title: Evaluation of Focused Obstetric Ultrasound Examinations by Health Care Personnel in the Democratic Republic of Congo, Guatemala, Kenya, Pakistan, and Zambia.
abstract: Prior studies have suggested that obstetrical (OB) ultrasound in low- and middle-income countries has aided in detection of high-risk conditions, which in turn could improve OB management. We are participating in a cluster-randomized clinical trial of OB ultrasound, which is designed to assess the effect of basic OB ultrasound on maternal mortality, fetal mortality, neonatal mortality, and maternal near-miss in 5 low-income countries. We designed a 2-week course in basic OB ultrasound, followed by 12 weeks of oversight, to train health care professionals with no prior ultrasound experience to perform basic OB ultrasound to screen for high-risk pregnancies. All patients with high-risk pregnancies identified by the trainees were referred to higher-level health facilities where fully trained sonographers confirmed the diagnoses before any actions were taken. Although there have been several published studies on basic OB ultrasound training courses for health care workers in low- and middle-income countries, quality control reporting has been limited. The purpose of this study is to report on quality control results of these trainees. Health care workers trained in similar courses could have an adjunctive role in ultrasound screening for high-risk OB conditions where access to care is limited. After completion of the ultrasound course, 41 trainees in 5 countries performed 3801 ultrasound examinations during a 12-week pilot period. Each examination was reviewed by ultrasound trainers for errors in scanning parameters and errors in diagnosis, using predetermined criteria. Of the 32,480 images comprising the 3801 examinations, 94.8% were rated as satisfactory by the reviewers. There was 99.4% concordance between trainee and reviewer ultrasound diagnosis. The results suggest that trained health care workers could play a role in ultrasound screening for high-risk OB conditions.
authors.affiliation: Department of Radiology, Harborview Medical Center, University of Washington Medical Center, Seattle, WA. Electronic address: ronathan@uw.edu.
authors.forename: Robert O
authors.initials: RO
authors.lastname: Nathan
authors.affiliation: Department of Radiology, Harborview Medical Center, University of Washington Medical Center, Seattle, WA. Electronic address: Swanson5@uw.edu.
authors.forename: Jonathan O
authors.initials: JO
authors.lastname: Swanson
authors.affiliation: Department of Radiology, Harborview Medical Center, University of Washington Medical Center, Seattle, WA. Electronic address: dladleyswanson@gmail.com.
authors.forename: David L
authors.initials: DL
authors.lastname: Swanson
authors.affiliation: Department of Statistics and Epidemiology, RTI International, Durham, NC. Electronic address: mcclure@rti.org.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: McClure
authors.affiliation: Department of Obstetrics, Kinshasa University, Kinshasa, Democratic Republic of the Congo. Electronic address: vlokomba@yahoo.fr.
authors.forename: Victor Lokomba
authors.initials: VL
authors.lastname: Bolamba
authors.affiliation: School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo. Electronic address: adrienloks@gmail.com.
authors.forename: Adrien
authors.initials: A
authors.lastname: Lokangaka
authors.affiliation: Fundación para la Alimentación y Nutrición de Centro América y Panamá (FANCAP), Guatemala City, Guatemala. Electronic address: spineda@fancap.org.
authors.forename: Irma Sayury
authors.initials: IS
authors.lastname: Pineda
authors.affiliation: Fundación para la Alimentación y Nutrición de Centro América y Panamá (FANCAP), Guatemala City, Guatemala. Electronic address: lfigueroa@fancap.org.
authors.forename: Lester
authors.initials: L
authors.lastname: Figueroa
authors.affiliation: Department of Obstetrics and Gynecology, San Carlos University Medical School, Guatemala City, Guatemala. Electronic address: drwlopezgomez@gmail.com.
authors.forename: Walter
authors.initials: W
authors.lastname: López-Gomez
authors.affiliation: Fundación para la Alimentación y Nutrición de Centro América y Panamá (FANCAP), Francisco Marroquin University, Guatemala City, Guatemala. Electronic address: agarces@fancap.org.
authors.forename: Ana
authors.initials: A
authors.lastname: Garces
authors.affiliation: Department of Pediatrics, Moi University School of Medicine, Eldoret, Kenya. Electronic address: dmuyodi6@gmail.com.
authors.forename: David
authors.initials: D
authors.lastname: Muyodi
authors.affiliation: Department of Pediatrics, Moi University School of Medicine, Eldoret, Kenya. Electronic address: fesamaki2007@gmail.com.
authors.forename: Fabian
authors.initials: F
authors.lastname: Esamai
authors.affiliation: Sonographer, Department of Radiology, Moi University School of Medicine, Eldoret, Kenya. Electronic address: n_kanaiza@yahoo.com.
authors.forename: Nancy
authors.initials: N
authors.lastname: Kanaiza
authors.affiliation: Department of Radiology, Aga Khan University, Karachi, Pakistan. Electronic address: waseem.mirza@aku.edu.
authors.forename: Waseem
authors.initials: W
authors.lastname: Mirza
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan. Electronic address: farnaz.naqvi@aku.edu.
authors.forename: Farnaz
authors.initials: F
authors.lastname: Naqvi
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan. Electronic address: sarah.saleem@aku.edu.
authors.forename: Sarah
authors.initials: S
authors.lastname: Saleem
authors.affiliation: Department of Pediatrics, University Teaching Hospital, Lusaka, Zambia. Electronic address: mmusaku@gmail.com.
authors.forename: Musaku
authors.initials: M
authors.lastname: Mwenechanya
authors.affiliation: Project Coordinator, Global Network for Women's and Children's Health Research, University Teaching Hospital, Lusaka, Zambia. Electronic address: Melodykunda2004@yahoo.com.
authors.forename: Melody
authors.initials: M
authors.lastname: Chiwila
authors.affiliation: Lead Sonographer, Radiology Department, University Teaching Hospital, Lusaka, Zambia. Electronic address: dhamsumonde@gmail.com.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Hamsumonde
authors.affiliation: Department of Statistics and Epidemiology, RTI International, Durham, NC. Electronic address: dwallace@rti.org.
authors.forename: Dennis D
authors.initials: DD
authors.lastname: Wallace
authors.affiliation: Department of Statistics and Epidemiology, RTI International, Durham, NC. Electronic address: hfranklin@rti.org.
authors.forename: Holly
authors.initials: H
authors.lastname: Franklin
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University, New York, NY. Electronic address: rlg88@cumc.columbia.edu.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Goldenberg
mesh_terms: D000328:Adult; D015023:Democratic Republic of the Congo; D005260:Female; D046689:Fetal Mortality; D006166:Guatemala; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007318:Inservice Training; D007630:Kenya; D008428:Maternal Mortality; D007744:Obstetric Labor Complications / Q000000981:diagnostic imaging*; D010154:Pakistan; D011247:Pregnancy; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D016216:Ultrasonography, Prenatal / Q000592:standards*; D015024:Zambia