Antenatal Doppler ultrasound implementation in a rural sub-Saharan African setting: exploring the perspectives of women and healthcare providers

Josaphat Byamugisha,Aris T Papageorghiou,Michael G Kawooya,Marcus J Rijken,Olive Kabajaasi,David Zakus,Sam Ali,Kerstin Klipstein-Grobusch

doi:10.1186/s12978-021-01233-5

Abstract

BackgroundThe World Health Organization recommends research to evaluate the effects of a single third trimester Doppler ultrasound examination on preventable deaths in unselected-risk pregnancies, particularly in low- and middle-income countries (LMICs) where the evidence base is scarce. While evaluating such technologies, researchers often ignore women and health care provider perspectives. This study explored the views and experiences of women and healthcare providers regarding the use of advanced ultrasound technology to optimize the health of mothers and their babies in a rural community in mid-western Uganda.MethodsWe enrolled 53 mothers and 10 healthcare providers, and captured data on their perceptions, barriers, and facilitators to the use of Doppler ultrasound technology using focus group discussions, semi-structured interviews and observations. Using qualitative content analysis, we inductively coded the transcripts in ATLAS.ti 8.0, detecting emerging themes.ResultsWomen were afraid that ultrasound would harm them or their fetuses and many of them had never seen an ultrasound scan. The majority of the women found their partners supportive to attend antenatal care and use ultrasound services. Healthcare providers in Kagadi Hospital were unfamiliar with Doppler technology and using it to guide clinical decisions. Other barriers to the implementation of Doppler ultrasound included shortage of trained local staff, insufficient equipment, long distance to and from the hospital, and frequent power cuts.ConclusionsWe found limited exposure to Doppler ultrasound technology among women and healthcare providers in mid-western Uganda. Engaging male partners may potentially influence the likelihood of accepting and using it to improve the health of women and their fetuses while wide spread myths and misconceptions about it may be changed by community engagement. Healthcare workers experienced difficulties in offering follow-up care to mothers detected with complications and Doppler ultrasound required a high level of training. While introducing advanced ultrasound machines to weak health systems, it is important to adequately train healthcare providers to avoid inappropriate interventions based on misinterpretation of the findings, consider where it is likely to be most beneficial, and embed it with realistic clinical practice guidelines.

Highlights

L’Organisation Mondiale de la Santé encourage la recherche sur l’échographie Doppler unique au troisième trimestre de grossesse et son impact sur la réduction des décès évitables chez les femmes enceintes non sélectionnées, particulièrement dans les pays à bas et moyen revenus où les évidences sont rares
One of the factors contributing to a high number of stillbirths in low-income countries is the difficulty in identifying complications and accessing high quality care during pregnancy
Antenatal Doppler scans are being widely used to diagnose complications in high-risk pregnancies in developed countries, studies evaluating it in low- and middle-income countries (LMICs) are needed before it is implemented on a wide scale

Summary

Introduction

L’Organisation Mondiale de la Santé encourage la recherche sur l’échographie Doppler unique au troisième trimestre de grossesse et son impact sur la réduction des décès évitables chez les femmes enceintes non sélectionnées, particulièrement dans les pays à bas et moyen revenus où les évidences sont rares. The World Health Organization recommends research to evaluate the effects of a single third trimes‐ ter Doppler ultrasound examination on preventable deaths in unselected-risk pregnancies, in low- and middle-income countries (LMICs) where the evidence base is scarce. While evaluating such technologies, researchers often ignore women and health care provider perspectives. Studies evaluating the effects of introducing Doppler ultrasound into antenatal care (ANC) on perinatal mortality are needed, especially in low-resource settings where evidence about the effects of this intervention is acutely lacking Stakeholder perspectives are vital to guide its integration into routine antenatal care to optimize the health of pregnant women and their fetuses

Methods

Results

Discussion

Conclusion