TITLE:
Barriers and Enablers That Influence Utilization of Ultrasound Screening Services among Antenatal Women in Kajiado and Kisii Counties Kenya
AUTHORS:
Micah Matiang’i, Koen Joosse, Priscillah Ngunju, Colleta Kiilu, Romy Harkx, Marianne Hangelbroek, Jarim Omogi
KEYWORDS:
Point of Care Ultrasonography Screening (POCUS), Midwives, Antenatal, Pri-mary Health Care Settings, Business Model
JOURNAL NAME:
Open Journal of Clinical Diagnostics,
Vol.11 No.1,
February
5,
2021
ABSTRACT: Background: The World Health Organization recommends to have all pregnant women to
undergo an obstetric ultrasound scan before 24 weeks gestation. However, this
has been a challenge as a result of limited access to appropriate Point of Care
Ultrasound Screening (POCUS) services in lower levels of developing countries’
Health Systems, cost of care, skills gap among care providers and unclear
regulatory policy frameworks. Obstetric Ultrasound scan helps to confirm
viability of a pregnancy, gestational age, multiple pregnancies and it also
helps rule out fetal abnormalities early enough. Methods: One year after intervention,
a cross-sectional study was carried in the two pilot counties of Kisii (rural) and Kajiado (peri-urban). This followed after selected midwives in the two
counties were trained on basic obstetric ultrasound screening for ANC women. A
total of 366 women who were either in their last phases of pregnancy or had
delivered within three months before the survey were interviewed. Cumulatively,
the 36 midwives had screened 1,250 mothers out of whom 18 high risk pregnancies
were identified. Open
Data Kit (ODK) was used to collect quantitative data and analysed using STATA
version 15. Descriptive statistics were used to summarize the data test
associations between variables. Bivariate and logistic regression was used to identify
predictive variables, and ORs with 95% confidence intervals used to measure the
strength of the associations. Findings: Slightly more than a third (36%)
of the women had recently delivered. In total, Kisii (rural county) had a
representation of 59% of the respondents. Half of the respondents were aged
between 25 - 34
years, 55% of the women interviewed were housewives while 48% had secondary
level of education. Only 21% of the women had undergone routine ultrasound
screening before 24 weeks of gestation with the average distance travelled by
majority (45%) of the respondents to access the POCUS service being 3 - 5 km. The need to confirm a pregnancy’s gestation
was the major (68.1%) motivator for seeking the service in the two pilot
counties. Employment status, household income, education level, pregnancy
gestation and distance to the facility had a statistical significance (P P Conclusion: Women in developing countries are eager to
access obstetric ultrasound screening services but for limited opportunities
and sustainable implementation frameworks on Point of Care Ultrasound Screening
(POCUS) services. Training and continuous coaching of frontline health
professionals are critical in deployment of POCUS but there is limited access to
standardised training content.