Maternal and neonatal mortality are major global public health issues. In 2023, approximately 260,000 maternal deaths were recorded, equivalent to one woman every two minutes [1]. More than 95% of these deaths occur in low- and middle-income countries, particularly in sub-Saharan Africa [2]. In Senegal, although progress has been made since 2000, the maternal mortality rate is still estimated at 236 deaths per 100,000 live births in 2020, with significant disparities between urban and rural areas [3]. Direct obstetric causes account for approximately 60% of maternal deaths [4]. To reduce this burden, the national strategy focuses on the continuous availability of Emergency Obstetric and Neonatal Care (EmONC) and the strengthening of staff skills [5]. Obstetric ultrasound is an essential tool for the early detection of high-risk pregnancies and improved care [6][7]. In this context, the UFR2S of Gaston Berger University, in partnership with the Regional Hospital of Saint-Louis, has been offering training in obstetric ultrasound applied to EmONC for midwives in the Pété health district since 2021. Between 2021 and 2025, eighteen midwives have been trained free of charge, in cohorts of three, for three-month practical internships. This initiative illustrates the social responsibility of the UFR2S and its desire to bring ultrasound to rural communities. The Pété district covers a vast rural area with major geographical and logistical constraints. The dispersion of villages, the distance of health posts from the health centre and the lack of transport contribute to the three classic delays in maternal mortality: delay in deciding to seek care, delay in accessing services and delay in receiving appropriate care [8]-[11]. The training of midwives in obstetric ultrasound aims to delegate skills and bring diagnosis closer to communities. However, there is still no local scientific data to measure its real impact. It is therefore essential to document this intervention in order to support its expansion and sustainability. The general objective was to evaluate the impact of obstetric ultrasound training applied to EmONC on the quality of obstetric care in the Pété district. The specific objectives were to describe the process and characteristics of obstetric ultrasound training applied to EmoNC carried out from 2021 to 2025 for midwives practising in the Pété health district, to present the profile of the actors involved in the implementation of the programme, specifying their roles and responsibilities at the Pété district level, from 2021 to 2025, to measure the changes observed in the professional practices of trained midwives in the Pété district, before and after the training at the Pété district level, from 2021 to 2025, and to assess the overall satisfaction of trained midwives at the Pété district level, from 2021 to 2025.

This is a descriptive, analytical, cross-sectional study conducted among all midwives who have received training in obstetric ultrasound applied to EmONC. This design was chosen to document the knowledge acquired, perceptions, changes in practices and effects felt after the training. The study was conducted in the Pété health district, Saint-Louis medical region, Senegal. The district covers an estimated rural population of more than 120,000 inhabitants spread across 10 health posts and 25 health huts. It is characterised by:

long distances between villages and health facilities;mobility constraints (tracks, seasonal flooding);a lack of logistical resources and imaging equipment;a high degree of community dependence on health posts for obstetric care.

Since 2021, as part of the partnership between the UFR2S of Gaston Berger University (UGB) and the Regional Hospital of Saint-Louis (HRSL), an innovative initiative has enabled the training of 14 midwives from the district in obstetric ultrasound applied to EmONC. These training courses were carried out in successive cohorts of three providers, with theoretical and practical supervision over three months. Data collection took place from 15 to 30 September 2025 at health posts and the health centre in the district of Pété. The target population included all midwives trained in obstetric ultrasound applied to EmONC in the Pété health district. The inclusion criteria were to have completed the training organised by UFR2S and HRSL; to be working in the Pété health district at the time of the survey; and to have given free and informed consent to participate in the study. We did not include midwives who had been trained but transferred to other districts; those who were absent or unavailable during the data collection period; or those who refused to participate in the survey.

The study included all trained midwives, using an exhaustive approach (complete census), justified by the limited number of training beneficiaries and the importance of having a comprehensive view of the impact in the district.

The independent variables were the sociodemographic profile: age, seniority, assignment structure, length of practice, level of initial training; training modalities: year, duration, modules taken, practical setting, support from trainers, and availability of ultrasound equipment at the health centre. The dependent variables d professional practices(number of ultrasounds performed per month, types of indications (antenatal care, emergencies, complications), types of pathologies detected); the perceived effect of the training(improved diagnoses, relevance of obstetric referrals, speed of decision-making, reduction in unjustified evacuations); satisfaction and appropriation: satisfaction with the content, teaching methods, duration and conditions of the training course; feeling of confidence and autonomy in ultrasound practice; constraints encountered: insufficient equipment, lack of maintenance, difficulties in interpretation, insufficient supervision.

