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DOI: 10.1055/s-0043-103948
Opportunities and Challenges in Realizing Universal Access to Obstetric Ultrasound in Sub-Saharan Africa
Publikationsverlauf
received 06. September 2016
revised 06. September 2016
accepted 31. Januar 2017
Publikationsdatum:
07. Juni 2017 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00028422/201702/lookinside/thumbnails/0098_10-1055-s-0043-103948-1.jpg)
Abstract
The potential benefits of obstetric ultrasound have yet to be fully realized in sub-Saharan Africa (SSA), despite the region bearing the greatest burden of poor perinatal outcomes. We reviewed the literature for challenges and opportunities of universal access to obstetric ultrasound and explored what is needed to make such access an integral component of maternity care in order to address the massive burden of perinatal morbidity and mortality in SSA. Original peer-reviewed literature was searched in various electronic databases using a ‘realist’ approach. While the available data were inconclusive, they identify many opportunities for potential future research on the subject within the region that can help build a strong case to justify the provision of universal access to ultrasound as an integral component of comprehensive antenatal care.
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References
- 1 FIGO Best practice in maternal-fetal medicine 2015. Ultrasound examination in pregnancy
- 2 Ostensen H. Developing countries. Ultrasound Med Biol 2000; 26 (Suppl. 01) s159-s161
- 3 Sippel S, Muruganandan K, Levine A, Shah S. Review Article: Use of ultrasound in the developing world. Int J Emerg Med 2011; 4: 72
- 4 de Bernis L, Kinney M, Stones W, ten Hoope-Bender P, Vivio D, Leisher S, Bhutta Z, Gülmezoglu M, Mathai M, Belizán J, Franco L, McDougall L, Zeitlin J, Malata A, Dickson K, Lawn J. Stillbirths: Ending preventable deaths by 2030. Lancet 2016; 387: 703-716
- 5 Aliyu LD, Kurjak A, Wataganara T, Moreira de Sa RA, Pooh R, Sen C, Ebrashy A, Ara A, Stanojevic M. Ultrasound in Africa: What can really be done?. J Prenat Med 2016; 44: 119-123
- 6 Bagayoko CO, Traore D, Thevoz L, Diabate S, Pecoul D, Niang M, Bediang G, Traore ST, Anne A, Geissbuhler A. Medical and economic benefits of telehealth in low and middle-income countries: Results of a study in four district hospitals in Mali. BMC Health Serv Res 2014; 14 (Suppl. 01) s9
- 7 Bagayoko CO, Anne A, Fieschi M, Geissbuhler A. Can ICTs contribute to efficiency and provide equitable access to the health care system in sub-Saharan Africa? The Mali Experience. Yearb Med Inform 2011; 6: 33-38
- 8 McClure EM, Nathan RO, Saleem S, Esamai F, Garces A, Chomba E, Tshefu A, Swanson D, Mabeya H, Figuero L, Mirza W, Muyodi D, Franklin H, Lokangaka A, Bidashimwa D, Pasha O, Mwenechanya M, Bose CL, Carlo WA, Hamidge KM, Leichty EA, Krebs N, Wallace DD, Swanson J, Koso-Thomas M, Widmer R, Goldenberg RL. First look: Cluster-randomised trial of ultrasound to improve pregnancy outcomes in low-income country settings. BMC Pregnancy Childbirth 2014; 14 (73) 2-8
- 9 Salomon LJ, Alfirevic Z, Berghella V, Bilardo C, Hernandez-Andrade E, Johnsen SL, Kalache K, Leung KY, Malinger G, Munoz H, Prefumo F, Toi A, Lee W. ISUOG Clinical Standards Committee . Practice guidelines for performance of the routine mid-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol 2010; 10: 1002
- 10 World Health Organization . The WHO Antenatal Care Randomised Trial: Manual of the implementation of the new mode WHO/RHR/0130. Geneva: WHO; 2010: p6
- 11 Marinac-Dabic D, Krulewitch CJ, Moore RM. The safety of prenatal ultrasound exposure in human studies. Epidemiology 2002; 13: S19-s22
- 12 Gammeltoft T, Thi H, Nguyen T. The commodification of obstetric ultrasound scanning in Hanoi, Viet Nam. Reprod Health Matters 2007; 15: 163-171
