for HIV/TB and trained physicians in a rural district hospital in South Africa. In this pilot study, high levels of confidence in identifying specific signs were rapidly achieved and ultrasound was introduced into routine clinical practice.

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Feasibility of an ultrasound service on district health care level in Botswana

Cited by 29 publications

References 19 publications

Estimation of gestational age from fundal height: a solution for resource-poor settings

Estimation of gestational age from fundal height: a solution for resource-poor settings

Abdominal tuberculosis: sonographic diagnosis and treatment response in HIV-positive adults in rural South Africa

Short Course for Focused Assessment with Sonography for Human Immunodeficiency Virus/Tuberculosis: Preliminary Results in a Rural Setting in South Africa with High Prevalence of Human Immunodeficiency Virus and Tuberculosis

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