title: Accuracy of Home-Based Ultrasonographic Diagnosis of Obstetric Risk Factors by Primary-Level Health Care Workers in Rural Nepal.
abstract: To assess the feasibility of ultrasonographic task shifting by estimating the accuracy at which primary-level health care workers can perform community-based third-trimester ultrasound diagnosis for selected obstetric risk factors in rural Nepal.
  
  
  
  Three auxiliary nurse-midwives received two 1-week ultrasound trainings at Tribhuvan University Teaching Hospital in Kathmandu. At a study site in rural Nepal, pregnant women who were 32 weeks of gestation or greater were enrolled and received ultrasound examinations from the auxiliary nurse-midwives during home visits. Each auxiliary nurse-midwife screened for noncephalic presentation, multiple gestation, and placenta previa. Deidentified digital ultrasonograms were stored and uploaded onto an online server, where certified sonologists and ultrasonographers reviewed the images and made their own diagnoses for the three conditions. Accuracy of auxiliary nurse-midwife diagnoses was then calculated.
  
  
  
  A total of 804 women contributed to the analysis. Each auxiliary nurse-midwife's κ statistic for diagnosis of noncephalic presentation was above 0.90 compared with the ultrasonogram reviewers. Sensitivity, specificity, and positive and negative predictive values were between 90% and 100% for all auxiliary nurse-midwives. For multiple gestation, the auxiliary nurse-midwives were in perfect agreement with both the ultrasonogram reviewers and maternal postpartum self-report. Two placenta previa cases were detected, and the ultrasonogram reviewers agreed with both.
  
  
  
  With limited training, primary-level health care workers in rural Nepal can accurately diagnose selected third-trimester obstetric risk factors using ultrasonography.
authors: Johns Hopkins Bloomberg School of Public Health, and the Johns Hopkins Hospital, Baltimore, Maryland; the Nepal Nutrition Intervention Project-Sarlahi, Lalitpur, and Tribhuvan University Teaching Hospital, Kathmandu, Nepal; and George Washington University Milken Institute School of Public Health, Washington, DC.
authors: Naoko
authors: N
authors: Kozuki
authors: Luke C
authors: LC
authors: Mullany
authors: Subarna K
authors: SK
authors: Khatry
authors: Ram K
authors: RK
authors: Ghimire
authors: Sharma
authors: S
authors: Paudel
authors: Karin
authors: K
authors: Blakemore
authors: Christine
authors: C
authors: Bird
authors: James M
authors: JM
authors: Tielsch
authors: Steven C
authors: SC
authors: LeClerq
authors: Joanne
authors: J
authors: Katz
mesh_terms: D000328:Adult; D005240:Feasibility Studies; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D009390:Nepal; D009721:Nurse Midwives; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging*; D011263:Pregnancy Trimester, Third; D012307:Risk Factors; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012424:Rural Population; D016216:Ultrasonography, Prenatal / Q000379:methods*; D055815:Young Adult