Impact of maternal ultrasound implementation in remote clinics in Mali

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.