Prenatal ultrasound is a critical part of obstetric care, yet many women in developing countries go their entire pregnancy without receiving a single scan. Imaging experts, however, believe they can help reverse this trend with adequate support.
A group of six radiography providers in Nigeria reviewed the challenges and benefits of doing just that, offering their own recommendations Thursday in Radiography.
“Ultrasound imaging equipment over the years has become more compact and portable … with improved image quality and reduced machine costs,” G. Luntsi, with the Department of Medical Radiography at the University of Maiduguri, and colleagues wrote. “This means that diagnostic imaging service provision is possible in an increasing number of clinical settings and a particular area of interest is the deployment of ultrasound in resource-scarce settings where access to imaging diagnostics is severely limited.”
Why it’s a problem
In sub-Saharan Africa, an estimated 546 mothers die per 100,000 live births, compared to the 17 deaths per 100,000 in developed countries, the authors noted.
Ultrasound imaging can quickly and accurately identify abnormalities that arise during pregnancy, such as severe bleeding and obstructive labor, that would enable providers to properly care for these women and potentially reduce mortality rates.
Also, in developed regions, women traditionally undergo two screening ultrasound scans during their pregnancy, with those performed at the 10th to 13th week of gestation proving particularly important. This time period is critical for determining gestational age, early risk stratification, and other fetal abnormalities.
Ongoing challenges to ensuring ultrasound access
One of the ever-present problems of instituting ultrasound in these resource-strapped areas is the shortage of sonographers and other specialists trained on the modality.
Scans can vary widely depending on users’ training and experience. International societies recommend trainees complete 100 exams with another 100 hours of supervision before practicing independently. Other groups, such as the WHO, have their own strict guidelines.
Additionally, in areas where diagnostic imaging is available, quality assurance and control are difficult. Nearly 70% of machines are not even fully functional, Luntsi et al. wrote.
Other, more deeply-rooted challenges include different cultural beliefs, illiteracy, inadequate infrastructure, and traditions that may oppose adopting technological services.
Fixes for the future
The authors called on a number of parties to help address these roadblocks.
Those include policymakers who can help provide a conducive environment and recommendations that enable exploration of ultrasound’s potential. Government leaders must also address illiteracy and poverty issues while providing information and awareness about the technology, they added.
Appropriate guidelines mandating supervision can make sure ultrasound does not end up in the hands of unqualified providers, potentially resulting in increased mortality rates.
They suggested foreign experts may rotate in on a regular basis to train individuals and make sure local US operators are registered with regulating bodies.
“Provision of ultrasound services in these settings has the potential to improve access and quality of health care services in areas such as point of care ultrasound service provision and in the fields of obstetrics and gynecology,” the researchers wrote. “A comprehensive regulation must be put in place to achieve maximum benefits and to ensure quality assurance, appropriate use of equipment and comprehensive ethics and training.”
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.