Impact of the introduction of ultrasound services in a limited resource setting: rural Rwanda 2008

Abstract

BackgroundOver the last decade, utilization of ultrasound technology by non-radiologist physicians has grown. Recent advances in affordability, durability, and portability have brought ultrasound to the forefront as a sustainable and high impact technology for use in developing world clinical settings as well. However, ultrasound's impact on patient management plans, program sustainability, and which ultrasound applications are useful in this setting has not been well studied.MethodsUltrasound services were introduced at two rural Rwandan district hospitals affiliated with Partners in Health, a US nongovernmental organization. Data sheets for each ultrasound scan performed during routine clinical care were collected and analyzed to determine patient demographics, which ultrasound applications were most frequently used, and whether the use of the ultrasound changed patient management plans. Ultrasound scans performed by the local physicians during the post-training period were reviewed for accuracy of interpretation and image quality by an ultrasound fellowship trained emergency medicine physician from the United States who was blinded to the original interpretation.ResultsAdult women appeared to benefit most from the presence of ultrasound services. Of the 345 scans performed during the study period, obstetrical scanning was the most frequently used application. Evaluation of gestational age, fetal head position, and placental positioning were the most common findings. However, other applications used included abdominal, cardiac, renal, pleural, procedural guidance, and vascular ultrasounds.Ultrasound changed patient management plans in 43% of total patients scanned. The most common change was to plan a surgical procedure. The ultrasound program appears sustainable; local staff performed 245 ultrasound scans in the 11 weeks after the departure of the ultrasound instructor. Post-training scan review showed the concordance rate of interpretation between the Rwandese physicians and the ultrasound-trained quality review physicians was 96%.ConclusionWe suggest ultrasound is a useful modality that particularly benefits women's health and obstetrical care in the developing world. Ultrasound services significantly impact patient management plans especially with regards to potential surgical interventions. After an initial training period, it appears that an ultrasound program led by local health care providers is sustainable and lead to accurate diagnoses in a rural international setting.

The Impact of Systematic Point-of-Care Ultrasound on Management of Patients in a Resource-Limited Setting

“…This is particularly relevant in resource-limited settings where patients may present to health services with advanced stages of disease. 10 In settings where alternative diagnostic modalities are not easily accessible due to logistical and/or financial constraints, targeted POC ultrasonography has been shown to lead to the avoidance of additional costly investigations and the implementation of futile treatment based on incorrect diagnosis. 10,11 This study suggests that the application of a systematic POC ultrasound exam by clinicians with limited training can lead to improved diagnostic capabilities influencing the implementation of timely patient management.…”

“…10 This expense remains a key barrier in the implementation of the use of such technologies in hospitals such as BMC. However, these issues are not unique to the use of ultrasound.…”

“…8 A study in rural Rwanda concluded that POC ultrasonography targeted to certain clinical conditions changed initial patient management in 43% of cases, with the most frequent management change being a plan to take the patient for an interventional procedure. 10 The aim of this study was to determine whether application of a systematic POC ultrasound scanning protocol applied to inpatients in a resource-limited setting impacted patient management. It was conducted at a tertiary referral hospital in Mwanza, Tanzania, which services a population of approximately 12 million.…”

A feasibility study to determine if minimally trained medical students can identify markers of chronic parasitic infection using bedside ultrasound in rural Tanzania

“…These studies showed a high concordance rate between trainee images and radiologist assessment (>90%). [20][21][22] Furthermore, ultrasound can be used in numerous medical assessments. In the same study in Rwanda, of the fi rst 345 ultrasounds performed, the majority were performed for obstetrical purposes (102), followed by abdominal (94), cardiac (49), renal (40) and pulmonary (36), along with a few procedural usages, soft tissue and vascular examinations.…”

Role of Echocardiography in Research into Neglected Cardiovascular Diseases in Sub-Saharan Africa

“…Experiences for dissemination of echocardiography to non-traditional users in Rwanda and Tanzania have been designed aiming at the evaluation of pericardial effusion, rheumatic heart disease, congestive heart failure and estimation of global left ventricular function Adler et al, 2008). The impact of this technology diffusion is being quantified, but early results show that ultrasound is a teachable skill, leads to accuracy of diagnosis, helps in management of common cardiovascular conditions, and improves professional satisfaction of local health providers (Shah et al, 2009). The role of task-shifting inside the health systems to allow non-cardiologists to perform echocardiographic screening for RHD must therefore be studied.…”