- 13 Greenhalgh S. Controlling births and bodies in village China. Am Ethnol 1994; 21: 3-30
- 14 FIGO Safe Motherhood and Newborn Health Committee, ICM, White Ribbon Alliance, International Pediatric Association, WHO . Mother-baby friendly birthing facilities. Int J Gynecol Obstet. 2015; 128: 95-99
- 15 Jha P, Kesler MA, Ram F, Ram U, Aleksandrowicz L, Bassani DG, Chandra S, Banthia JK. Trends in selective abortions of girls in India: Analysis of nationally representative birth histories from 1990 to 2005 and census data 1991 to 2011. Lancet 2011; 377: 1921-1928
- 16 Junking C. Prenatal sex determination and sex-selective abortion in rural Central China. Popul Dev Rev 2001; 27: 259-281
- 17 Pawson R, Greenhalgh T, Harvey G, Walshe K. “Realist review – a new method of systematic review designed for complex policy interventions”. J Health Serv Res Policy 2005; 10 (Suppl. 01) 21-34
- 18 Wong G, Greenhalgh T, Westhorp G, Pawson R. “Realist methods in medical education research: What are they and what can they contribute?”. Med Educ 2012; 46: 89-96
- 19 Ewigman BG, Crane JP, Frogoletto FD, LeFevre ML, Bain RP, McNellis D. the RADIUS study group . Effect of prenatal ultrasound screening on perinatal outcome. N Engl J Med 1993; 329: 821-827
- 20 Bricker L, Neilson JP, Dowswell T. Routine ultrasound in late pregnancy (after 24 weeks gestation). Cochrane Database of systematic Reviews 2015; 6: CD001451
- 21 Geerts L, Brand EJ, Theron G. Routine obstetric ultrasound examinations in South Africa: Cost and effect on perinatal outcome-a prospective randomised controlled trial. Br J Obstet Gynaecol 1996; 103: 501-507
- 22 Van Dyke B, Motto JA, Buchmann EJ. Routine second-trimester ultrasound for low risk pregnancies in a South African community. Int J Gynaecol Obstet 2007; 98: 257-258
- 23 Hofmeyr GJ. Routine ultrasound examination in early pregancy: Is it worthwhile in low-income countries?. Ultrasound Obstet Gynecol 2009; 34: 367-370
- 24 Carvalho JS, Mavrides E, Shinebourne EA, Campbell S, Thaliganathan B. Improving the effectiveness of routine prenatal screening for major congenital heart defects. Heart 2002; 88: 387-391
- 25 Maggio L, Dahlke JD, Mendez-Figueroa H, Albright CM, Chauhan SP, Wenstrom KD. Perinatal outcomes with normal compared with elevated umbilical artery systolic-to-diastolic ratios in fetal growth restriction. Obstet Gynecol 2015; 125: 863-869
- 26 Spinillo A, Montanari L, Bergante C, Gaia G, Chiara A, Fazzi E. Prognostic value of umbilical artery Doppler studies in unselected preterm deliveries. Obstet Gynecol 2005; 105: 613-620
- 27 Haws RA, Yakoob MY, Soomro T, Menezes EV, Darmstadt GL, Bhutta ZA. Reducing stillbirths: Screening and monitoring during pregnancy and labour. BMC Pregnancy Childbirth 2009; 9 (Suppl. 01) s5
- 28 Goldenberg RL, McClure EM, Bann CM. The relationship of intrapartum and antepartum stillbirth rates to measures of obstetric care in developed and developing countries. Acta Obstet Gynecol 2007; 86: 1303-1309
- 29 Robinson HP. A critical evaluation of sonar crown-rump length measurements. Br J Obstet Gynaecol 1975; 82: 702-710
- 30 Bennett KA, Crane JMG, O’Shea P, Lacelle J, Hutchens D, Copel JA. First trimester ultrasound is effective in reducing postterm labor induction rates: A randomised controlled trial. Am J Obstet Gynecol 2004; 190: 1077-10781
- 31 Papageorghiou AT, Kemp B, Stones W, Ohuma EO, Kennedy SH, Purwar M, Salomon LJ, Altman DG, Noble JA, Bertino E, Gravett MG, Pang R, Ismail LC, Barros FC, Lambert A, Jaffer YA, Victora CG, Bhutta ZA, Villar J. International Fetal Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st). Ultrasound based gestational age estimation in late pregnancy. Ultrasound Obstet Gynecol 2016; DOI: 10.1002/uog.15894.