Data collection was carried out using a structured, self-administered questionnaire designed in Google Forms and pre-tested on two midwives who were not included in the study. The questionnaire comprised five sections: general information and provider profile; training methods and assessment; ultrasound practices before and after training; perception of the effects of training on quality of care; difficulties encountered and suggestions for improving the programme. The midwives completed the questionnaire via telephone or tablet. The data was exported to Excel for validation and cleaning prior to analysis. The data was entered into Excel and then analysed using Epi Info 7. A double check was carried out to ensure consistency and completeness. The descriptive analysisfocused on frequencies, percentages, means and standard deviations for quantitative and qualitative variables. Comparative analysis: comparison of indicators before/after training (average number of ultrasounds, complications detected, obstetric referrals) using McNemar or Wilcoxon tests depending on the nature of the variables. Thematic analysis: for open-ended questions, responses were grouped into themes (perception, motivation, constraints, suggestions). The statistical significance threshold was set at p < 0.05 with a 95% confidence interval (95% CI).

Free and informed consent was obtained from each participant after explaining the objectives, benefits and minimal risks of the study. Anonymity and confidentiality were guaranteed: no names or specific structures were mentioned in the database. The results will be presented to midwives, the Pété health district and partners (UFR2S, HRSL) in line with social responsibility and continuous improvement of professional skills.

The results of this study confirm that training in obstetric ultrasound applied to SONUs had a significant impact on the skills, quality of care and clinical performance of midwives in the Pété health district. This improvement reflects the relevance of a decentralised and practical training approach, already documented in several African contexts [6]-[12]. The increase in the average number of monthly ultrasounds after training demonstrates the midwives’ increased technical proficiency and decision-making autonomy. Studies conducted in Ethiopia, Tanzania and Malawi have shown that targeted training in basic ultrasound for mid-level providers improves the detection of high-risk pregnancies and the quality of obstetric triage [7]-[13].

These results are consistent with WHO recommendations, which encourage the integration of ultrasound into antenatal care to strengthen maternal and foetal monitoring [14]. Thus, in the Senegalese context, this initiative helps to reduce dependence on regional hospitals and promotes rapid decision-making at the peripheral level. The study shows a notable increase in complications detected early after training (HRP, ectopic pregnancy, placenta praevia, intrauterine foetal death). This improvement is in line with Thaddeus and Maine’s three delays model, according to which early detection is one of the major determinants of maternal survival [11]. Similar programmes implemented in Kenya and Zambia have shown that the introduction of point-of-care ultrasound by midwives significantly reduces severe maternal morbidity [15][16]. Training therefore enhances clinical safety while improving patients’ confidence in primary care facilities.

The increase in the relevance of obstetric referrals (from 62% to 87%) shows that trained midwives now refer cases according to objective criteria based on ultrasound examination. Studies in Nigeria and Ghana have shown that such rationalisation reduces unjustified transfers by up to 40% [10]-[17]. This development optimises the management of obstetric emergencies and allows for better use of hospital resources.

Over 90% of midwives surveyed reported being satisfied or very satisfied.This result reflects the perceived value of the training and its relevance to daily practice.

As reported by Mwansa et al. in Zambia, post-training satisfaction is a determining factor in staff motivation and retention [18]. The direct involvement of UFR2S and HRSL strengthened institutional confidence and promoted local ownership of the programme.

Pété’s experience illustrates an effective partnership model between the university, the health district and the referral hospital. This system is in line with the guidelines of the 2019-2028 National Health and Social Development Plan and aligns with Sustainable Development Goal 3.1, which aims to reduce the maternal mortality ratio to below 70 per 100,000 live births by 2030 [14]-[19]. Its regional extension would strengthen universal health coverage for maternal health in Senegal.

Limitations of the study are the small sample size (14 midwives), limiting the generalisability of the results, the comparative before/after data based on declarative memory, and the absence of direct measurement on patients. However, these limitations do not affect the internal validity of the descriptive and interpretative results.

The aim of this study, conducted in the Pété health district between 2021 and 2025, was to assess the impact of obstetric ultrasound training applied to EmONC on midwives’ skills, the quality of obstetric care and the performance of the local health system.