Kawooya Michael G, Nathan Robert O, Swanson Jonathan, Swanson David L, Namulema Edith, Ankunda Racheal, Kirumira Fred, Ddungu-Matovu Peter
*Ernest Cook Ultrasound Research and Education Institute, Mengo Hospital, Kampala, Uganda; and †Department of Radiology, University of Washington, Seattle, WA.
Ultrasound Q. 2015 Dec;31(4):285-9. doi: 10.1097/RUQ.0000000000000142.
The preponderance of global maternal and neonatal deaths occurs in low-resource countries. The risk factors that lead to these deaths are often detectable with ultrasound (US) and potentially preventable. We assessed the impact of performing US scanning during antenatal care (ANC) on reproductive health service utilization in a rural Ugandan district. This pragmatic comparative study was conducted in 2 constituencies of Mpigi district in Uganda. In the 5 intervention sites located in the Mawokota North constituency, facility midwives were trained in limited obstetric US scanning. They were equipped with solar-powered portable US machines and redeployed to offer US scanning as an integral component of ANC. The 5 control sites in the Mawokota South constituency offered the same ANC services without US scanning. We compared the difference in the first and fourth ANC attendance, facility deliveries, and referral of obstetric complications in the intervention and the control sites before and after the introduction of US. There was a 32% increase in the first ANC attendance at the intervention sites compared with 7.4% in the controls sites (P < 0.001). In the intervention sites, the fourth antenatal attendance increased by 147% compared with 0.6% decline in the control sites (P < 0.001). Referrals of high-risk pregnancies increased by 40.7% in the intervention sites compared with 25% in the control site. The number of births at the interventional sites increased by 34.1% compared with 29.5% in the control sites. Integration of limited obstetric US into routine ANC visits is associated with an increase in ANC attendance.
全球孕产妇和新生儿死亡大多发生在资源匮乏的国家。导致这些死亡的风险因素通常可以通过超声（US）检测出来，并且有可能预防。我们评估了在乌干达一个农村地区的产前护理（ANC）期间进行超声扫描对生殖健康服务利用情况的影响。这项务实的比较研究在乌干达姆皮吉区的2个选区进行。在位于马沃科塔北区的5个干预点，机构助产士接受了有限的产科超声扫描培训。他们配备了太阳能便携式超声设备，并重新部署以提供超声扫描，作为产前护理的一个组成部分。马沃科塔南区的5个对照点提供相同的产前护理服务，但不进行超声扫描。我们比较了在引入超声前后，干预点和对照点在首次和第四次产前检查、机构分娩以及产科并发症转诊方面的差异。干预点的首次产前检查出勤率增加了32%，而对照点为7.4%（P<0.001）。在干预点，第四次产前检查出勤率增加了147%，而对照点下降了0.6%（P<0.001）。干预点高危妊娠的转诊率增加了40.7%，而对照点为25%。干预点的分娩数量增加了34.1%，对照点为 29.5%。将有限的产科超声检查纳入常规产前检查与产前检查出勤率的增加有关。
