Abstract
BackgroundThis study, undertaken in Rwanda, aimed to investigate health professionals’ experiences and views on the following topics: current clinical guidelines for ultrasound from second trimester at the clinic, regional and national levels, and adherence to clinical guidelines; medically indicated ultrasound examinations; non-medical use of ultrasound including ultrasounds on maternal request; commercialisation of ultrasound; the value of ultrasound in relation to other clinical examinations in pregnancy; and ultrasound and medicalisation of pregnancy.MethodsA cross-sectional design was adopted. Health professionals providing antenatal care and delivery services to pregnant women in 108 health facilities were invited to complete a survey, which was developed based on the results of earlier qualitative studies undertaken as part of the CROss Country Ultrasound Study (CROCUS).ResultsNine hundred and seven health professionals participated: obstetricians/gynecologists (3.2%,) other physicians (24.5%), midwives (29.7%) and nurses (42.7%). Few physicians reported the existence of clinical guidelines at clinic, regional or national levels in Rwanda, and guidelines were moderately adhered to. Three obstetric ultrasound examinations were considered medically indicated in an uncomplicated pregnancy. Most participants (73.0%) were positive about obstetric ultrasound examinations on maternal request. Commercialisation was not considered a problem, and the majority (88.5%) agreed that ultrasound had contributed to medicalisation of pregnancy.ConclusionsFindings indicate that clinical guidelines for the use of obstetric ultrasound are limited in Rwanda. Non-medically indicated obstetric ultrasound was not considered a current problem at any level of the healthcare system. The positive attitude to obstetric ultrasound examinations on maternal request may contribute to further burden on a maternal health care system with limited resources. It is essential that limited obstetric ultrasound resources are allocated where they are most beneficial, and clearly stated medical indications would likely facilitate this.
Highlights
This study, undertaken in Rwanda, aimed to investigate health professionals’ experiences and views on the following topics: current clinical guidelines for ultrasound from second trimester at the clinic, regional and national levels, and adherence to clinical guidelines; medically indicated ultrasound examinations; non-medical use of ultrasound including ultrasounds on maternal request; commercialisation of ultrasound; the value of ultrasound in relation to other clinical examinations in pregnancy; and ultrasound and medicalisation of pregnancy
Findings indicate that clinical guidelines for the use of obstetric ultrasound are limited in Rwanda
Categorizing the health professionals in relation to health profession and workplace showed that 27.7% (n = 251) of participants were physicians working in hospitals (P-H); 36.7% (n = 333) of participants were midwives/nurses working in hospitals (MN-H; the majority were midwives); and 35.6% (n = 323) were nurses/midwives working in health centres (NM-HC; the majority were nurses) (Table 2)
Summary
This study, undertaken in Rwanda, aimed to investigate health professionals’ experiences and views on the following topics: current clinical guidelines for ultrasound from second trimester at the clinic, regional and national levels, and adherence to clinical guidelines; medically indicated ultrasound examinations; non-medical use of ultrasound including ultrasounds on maternal request; commercialisation of ultrasound; the value of ultrasound in relation to other clinical examinations in pregnancy; and ultrasound and medicalisation of pregnancy. Some evidence suggests that introduction of routine ultrasound examinations has benefits including increased use of ANC, deliveries at health facilities and referrals for obstetric complications [12,13,14]. In a recent cluster randomised trial in five countries including Democratic Republic of Congo, Guatemala, Kenya, Pakistan, and Zambia, introduction of two routine ultrasound scans at 16–22 weeks and 32–36 weeks, did not increase ANC attendance or hospital delivery for complicated pregnancies, and did not improve maternal, fetal and neonatal mortality, or nearmiss maternal mortality. A number of studies have indicated important benefits of selective obstetric ultrasound in these settings, including confirmation of clinically suspected obstetric complications, improved patient management and quality of care [11]
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