Implementing Diagnostic Imaging Services in a Rural Setting of Extreme Poverty: Five Years of X-ray and Ultrasound Service Delivery in Achham, Nepal

Filkins, Malina; Halliday, Scott; Daniels, Brock; Bista, Roshan; Thapa, Sudan; Schwarz, Ryan; Schwarz, Dan; Gauchan, Bikash; Maru, Duncan

doi:10.7191/jgr.2015.1001

Cited by 8 publications

(10 citation statements)

References 35 publications

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“…In Nepal, radiologists generally perform ultrasound scans, but Nepal has only 150 radiologists (1 per 185,000 populations), who are largely concentrated around the capital city [10]. This uneven distribution overwhelms ultrasound services in urban areas and thus, service quality control in antenatal care is difficult to achieve [10][11][12]. Moreover, non-radiologists have limited ultrasound training during their medical school, engaging only a short 15-day rotation in the radiology department.…”

Section: Introductionmentioning

confidence: 99%

An evaluation of obstetric ultrasound education program in Nepal using the RE-AIM framework

et al. 2021

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Background Nepal has a high prevalence of congenital anomaly contributing to high infant mortality. Ultrasound, an important tool to detect congenital anomalies and manage maternity-related risk factors, is not properly used in Nepal because Nepali doctors have limited opportunities for learning ultrasound techniques. Hence, we developed and implemented an ultrasound education program from 2016 to 2018. The objective of this study is to evaluate the education program using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Methods We conducted a mixed-method study to evaluate each component of RE-AIM. The team collected quantitative data from administrative records, tests, surveys, and an online follow-up survey. Qualitative data were collected from individual in-depth interviews at least a year after the program. The proportions, means, and t-tests were used for quantitative data, and thematic coding for qualitative data. Results A total of 228 healthcare workers representing 27.3% of the districts of Nepal were reached from 2016 to 2018. The program improved participants’ knowledge (29.3, 8.7, and 23.8 increases out of 100, each year, p< 0.001, n=85) and self-confidence (0.6, 0.3, 1.3 increases out of 4.0, p< 0.01, n=111). The participants were highly satisfied with the program (4.2, 4.1, and 4.0 out of 5.0, n=162). Among the respondents of the online follow-up survey (n=28), 60.7% had used ultrasound in their daily practice after the education program, and a medical institution established an ultrasound training center. The absence of clear accreditation and practical guidelines in ultrasound use were presented as barriers for adoption and maintenance. Conclusion The program was successful in improving participant’s knowledge and self-confidence in ultrasound techniques and showed great potential for the adoption and maintenance of the techniques in their practice. Continuous implementation of the program and institutional policy changes to facilitate ultrasound use may increase the ultrasound use and improve ultrasound service quality in Nepal.

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Section: Introductionmentioning

confidence: 99%

An evaluation of obstetric ultrasound education program in Nepal using the RE-AIM framework

et al. 2021

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“…The limited use may be due to more severe illness in infants with suspected NEC and the lack of mobile X-ray machines. Previous research in LMIC settings has reported that diagnosis is impaired by a lack of abdominal X rays, since even when X-ray machines are available and functioning, they are often too expensive for patients and families to afford 32. This is likely here since only two out of the seven NNUs provide free of charge neonatal health services.…”

Section: Discussionmentioning

confidence: 99%

“…Previous research in LMIC settings has reported that diagnosis is impaired by a lack of abdominal X rays, since even when X-ray machines are available and functioning, they are often too expensive for patients and families to afford. 32 This is likely here since only two out of the seven NNUs provide free of charge neonatal health services. This means that diagnosis is very difficult for conditions such as NEC where specific X-ray findings are critically important.…”

