Original Contribution
Focused Maternal Ultrasound by Midwives in Rural Zambia

https://doi.org/10.1016/j.ultrasmedbio.2010.05.017Get rights and content

Abstract

Point-of-care ultrasound is being increasingly implemented in resource-poor settings in an ad hoc fashion. We developed a focused maternal ultrasound-training program for midwives in a rural health district in Zambia. Four hundred forty-one scans were recorded by 21 midwives during the 6-month study period. In 74 scans (17%), the ultrasound findings prompted a change in clinical decision-making. Eight of the midwives were evaluated with a 14-question observed structured clinical examination (OSCE) and demonstrated a slight overall improvement with mean scores at 2 and 6 months of 10.0/14 (71%) and 11.6/14 (83%), respectively. Our pilot project demonstrates that midwives in rural Zambia can be trained to perform basic obstetric ultrasound and that it impacts clinical decision-making. Ultrasound skills were retained over the study period. More data is necessary to determine whether the introduction of ultrasound ultimately improves outcomes of pregnant women in rural Zambia. (E-mail: [email protected])

Section snippets

Introduction and Literature

Over the last decade, ultrasound technology has become more compact, interface software has simplified and machine costs have decreased. As a result, the advantages of portable diagnostic imaging can be accessed in an increasing number of clinical settings. One particular area of interest has been the use of ultrasound in resource-scarce settings where access to imaging diagnostics is severely limited (Dean et al., 2007, Kobal et al., 2004, Shah et al., 2008, Spencer and Adler, 2008, Steinmetz

Sites

The study was carried out at three sites in the Kapiri Mposhi District within the Central Province of Zambia: Kapiri District Hospital, Mukonchi Rural Health Center, and Nkole Rural Health Center. In 2008, Kapiri District Hospital assisted 1927 deliveries; Mukonchi had 278 deliveries; and Nkole 126 deliveries. Neither the hospital nor the health centers have the capacity to perform cesarean sections. Patients must be referred to a regional hospital 60 km away in a neighboring district (Kabwe

Ultrasounds recorded

A total of 21 of midwives underwent focused obstetric ultrasound training. The mean number of scans per midwife was 21 (range 1–179). Four hundred and forty-one ultrasound scans were recorded over the 6-month study period (Table 1). Most recorded scans were performed in second and third trimester as this is the time most patients presented to antenatal clinic or to the labor ward. One hundred ninety-one (43%) of the scans were supervised by one of the training physicians, the rest were

Discussion and Summary

There is limited published literature regarding ultrasound as a tool for responding to the high rates of maternal and newborn morbidity and mortality in the developing world. The data from our pilot program indicate that midwives in rural Zambia with no prior ultrasound experience can be trained to use a portable ultrasound machine to perform basic obstetric ultrasound. Not only were they able to learn a new technology, they retained their skills over the 6-month study period and they began to

Conclusion

Midwives in rural Zambia can be taught basic obstetric ultrasound applications, such as identifying number of gestations, locating fetal heart rate and identifying fetal presentation. They are able to retain those skills over a 6-month time period and continued to utilize the ultrasound at a one-year impact assessment. Clinical decision-making was altered in 17% of patients scanned. More data is necessary to assess the long-term sustainability of the skills learned and to determine whether the

Acknowledgments

Ultrasound machines used in this study were donated to the Maternal and Infant Health Initiative by SonoSite.

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