Abstract
BackgroundNepal 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.MethodsWe 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.ResultsA 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.ConclusionThe 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.
Highlights
Nepal has a high prevalence of congenital anomaly contributing to high infant mortality
The course was for two days and titled “The Ultrasound, Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) Education Program for Obstetric, Fetal, Neonatal, and Congenital Anomaly” The course was conducted in collaboration with the Nepali Professional Societies
A total of 228 healthcare workers attended the program, and most of them were aged less than 30 years (46.5, 41.3, and 75.8% in 2016, 2017, and 2018, respectively) and were affiliated with medical colleges (70.7, 54.0, and 81.8% in 2016, 2017, and 2018, respectively), but participants representing other types of institutions such as private hospital, government hospital, healthcare center, and NonGovernmental Organization (NGO) hospital were present
Summary
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. 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. Congenital anomaly contributes to 5–7% of perinatal and neonatal mortality in low- and middle-income countries (LMICs) [1]. Literature on the care and management of defects in Nepal is limited. Ultrasound is an important noninvasive screening tool that detects congenital anomalies and manages maternity-related risk factors for both morbidity and mortality [5, 6]. The World Health Organization (WHO) recommends pregnant women undergo at least one ultrasound scan before 24 weeks of gestation [7]
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