Obstetric ultrasound use in low and middle income countries: a narrative review

Abstract

IntroductionAlthough growing, evidence on the impact, access, utility, effectiveness, and cost-benefit of obstetric ultrasound in resource-constrained settings is still somewhat limited. Hence, questions around the purpose and the intended benefit as well as potential challenges across various domains must be carefully reviewed prior to implementation and scale-up of obstetric ultrasound technology in low-and middle-income countries (LMICs).Main BodyThis narrative review discusses these issues for those trying to implement or scale-up ultrasound technology in LMICs. Issues addressed in this review include health personnel capacity, maintenance, cost, overuse and misuse of ultrasound, miscommunication between the providers and patients, patient diagnosis and care management, health outcomes, patient perceptions and concerns about fetal sex determination.ConclusionAs cost of obstetric ultrasound becomes more affordable in LMICs, it is essential to assess the benefits, trade-offs and potential drawbacks of large-scale implementation. Additionally, there is a need to more clearly identify the capabilities and the limitations of ultrasound, particularly within the context of limited training of providers, to ensure that the purpose for which an ultrasound is intended is actually feasible. We found evidence of obstetric uses of ultrasound improving patient management. However, there was evidence that ultrasound use is not associated with reducing maternal, perinatal or neonatal mortality. Patients in various studies reported to have both positive and negative perceptions and experiences related to ultrasound and lastly, illegal use of ultrasound for determining fetal sex was raised as a concern.

Health Pregnancy, Healthy Baby: testing the added benefits of pregnancy ultrasound scan for child development in a randomised control trial

“…US studies conducted in sub-Saharan Africa have principally focused on US costs, maintenance, training, human resources, acceptability and other aspects of feasibility, including in Ghana [25], Kenya [26], Zambia [27], Nigeria [28][29][30], Rwanda [31], South Africa [32], Tanzania [33,34] and Uganda [35,36]. In general, US is thought to enhance antenatal care through confirmation of pregnancy status and more accurate estimation of gestational age, but concerns remain about feasibility of wide-scale use in low and middle-income countries and the potential misuse of US for sex determination in countries with a high preference for male children [37]. A recent, large, clusterrandomised control trial in Pakistan, Kenya, Zambia, DRC and Guatemala suggested that US did not increase ANC use or hospital births [38].…”

Health Pregnancy, Healthy Baby: Testing the added benefits of pregnancy ultrasound for child development in a randomised control trial

“…Uganda (35,36). In general US is thought to enhance antenatal care through confirmation of pregnancy status and more accurate estimation of gestational age, but concerns remain about feasibility of wide-scale use in low and middle-income countries and the potential misuse of US for sex determination in countries with high preference for male children (37). A recent large clusterrandomised control trial in Pakistan, Kenya, Zambia, DRC and Guatemala suggested that US did not increase ANC use or hospital births (38).…”

Portable Continuous Wave Doppler Ultrasound for Primary Healthcare in South Africa: Can the EUnetHTA Core Model Guide Evaluation Before Technology Adoption?

“…However, Goldenberg et al [7] in their cluster randomized trial, concluded that routine conventional ultrasound found no effect on ANC attendance, reduction in maternal, stillbirth or neonatal mortality. Furthermore, it seems to contribute to the improvement of patient management and the con rmation of clinically suspected obstetric complications [8]. The potential impact of routine ultrasound use in LMICs where perinatal and maternal mortality rates are high, and access to and quality of antenatal care are poor [7,9] can be signi cant.…”