title: Ancillary benefits of antenatal ultrasound: an association between the introduction of a low-cost ultrasound program and an increase in the numbers of women receiving recommended antenatal treatments.
abstract: BACKGROUND
  In June of 2010, an antenatal ultrasound program was introduced to perform basic screening examinations at a health care clinic in rural Uganda. The impact of the program on the existing antenatal care infrastructure including the proportion and number of women receiving recommended antenatal care at clinic visits was unknown. The aim of this study was to investigate the relationship between the advent of the ultrasound program and the proportion of women receiving recommended antenatal interventions at their clinic visits. Change in the absolute numbers of antenatal services provided was also assessed.
  
  
  METHODS
  Records at the Nawanyago clinic were reviewed to determine the total numbers of women receiving specific interventions before and after the advent of the ultrasound program including HIV testing, intermittent preventive therapy for malaria, presumptive anti-parasitic treatment, and provision of iron and folate for anemia. The rate at which these interventions were provided (number of interventions per clinic visit) was also assessed. The differences in absolute numbers of antenatal interventions before and after the introduction of the ultrasound program were assessed using the Wilcoxon rank-sum test. Differences in intervention rate were assessed using negative binomial regression modeling.
  
  
  RESULTS
  The mean monthly numbers of women receiving each of these interventions increased significantly with the greatest increase seen in numbers of women receiving anemia and deworming treatments at +113% and +102% respectively (p < 0.001). The intervention rate increased for anemia treatment, deworming treatment, and 2nd dose of intermittent preventive therapy for malaria. A slight decrease in intervention rate was observed for 1st dose of malaria treatment with a rate ratio of 0.88 (0.79 - 0.98, 95% CI). Intervention rate for HIV testing was not significantly changed.
  
  
  CONCLUSIONS
  The introduction of a low-cost antenatal ultrasound program at a health care clinic in rural Uganda was associated with increases in the number of women receiving specific recommended antenatal care interventions. Effect on intervention rates was mixed but showed an overall increase. The use of ultrasound in this context may provide a benefit to the maternal and neonatal health of the community.
authors.affiliation: Department of Radiology, University of Vermont Medical Center, 111 Colchester Rd., Burlington, Vermont, 05401, USA. Andrew.Ross@vtmednet.org.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Ross
authors.affiliation: Department of Radiology, University of Vermont Medical Center, 111 Colchester Rd., Burlington, Vermont, 05401, USA. Kristen.DeStigter@vtmednet.org.
authors.forename: Kristen K
authors.initials: KK
authors.lastname: DeStigter
authors.affiliation: University of Vermont College of Medicine, 89 Beaumont Ave., Burlington, Vermont, 05405, USA. Anastasia.Coutinho@med.uvm.edu.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Coutinho
authors.affiliation: Clinical Research Division, Philips Healthcare, 22100 Bothell Everett Hwy, Bothell, Washington, 98021, USA. Sonia.Souza@philips.com.
authors.forename: Sonia
authors.initials: S
authors.lastname: Souza
authors.affiliation: Clinical Research Division, Philips Healthcare, 22100 Bothell Everett Hwy, Bothell, Washington, 98021, USA. Tony.Mwatha@philips.com.
authors.forename: Anthony
authors.initials: A
authors.lastname: Mwatha
authors.affiliation: Department of Surgery, Mubende Regional Referral Hospital, Mubende, Uganda. dalhmatovu@yahoo.co.uk.
authors.forename: Alphonsus
authors.initials: A
authors.lastname: Matovu
authors.affiliation: Ernest Cook Ultrasound Research and Education Institute, Mengo Hospital, Sir Albert Cook Rd., Kampala, Uganda. kawooyagm@yahoo.co.uk.
authors.forename: Michael Grace
authors.initials: MG
authors.lastname: Kawooya
authors.affiliation: Imaging the World Africa, Nayla-Namugongo Rd., Nayla, Uganda. rennylenard@yahoo.com.
authors.forename: Ssembatya
authors.initials: S
authors.lastname: Renny
mesh_terms: D000740:Anemia / Q000517:prevention & control; D000871:Anthelmintics / Q000627:therapeutic use; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D007501:Iron / Q000627:therapeutic use; D008288:Malaria / Q000517:prevention & control; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data* / Q000639:trends; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D012424:Rural Population; D014454:Uganda; D016216:Ultrasonography, Prenatal / Q000706:statistics & numerical data*
chemical_list: D000871:Anthelmintics; D005492:Folic Acid; D007501:Iron