TY - JOUR
T1 - Antenatal Doppler ultrasound implementation in a rural sub-Saharan African setting
T2 - exploring the perspectives of women and healthcare providers
AU - Ali, Sam
AU - Kabajaasi, Olive
AU - Kawooya, Michael G.
AU - Byamugisha, Josaphat
AU - Zakus, David
AU - Papageorghiou, Aris T.
AU - Klipstein-Grobusch, Kerstin
AU - Rijken, Marcus J.
N1 - Funding Information: The authors thank the research participants and a team from Kagadi district, ECUREI and Makerere University College of Health Sciences for supporting the implementation of the EPID study. The University of Oxford, Oxford, United Kingdom contributed the ultrasound equipment for data collection. Linda McPhee guided the authors in developing the manuscript. We thank Fosca Tumushabe for additional editorial support. We immensely thank the study funders (Grand Challenges Canada and the UMC Utrecht Global Health Support Program). ATP is supported by the Oxford Partnership Comprehensive Biomedical Research Centre with funding from the NIHR Biomedical Research Centre (BRC) funding scheme. Funding Information: Grand Challenges Canada (Grant Number: R-ST-POC-1808-17038) funded the EPID study through a grant to Makerere University College of Health Sciences. SA is supported by the UMC Utrecht Global Health Support Program (Ref: FM/ADB/D-18-015006), University Medical Center Utrecht, Utrecht, The Netherlands. Funding Information: The authors thank the research participants and a team from Kagadi district, ECUREI and Makerere University College of Health Sciences for supporting the implementation of the EPID study. The University of Oxford, Oxford, United Kingdom contributed the ultrasound equipment for data collection. Linda McPhee guided the authors in developing the manuscript. We thank Fosca Tumushabe for additional editorial support. We immensely thank the study funders (Grand Challenges Canada and the UMC Utrecht Global Health Support Program). ATP is supported by the Oxford Partnership Comprehensive Biomedical Research Centre with funding from the NIHR Biomedical Research Centre (BRC) funding scheme. Publisher Copyright: © 2021, The Author(s).
PY - 2021/12/1
Y1 - 2021/12/1
N2 - Background: The 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. Methods: We 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. Results: Women 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. Conclusions: We 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.
AB - Background: The 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. Methods: We 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. Results: Women 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. Conclusions: We 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.
KW - Antenatal care
KW - Doppler ultrasound
KW - Healthcare workers
KW - Low- and middle-income countries
KW - Pregnancy
KW - Qualitative
UR - http://www.scopus.com/inward/record.url?scp=85116550698&partnerID=8YFLogxK
U2 - https://doi.org/10.1186/s12978-021-01233-5
DO - https://doi.org/10.1186/s12978-021-01233-5
M3 - Article
C2 - 34620186
SN - 1742-4755
VL - 18
JO - Reproductive health
JF - Reproductive health
IS - 1
M1 - 199
ER -