Section: Discussionmentioning

confidence: 99%

Prospective observational study of the challenges in diagnosing common neonatal conditions in Nigeria and Kenya

et al. 2022

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ObjectivesAccurate and timely diagnosis of common neonatal conditions is crucial for reducing neonatal deaths. In low/middle-income countries with limited resources, there is sparse information on how neonatal diagnoses are made. The aim of this study was to describe the diagnostic criteria used for common conditions in neonatal units (NNUs) in Nigeria and Kenya.DesignProspective observational study. Standard case report forms for suspected sepsis, respiratory disorders, birth asphyxia and abdominal conditions were co-developed by the Neonatal Nutrition Network (https://www.lstmed.ac.uk/nnu) collaborators. Clinicians completed forms for all admissions to their NNUs. Key data were displayed using heatmaps.SettingFive NNUs in Nigeria and two in Kenya comprising the Neonatal Nutrition Network.Participants2851 neonates, which included all neonates admitted to the seven NNUs over a 6-month period.Results1230 (43.1%) neonates had suspected sepsis, 874 (30.6%) respiratory conditions, 587 (20.6%) birth asphyxia and 71 (2.5%) abdominal conditions. For all conditions and across all NNUs, clinical criteria were used consistently with sparse use of laboratory and radiological criteria.ConclusionOur findings highlight the reliance on clinical criteria and extremely limited use of diagnostic technologies for common conditions in NNUs in sub-Saharan Africa. This has implications for the management of neonatal conditions which often have overlapping clinical features. Strategies for implementation of diagnostic pathways and investment in affordable and sustainable diagnostics are needed to improve care for these vulnerable infants.

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“…West D et al [ 11 ] reported that the use of mobile devices and mobile ultrasound services help with maternal care, chronic disease management and disease epidemics. They improve the efficiency and effectiveness of the medical system through patient tracking and reporting and they extend critically needed health services to underserved areas [ 10 - 12 ]. The report also showed that the mobile ultrasound patrol program in Morocco uses portable ultrasound machines and 3D smart phones to improve diagnostic times for expectant mothers [ 11 ]…”

Section: Introductionmentioning

confidence: 99%

“…Nigeria is the most populous country in Africa and many areas have little or no access to adequate healthcare, well below that of other African countries. The country represents a potentially important example of mobile health solution with more than 174 million residents [ 10 - 12 ].…”

Section: Introductionmentioning

confidence: 99%

The Value of Mobile Ultrasound Services in Rural Communities in South-South Nigeria

Ikpeme

Ani

Ago

et al. 2017

Open Access Maced J Med Sci

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AIM:This paper examines the activities of mobile services units including ultrasound services in rural and urban communities in the Calabar region of South-South, Nigeria.MATERIALS AND METHODS:Consenting individuals were invited and attended five medical outreach activities in rural and urban areas of the Calabar region between January and June 2016. Abdomino-pelvic scans were done. Subsequently the results were analyzed.RESULTS:Five hundred and seventy-four (574) individuals had Abdomino-pelvic scans done, using a curvilinear probe to assess the abdomino-pelvic organs. The female to male ratio was 1.46:1. The age ranged from 1-78 years with a mean of 40.63 (standard deviation of 17.5). The commonest sonographic finding was uterine fibroids, 21 (8.1%). Fifty-four percent of the scans were normal. The commonest sonographic finding in men was prostatic enlargement.CONCLUSION:Medical outreach activities provided by mobile units provide much needed ultrasound services in poor resource settings in Nigeria. Significant clinical pathologies were identified at fairly high rates.

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Implementing Diagnostic Imaging Services in a Rural Setting of Extreme Poverty: Five Years of X-ray and Ultrasound Service Delivery in Achham, Nepal

Cited by 8 publications

References 35 publications

An evaluation of obstetric ultrasound education program in Nepal using the RE-AIM framework

An evaluation of obstetric ultrasound education program in Nepal using the RE-AIM framework

Prospective observational study of the challenges in diagnosing common neonatal conditions in Nigeria and Kenya

The Value of Mobile Ultrasound Services in Rural Communities in South-South Nigeria

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