Abstract
Prior studies have suggested that obstetrical (OB) ultrasound in low- and middle-income countries has aided in detection of high-risk conditions, which in turn could improve OB management. We are participating in a cluster-randomized clinical trial of OB ultrasound, which is designed to assess the effect of basic OB ultrasound on maternal mortality, fetal mortality, neonatal mortality, and maternal near-miss in 5 low-income countries. We designed a 2-week course in basic OB ultrasound, followed by 12 weeks of oversight, to train health care professionals with no prior ultrasound experience to perform basic OB ultrasound to screen for high-risk pregnancies. All patients with high-risk pregnancies identified by the trainees were referred to higher-level health facilities where fully trained sonographers confirmed the diagnoses before any actions were taken. Although there have been several published studies on basic OB ultrasound training courses for health care workers in low- and middle-income countries, quality control reporting has been limited. The purpose of this study is to report on quality control results of these trainees. Health care workers trained in similar courses could have an adjunctive role in ultrasound screening for high-risk OB conditions where access to care is limited. After completion of the ultrasound course, 41 trainees in 5 countries performed 3801 ultrasound examinations during a 12-week pilot period. Each examination was reviewed by ultrasound trainers for errors in scanning parameters and errors in diagnosis, using predetermined criteria. Of the 32,480 images comprising the 3801 examinations, 94.8% were rated as satisfactory by the reviewers. There was 99.4% concordance between trainee and reviewer ultrasound diagnosis. The results suggest that trained health care workers could play a role in ultrasound screening for high-risk OB conditions.
Highlights
Prior studies have suggested that the use of obstetrical (OB) ultrasound in low- and middle-income countries (LMIC) could improve OB management by aiding in identification of high-risk conditions.[1,2,3,4,5] We are participating in a cluster-randomized clinical trial of OB ultrasound under the auspices of the Global Network for Women’s and Children’s Health Research.[6]
We report on written and practical testing of 41 trainees and the quality control (QC) results for 3801 reviewed examinations performed by the trainees during a pretrial training period
The basic OB ultrasound course was administered to the 41 health care workers in the following 5 sites: Karawa, Democratic Republic of Congo; Chimaltenango, Guatemala; Eldoret, Kenya; Karachi, Pakistan; and Lusaka, Zambia
Summary
Prior studies have suggested that the use of obstetrical (OB) ultrasound in low- and middle-income countries (LMIC) could improve OB management by aiding in identification of high-risk conditions.[1,2,3,4,5] We are participating in a cluster-randomized clinical trial of OB ultrasound under the auspices of the Global Network for Women’s and Children’s Health Research.[6]. Eligible pregnant women undergo basic OB ultrasound screening examinations in health center intervention clusters and are referred to participating higher-level facilities if high-risk pregnancies are identified. Because trained sonographers were not available to staff the rural health centers in which the study ultrasounds were to be performed, the University of Washington’s Department of Radiology (UW) designed a 2-week course in basic OB ultrasound for health care professionals with no prior ultrasound experience.[7] This course was used to train 41 ultrasound-naïve health care workers (midwives, nurses, radiographers, and medical officers) in 5 LMIC countries to perform basic OB ultrasound to screen for high-risk pregnancies.
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