Institutionalization of limited obstetric ultrasound leading to increased antenatal, skilled delivery, and postnatal service utilization in three regions of Ethiopia: A pre-post study

Abawollo, Hailemariam Segni; Argaw, Mesele Damte; Tsegaye, Zergu Taffesse; Beshir, Ismael Ali; Guteta, Asfaw Adugna; Heyi, Atrie Fekadu; Mengesha, Birhan Tenaw; Mamo, Tsega Teferi; Gebremedhin, Zenawork Kassa; Damte, Heran Demissie; Kibret, Mengistu Asnake; Desta, Binyam Fekadu

doi:10.1371/journal.pone.0281626

Cited by 4 publications

(2 citation statements)

References 28 publications

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“…An observational study evaluating pointof-care ultrasound in Ethiopia, indicated an increased utilisation of rst and fourth ANC visits in primary facilities comparing pre-and post-introduction periods using routine service statistics. 21 Similarly, two studies in Uganda, a cluster-randomised trial advertising ultrasound and a pre-post assessment with non-randomised comparison facilities indicated increase in ANC attendances. 22,23 However, a welldesigned cluster-randomized trial in ve LMIC countries, among them Kenya, did not indicate increased use of ANC.…”

Section: Discussionmentioning

confidence: 98%

Feasibility and effects of the Mimba Yangu (My Pregnancy) project in improving routine prenatal ultrasound by nurses-midwives in rural Kenya: A before-after study

Nyaga,

Hanson,

Leekha

et al. 2024

Preprint

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Introduction Point-of-care ultrasound delivered by nurses and midwives has the potential to improve the quality of antenatal care. The 2016 World Health Organizations Antenatal Care Guidelines recommend one ultrasound below 24 weeks of gestational age for every pregnant woman, however programming is facing difficulties. Here we report on the feasibility, effects and acceptability of the Mimba Yangu implementation research project in Kenya using point-of-care ultrasound supported by digital training and supervision. Methods We conducted a quasi-experimental trial including 28 primary care facilities in Kilifi County, Kenya between April 2021 and March 2022. Fourteen facilities received the ultrasound intervention composed of i) a task-shifting approach where ultrasound was delivered by nurses-midwives using portable ultrasound devices (LumifyTM) connected to a tablet and ii) a unique digital platform to facilitate distant support. Hybrid training of 32 nurse-midwives was provided based on a nationally derived and agreed curriculum including theoretical and hands-on components by an academic team of obstetricians and radiologists. Data collection used i) exit interviews with pregnant women and those who had delivered within the last six months, and ii) data abstraction from the health facility records and Kenyan health management information system, and iii) in-depth interviews with nurse-midwives and health care managers. We descriptively analyzed data and used a difference-in-difference analysis based on a generalized linear model to assess the effect of the intervention on the number of antenatal visits. Results The intervention was successfully and consistently implemented during a nine-month period in all 14 health facilities with 2,799 pregnant women. Interviews with trained nurse-midwives indicated that the intervention was relevant, acceptable, and feasible. In intervention facilities, 50.4% of women received at least one ultrasound compared to 19.2% in the comparison facilities, where women were referred to other facilities for their ultrasound. Furthermore, our analysis suggested a non-significant change of 10.5% in ANC 4+ visits in the intervention compared to comparison facilities. Conclusion Our analysis provides evidence of the feasibility, acceptance and relevance of providing ultrasound at primary care level delivered by nurse-midwives. Scaling-up will demand policy reforms to allow task-sharing at national and sub-national levels and embedding the approach in basic nursing/midwifery education.

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Section: Discussionmentioning

confidence: 98%

Feasibility and effects of the Mimba Yangu (My Pregnancy) project in improving routine prenatal ultrasound by nurses-midwives in rural Kenya: A before-after study

Nyaga,

Hanson,

Leekha

et al. 2024

Preprint

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“…Unlike HICs, where ultrasonography, genetic testing, and other prenatal evaluations may identify which newborns are likely to be imperiled or have a poor prognosis, such anticipation is only recently being provided in LMICs with the expanding use of ultrasound ( 57 ). Thus, many perinatal/neonatal deaths happen unexpectedly, without adequate preparation and discussion with the family.…”

Section: Introductionmentioning

confidence: 99%

Perinatal palliative care in sub-Saharan Africa: recommendations for practice, future research, and guideline development

et al. 2023

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Worldwide, sub-Saharan Africa has the highest burden of global neonatal mortality (43%) and neonatal mortality rate (NMR): 27 deaths per 1,000 live births. The WHO recognizes palliative care (PC) as an integral, yet underutilized, component of perinatal care for pregnancies at risk of stillbirth or early neonatal death, and for neonates with severe prematurity, birth trauma or congenital anomalies. Despite bearing a disproportionate burden of neonatal mortality, many strategies to care for dying newborns and support their families employed in high-income countries (HICs) are not available in low-and-middle-income countries (LMICs). Many institutions and professional societies in LMICs lack guidelines or recommendations to standardize care, and existing guidelines may have limited adherence due to lack of space, equipment, supplies, trained professionals, and high patient load. In this narrative review, we compare perinatal/neonatal PC in HICs and LMICs in sub-Saharan Africa to identify key areas for future, research-informed, interventions that might be tailored to the local sociocultural contexts and propose actionable recommendations for these resource-deprived environments that may support clinical care and inform future professional guideline development.

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Utilization of Antenatal Care and Skilled Birth Delivery Services in Sub-Saharan Africa: A Systematic Scoping Review

Lateef,

Kuupiel,

Mchunu

et al. 2024

IJERPH

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Daily, the number of women who die around the world reaches an average of 800; these deaths are a result of obstetric complications in pregnancy and childbirth, and 99% of these deaths occur in low- and middle-income countries. This review probes the use of antenatal care (ANC) and skilled birth delivery (SBD) services in sub-Saharan Africa (SSA) and highlights research gaps using Arksey and O’Malley’s methodological approach. The screening of abstracts and full text was carried out by two independent authors who ensured the eligibility of data extraction from the included articles. An exploration of the data was undertaken with descriptive analyses. In total, 350 potentially eligible articles were screened, and 137 studies were included for data extraction and analysis. From the 137 included studies, the majority were from Ethiopia (n = 40, 29.2%), followed by Nigeria (n = 30, 21.9%). Most of the studies were published between 2019 and 2023 (n = 84, 61%). Significant trends and challenges with ANC and SBD services emerged from the studies. It is revealed that there are wide gaps in the utilization of ANC and SBD services. Policy attention, intervention strategies to improve access, resources, rural–urban disparity, and women’s literacy are recommended to improve the utilization of ANC and SBD services in SSA countries.

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Institutionalization of limited obstetric ultrasound leading to increased antenatal, skilled delivery, and postnatal service utilization in three regions of Ethiopia: A pre-post study

Cited by 4 publications

References 28 publications

Feasibility and effects of the Mimba Yangu (My Pregnancy) project in improving routine prenatal ultrasound by nurses-midwives in rural Kenya: A before-after study

Feasibility and effects of the Mimba Yangu (My Pregnancy) project in improving routine prenatal ultrasound by nurses-midwives in rural Kenya: A before-after study

Perinatal palliative care in sub-Saharan Africa: recommendations for practice, future research, and guideline development

Utilization of Antenatal Care and Skilled Birth Delivery Services in Sub-Saharan Africa: A Systematic Scoping Review

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