Impact of Introducing Routine Antenatal Ultrasound Services on Reproductive Health Indicators in Mpigi District, Central Uganda

Abstract

The preponderance of global maternal and neonatal deaths occurs in low-resource countries. The risk factors that lead to these deaths are often detectable with ultrasound (US) and potentially preventable. We assessed the impact of performing US scanning during antenatal care (ANC) on reproductive health service utilization in a rural Ugandan district. This pragmatic comparative study was conducted in 2 constituencies of Mpigi district in Uganda. In the 5 intervention sites located in the Mawokota North constituency, facility midwives were trained in limited obstetric US scanning. They were equipped with solar-powered portable US machines and redeployed to offer US scanning as an integral component of ANC. The 5 control sites in the Mawokota South constituency offered the same ANC services without US scanning. We compared the difference in the first and fourth ANC attendance, facility deliveries, and referral of obstetric complications in the intervention and the control sites before and after the introduction of US. There was a 32% increase in the first ANC attendance at the intervention sites compared with 7.4% in the controls sites (P < 0.001). In the intervention sites, the fourth antenatal attendance increased by 147% compared with 0.6% decline in the control sites (P < 0.001). Referrals of high-risk pregnancies increased by 40.7% in the intervention sites compared with 25% in the control site. The number of births at the interventional sites increased by 34.1% compared with 29.5% in the control sites. Integration of limited obstetric US into routine ANC visits is associated with an increase in ANC attendance.

Improved maternity care if midwives learn to perform ultrasound: a qualitative study of Rwandan midwives’ experiences and views of obstetric ultrasound

“…Other studies have shown that introducing obstetric ultrasound at the lowest level of the healthcare system in a low-resource setting increases ANC attendance and referral of high-risk pregnancies, and can motivate women to give birth at a health facility [46,47]. The participants also wished to decrease the gap between different socio-economic groups in relation to access to obstetric ultrasound.…”

Perception of Ghanaian Primigravidas Undergoing Their First Antenatal Ultrasonography in Cape Coast

“…A correct determination of gestational age is needed to distinguish preterm newborns from newborns who are with low birth weight (but not preterm), which is important because the needed interventions may differ [ 9 ]. The regular use of ultrasound scan in the management of pregnancy has dramatically improved the detection of high-risk pregnancies and increased prenatal care attendance although there is no consensus about whether the use of obstetric ultrasound has the ability to decrease maternal and child mortality in low- and middle-income countries [ 10 – 12 ].…”

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

“…[15] If applied to the statistics provided by the midwives, this would mean an average of an additional 2-3 obstetrics referrals per midwife per month. The need for increased human resources is also supported by the 2006 World Health Report, which estimated that an additional 1.5 million health care workers would be needed in Africa to meet the health care demands.…”