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

Abstract

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. 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. Cette étude a exploré les opinions et expériences des femmes enceintes et des prestataires sur l’utilisation des technologies ultrasonographiques avancées dans une communauté rurale du mid-ouest Ougandais. Méthodes Nous avons inclus 53 mères et 10 prestataires de santé, et documenté leurs opinions, les barrières et facilitateurs de l’utilisation de l’échographie Doppler via des entretiens semi-structurés de groupe et individuels et des observations. L’analyse de contenu à partir des transcripts codés de façon inductive dans ATLAS.ti 8.0, ont permis l’identification des thèmes principaux. Résultats Les femmes craignaient pour elles et pour leur foetus les lésions que causeraient l’échographie et la plupart n’avaient jamais vu d’échographe. La majorité des femmes avaient le soutien de leurs partenaires pour bénéficier des soins anténatals et passer une échographie. Les prestataires du “Kagadi Hospital” avaient étaient peu sensibilisés de la technologie Doppler et de son utilisation dans la décision clinique. Les autres barrières à l’implémentation de l’écho Doppler incluaient le manque de compétences du staff local, les équipements insuffisants, la distance pour accéder à l’hôpital, et les fréquentes coupures d’électricité. Conclusions Les femmes et les prestataires de soins dans le mid-ouest Ougandais sont faiblement exposés à l’échographie. Impliquer les partenaires masculins permettrait d’augmenter son acceptabilité et utilisation et ainsi améliorer la santé des femmes et des bébés. Aussi, des activités d’éducation communautaire contribueraient à modifier les mythes largement propagés et les conceptions erronées sur l’écho Doppler. Par ailleurs, les prestataires font face à des difficultés dans le suivi des femmes présentant des complications, et le Doppler requiert des compétences de haut niveau. L’introduction de technologies avancées d’échographie dans des systèmes de santé fragiles doit tenir compte de l’impact attendu, et nécessite la formation des prestataires afin d’éviter des interprétations biaisées et une prise en charge inappropriée, et leur inclusion dans les guides de pratique clinique. Globally, nearly three million babies are stillborn every year, but most especially in low- and middle-income countries like Uganda. 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. Although antenatal Doppler scans are being widely used to diagnose complications in high-risk pregnancies in developed countries, studies evaluating it in LMICs are needed before it is implemented on a wide scale. We engaged 53 mothers, eight health workers from a hospital and two healthcare managers from a local government in Uganda to attain their opinions about Doppler ultrasound. We found that spousal involvement may promote acceptance and use of ultrasound services. However, the health workers did not have adequate knowledge about Doppler technology and using it for the benefit of mothers and the mothers feared that ultrasound procedures might harm them or their unborn babies. Making matters worse, the hospital faced frequent power cuts that affected the use of the equipment. Further, mothers must cover a long distance to access the hospital and its services. To reduce the number of babies dying during pregnancy or a few days after birth in Uganda and similar low-resource settings using Doppler technology, it is essential to strengthen the health systems. Starting with the training of healthcare providers to equipping and stabilizing power supply in health facilities, and educating the public about critical health procedures to break myths and misconceptions.