- 32 Okong P, Byamugisha J, Mirembe F, Byaruhanga R, Bergstrom S. Audit of severe maternal morbidity in Uganda-implications for quality of obstetric care. Acta Obstet Gynecol 2006; 85: 797-804
- 33 Shah SP, Epino H, Bukhman G, Umulisa I, Dushimiyimana JMV, Reichman A, Noble VE. Impact of the introduction of ultrasound services in a limited resource setting: rural Rwanda 2008. BMC Int Health Hum Rights 2009; 9: 4
- 34 Tautz S, Jahn A, Molokomme I, Gorgen R. Between fear and relief. How rural pregnant women experience foetal ultrasound in a Botswana district hospital. Soc Sci Med 2000; 59: 689-701
- 35 Gonzaga MA, Kiguli-Malwadde E, Francis B, Rosemary B. Current knowledge, attitudes and practise of expectant women toward routine sonography in pregnancy at Naguru health centre, Uganda. Pan Afr Med J 2009; 8: 18
- 36 Oluoch AO, Mwangome N, Kemp B, Seale AC, Koech A, Papageorghiou AT, Berkley JA, Kennedy SH. Jones COH. “You cannot know if it’s a baby or not a baby”: Uptake, provision and perceptions of antennal care and routine antenatal ultrasound scanning in rural Kenya. BMC Pregnancy Childbirth 2015; 15: 127
- 37 Mensah YB, Nkyekyer K, Mensah K. The Ghanian woman’s experience and perception of ultrasound use in antenatal care. Ghana Med J 2014; 48: 31-38
- 38 Enakpene CA, Morhason-Bello IO, Marinho AO, Adedokun BO, Kalejaiye AO, Sogo K, Gradamos SA, Awoyinka BS, Enabor OO. Clients’ reasons for prenatal ultrasonography in Ibadan, South West of Nigeria. BMC Women’s Health 2009; 9: 12
- 39 Yeboah MY, Dassah ET, Odoi AT, Manu AA. The appropriateness of healthcare provider requests for obstetric and gynaecologic ultrasound in a low-resource setting. Int J Gynecol Obstet 2010; 111: 264-274
- 40 Shah S, Bellows BA, Adedipe A, Totten JE, Backlund BH, Sajed D. Perceived barriers in the use of ultrasound in developing countries. Crit Ultrasound J 2015; 7: 11
- 41 Rijken MJ, Mulder EJH, Papageorghiou AT, Thiptharakun S, Wah N, Paw TK, Dwell SLM. et al. Quality of ultrasound biometry obtained by local health workers in a refugee camp on the Thai-Burmese border. Ultrasound Obstet Gynecol 2012; 40: 151-157
- 42 Wylie BJ, Kalilani-Phiri L, Madanista M, Membe G, Nyirend O, Mawindo P, Kuyenda R, Malenga A, Masonbrink A, Makanani B, Thesing P, Laufer MK. Gestational age assessment in malaria pregnancy cohorts: A prospective ultrasound demonstration project in Malawi. Malar J 2013; 12: 183
- 43 Swanson JO, Kawooya MG, Swanson DL, Hippe DS, Dungu-Matovu P, Nathan R. The diagnostic impact of limited, screening obstetric ultrasound when performed by midwives in rural Uganda. J Perinatol 2014; 34: 508-512
- 44 Meloni MF, Ferraioli G. Sonographic Training program at a District hospital in a developing country: Work in progress. Am J Roentgenol 2007; 189: W119-W122
- 45 Greenwold N, Wallace S, Prost A. Jauniaux. Implementing and obstetric ultrasound training program in rural Africa. Int J Gynecol Obstet 2014; 124: 274-277
- 46 LaGrone LN, Sadasivam V, Kushner AL, Groen RS. A review of training opportunities for ultrasonography in low and middle-income countries. Tropl Med Int Health 2012; 17: 808-819
- 47 Harris RD, Marks WM. Compact ultrasound for improving maternal and perinatal care in low-resource settings: Review of the potential benefits, implementation challenges, and public health issues. J Ultrasound Med 2009; 28: 1067-1076
- 48 Harvey HB, Ahn R, Price DD, Burke TF. Innovating for the developing world: Meeting the affordability challenge. Am J Roentgenol 2014; 203: 835-837