Abstract
BackgroundIn June of 2010, an antenatal ultrasound program to perform basic screening for high-risk pregnancies was introduced at a community health care center in rural Uganda. Whether the addition of ultrasound scanning to antenatal visits at the health center would encourage or discourage potential patients was unknown. Our study sought to evaluate trends in the numbers of antenatal visits and deliveries at the clinic, pre- and post-introduction of antenatal ultrasound to determine what effect the presence of ultrasound at the clinic had on these metrics.Methods and FindingsRecords at Nawanyago clinic were reviewed to obtain the number of antenatal visits and deliveries for the 42 months preceding the introduction of ultrasound and the 23 months following. The monthly mean deliveries and antenatal visits by category (first visit through fourth return visit) were compared pre- and post- ultrasound using a Kruskal-Wallis one-way ANOVA. Following the introduction of ultrasound, significant increases were seen in the number of mean monthly deliveries and antenatal visits. The mean number of monthly deliveries at the clinic increased by 17.0 (13.3–20.6, 95% CI) from a pre-ultrasound average of 28.4 to a post-ultrasound monthly average of 45.4. The number of deliveries at a comparison clinic remained flat over this same time period. The monthly mean number of antenatal visits increased by 97.4 (83.3–111.5, 95% CI) from a baseline monthly average of 133.5 to a post-ultrasound monthly mean of 231.0, with increases seen in all categories of antenatal visits.ConclusionsThe availability of a low-cost antenatal ultrasound program may assist progress towards Millennium Development Goal 5 by encouraging women in a rural environment to come to a health care facility for skilled antenatal care and delivery assistance instead of utilizing more traditional methods.
Highlights
In 2000, 189 member states came together to sign the UnitedNations Millennium Declaration, a road map of ambitious goals to address the many faces of poverty widely prevalent in the world’s developing nations
The mean number of deliveries and Antenatal care (ANC) visits prior to, and after introduction of ultrasound are summarized in Figure 1 and Table 1
Significant increases were seen in the monthly mean number of deliveries and ANC visits following the introduction of the antenatal ultrasound program at Nawanyago (KW-ANOVA p-value,0.0001 in all cases)
Summary
Two targets were selected to monitor progress towards MDG 5 by the 2015 deadline: 1) reducing the maternal mortality ratio (MMR, defined as number of maternal deaths per 100000 live births) by 75% and 2) increasing the proportion of births attended by skilled health care personnel by 90%. The challenges identified are numerous and varied but include inadequate health care systems, low numbers of skilled birth attendants, high fertility rates, and low levels of education These problems are most acute in the rural areas of the developing world leading to staggering inequities in the burden of maternal death. Our study sought to evaluate trends in the numbers of antenatal visits and deliveries at the clinic, pre- and post-introduction of antenatal ultrasound to determine what effect the presence of ultrasound at the clinic had on these metrics
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