Use of a portable system with ultrasound and blood tests to improve prenatal controls in rural Guatemala.
BACKGROUND
Maternal and neonatal mortality figures remain unacceptably high worldwide and new approaches are required to address this problem. This paper evaluates the impact on maternal and neonatal mortality of a pregnancy care package for rural areas of developing countries with portable ultrasound and blood/urine tests.


METHODS
An observational study was conducted, with intervention and control groups not randomly assigned.


METHODS
Rural areas of the districts of Senahu, Campur and Carcha, in Alta Verapaz Department (Guatemala). The control group is composed by 747 pregnant women attended by the community facilitator, which is the common practice in rural Guatemala. The intervention group is composed by 762 pregnant women attended under the innovative Healthy Pregnancy project. That project strengthens the local prenatal care program, providing local nurses training, portable ultrasound equipment and blood and urine tests. The information of each pregnancy is registered in a medical exchange tool, and is later reviewed by a gynecology specialist to ensure a correct diagnosis and improve nurses training.


RESULTS
No maternal deaths were reported within the intervention group, versus five cases in the control group. Regarding neonatal deaths, official data revealed a 64 % reduction for neonatal mortality. A 37 % prevalence of anemia was detected. Non-urgent referral was recommended to 70 pregnancies, being fetal malpresentation the main reported cause.


CONCLUSIONS
Impact data on maternal mortality (reduction to zero) and neonatal mortality (NMR was reduced to 36 %) are encouraging, although we are aware of the limitations of the study related to possible biasing and the small sample size. The major reduction of maternal and neonatal mortality provides promising prospects for these low-cost diagnostic procedures, which allow to provide high quality prenatal care in isolated rural communities of developing countries.


BACKGROUND
This research was not registered because it is an observational study where the assignment of the medical intervention was not at the discretion of the investigators.
Department of Obstetrics and Gynecology, Alcorcón Foundation University Hospital, Madrid, Spain.
Patricia Hanna
PH
Crispín Milart
TulaSalud - non-governmental organization, Alta Verapaz, Guatemala.
César Augusto
CA
Diaz Molina
EHAS Foundation, ESTI de Telecomunicación, Ciudad Univesitaria s/n, 28040, Madrid, Spain. ignacio.prieto@ehas.org.
Ignacio
http://orcid.org/0000-0002-4410-8721
I
Prieto-Egido
Higher Technical School of Telecommunications Engineering, Rey Juan Carlos University, Madrid, Spain.
Andrés
A
Martínez-Fernández
D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D061345:Early Medical Intervention; D005260:Female; D005865:Gestational Age; D006166:Guatemala / Q000453:epidemiology; D006403:Hematologic Tests / Q000379:methods*; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000592:standards*; D008428:Maternal Mortality / Q000639:trends; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000000981:diagnostic imaging* / Q000453:epidemiology; D011295:Prenatal Care / Q000379:methods*; D019035:Rural Health Services / Q000592:standards*; D016216:Ultrasonography, Prenatal / Q000592:standards*; D055815:Young Adult
Developing countries; Health information systems; Maternal mortality; Neonatal mortality; Portable ultrasound; Prenatal care