title: Addressing Obstetrical Challenges at 12 Rural Ugandan Health Facilities: Findings from an International Ultrasound and Skills Development Training for Midwives in Uganda.
abstract: BACKGROUND
  Like much of Sub-Saharan Africa, Uganda is facing significant maternal and fetal health challenges. Despite the fact that the majority of the Uganda population is rural and the major obstetrical care provider is the midwife, there is a lack of data in the literature regarding rural health facilities' and midwives' knowledge of ultrasound technology and perspectives on important maternal health issues such as deficiencies in prenatal services.
  
  
  METHODS
  A survey of the current antenatal diagnostic and management capabilities of midwives at 12 rural Ugandan health facilities was performed as part of an international program initiated to provide ultrasound machines and formal training in their use to midwives at antenatal care clinics.
  
  
  RESULTS
  The survey revealed that the majority of pregnant women attend less than the recommended minimum of four antenatal care visits. There were significant knowledge deficits in many prenatal conditions that require ultrasound for early diagnosis, such as placenta previa and macrosomia. The cost of providing ultrasound machines and formal training to 12 midwives was $6,888 per powered rural health facility and $8,288 for non-powered rural health facilities in which solar power was required to maintain ultrasound.
  In order to more successfully meet Millennium Development Goal 4 (reduce child mortality), 5 (improve maternal health) and 6 (combat HIV) through decreasing maternal to child transmission of HIV, the primary healthcare provider, which is the midwife in Uganda, must be competent at the diagnosis and management of a wide spectrum of obstetrical challenges. A trained ultrasound-based approach to obstetrical care is a cost effective method to take on these goals.
authors.affiliation: Sutter Health Family Medicine, AAFP Family Medicine Leads Emerging Leader Scholar, 2030 Sutter Place, Suite 2000, Davis, CA 95616, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Kinnevey
authors.affiliation: Ernest Cook Ultrasound Research and Education Institute (ECUREI), Mengo Hospital, Albert Cook Building, Albert Cook Road, P. O. BOX 7161, Kampala, UGANDA.
authors.forename: Michael
authors.initials: M
authors.lastname: Kawooya
authors.affiliation: Uganda Protestant Medical Bureau (UPMB), Plot 877 Balintuma Rd, Mengo, P. O Box 4127, Kampala, UGANDA.
authors.forename: Tonny
authors.initials: T
authors.lastname: Tumwesigye
authors.affiliation: Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA.
authors.forename: David
authors.initials: D
authors.lastname: Douglas
authors.affiliation: Grant Family Medicine Residency Program, 285 East State Street Suite 670 Columbus, OH 43215, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Sams
keywords: Antenatal Care; Fetal Health; Maternal Health; Rural; Sub-Saharan Africa; Uganda; Ultrasound