244942 Impact of maternal ultrasound implementation in remote clinics in Mali

Tuesday, November 1, 2011

Melody Eckardt, MD, MPH , Division of Global Health and Human Rights, Massachusetts General Hospital, Boston, MA
Roy Ahn, MPH, ScD , Division of Global Health & Human Rights, Massachusetts General Hospital, Boston, MA
Raquel Reyes, MD, MPA , Departments of Internal Medicine and Pediatrics, Massachusetts General Hospital, Boston, MA
Elizabeth Cafferty, MSc , Division of Global Health & Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
Jean Crawford, MA , Lab for Developmental Studies (Harvard), Department of Linguistics (UConn), Harvard University and University of Connecticut, Boston, MA
Allison Mulcahy, MD , Department of Emergency Medicine, Alameda County Medical Center/ UCSF, Oakland, CA
Thomas F. Burke, MD , Division of Global Health & Human Rights, Massachusetts General Hospital, Boston, MA
Background: In the developing world, maternity health care facilities are often underutilized, contributing to high maternal mortality. The impact of ultrasound in these settings on patients, health providers, and communities, is poorly understood. Purpose: To quantitatively and qualitatively assess the impact of the introduction of maternal ultrasound in a population not previously exposed to this intervention, and to identify barriers and opportunities for using ultrasound to improve maternal health. Methods: An NGO-led program trained nurses at four remote clinics outside Koutiala, Mali who performed 4,163 maternal ultrasound scans over three years. Our team of researchers conducted an impact assessment of this project that involved log book review, sonographer skill assessment, referral follow up, semi-structured interviews of clinic staff and patients, and gender-specific focus groups of community members in surrounding villages. Analysis included the impact of ultrasound on clinic function, job satisfaction, community utilization of prenatal care and maternity services, alterations in clinical decision making, sonographer skill and referral frequency. We used QRS NVivo9 to organize qualitative findings, code data, and identify emergent themes. Results: Clinically significant findings were noted in 7.5% of ultrasounds, with a 3% documented referral rate to comprehensive maternity care facilities. Skill retention and job satisfaction for ultrasound providers was high, and maternal service utilization was robust. Qualitative analysis of data related to acceptance of and barriers to ultrasound adoption, will be presented. Conclusion: Use of maternal ultrasound in remote settings improves diagnosis, facilitates referral and also impacts job satisfaction and maternal health care seeking behavior.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs

Learning Objectives:
1) Describe a model for implementation of maternal ultrasound in remote settings to enhance uptake of antenatal care and provide risk assessment for referal to comprehensive maternal care centers for delivery 2) Explore community response to the introduction of this complex technology and its impact on health seeking behaviors.

Keywords: Prenatal Interventions, International Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a senior Global Health Fellow and the Director of Maternal Health for the Maternal Newborn and Child Survival Initiative at the Division of Global Health and Human Rights in the Department of Emergency Medicine at Massachesetts General Hospital, and I am a Faculty Instructor in Obstetrics and Gynecology and the Director of Women's Refugee Health at Boston Medical Center.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.