Knowledge and Skills Gap of Midwives to Conduct Obstetric Ultrasonography Screening in Primary Health Care Facilities in Kajiado and Kisii Counties, Kenya
Background: Ultrasound remains a tool of much importance in
maternity care with midwives regarded as key health professionals when it comes
to care of pregnant mothers. There is however limited study on the knowledge
and skills gaps of midwives in conducting obstetric ultrasonography screening.
The purpose of this study was to assess the specific obstetric ultrasonography
knowledge and skills gaps among midwives based in primary health care facilities. Methods: A cross-sectional study employing both qualitative and quantitative
method was conducted between July and August 2019 with 274 midwives. A
structured questionnaire was used to collect data while Focus group discussion
and Key Informants Interview were used to collect qualitative data. Descriptive
statistics were used to summarize the data test associations between variables
while the qualitative data were used to compliment the questionnaire data in
eliciting more information on the gaps. Findings: Almost all (94.5%) the
midwives had never been trained on any basic obstetric ultrasound while six of
those that had been trained in early stages by the projectlacked equipment
to practice the acquired skills. More than three quarters of the respondents
opined that they wished to provide personalized care services to
mothers/clients seeking Antenatal Care Services (ANC) in their community at a fee while only 13.9% had
knowledge that obstetric screening should be done before 24 weeks
gestation. Four out of tenof the respondents scored themselves a one
(1) on the level of confidence they have using an ultrasound machines or
technology. Conclusion: There still remains a huge gap as far as training of midwives on basic ultrasound screening
is concerned. The lack of basic obstetric ultrasound screening skills is
a barrier to rolling out Point of Care
Ultrasound (POCUS)
References
[1]
Wanyonyi, S.Z., Mariara, C.M., Vinayak, S. and Stones, W. (2017) Opportunities and Challenges in Realizing Universal Access to Obstetric Ultrasound in Sub-Saharan Africa. Ultrasound International Open, 3, E52-E59.
https://doi.org/10.1055/s-0043-103948
[2]
Kim, E.T., Singh, K., Moran, A., Armbruster, D. and Kozuki, N. (2018) Obstetric Ultrasound Use in Low and Middle Income Countries: A Narrative Review. Reproductive Health, 15, Article No. 129. https://doi.org/10.1186/s12978-018-0571-y
[3]
Holmlund, S., Ntaganira, J., Edvardsson, K., Lan, P.T., Semasaka Sengoma, J.P., Lesio Kidanto, H., Ngarina, M., Small, R. and Mogren, I. (2018) Health Professionals’ Experiences and Views on Obstetric Ultrasound in Rwanda: A Cross-Sectional Study. PLoS ONE, 13, e0208387. https://doi.org/10.1371/journal.pone.0208387
[4]
Franklin, H.L., Mirza, W., Swanson, D.L., Newman, J.E., Goldenberg, R.L., Muyodi, D., Figueroa, L., Nathan, R.O., Swanson, J.O., Goldsmith, N., Kanaiza, N., Naqvi, F., Pineda, I.S., López-Gomez, W., Hamsumonde, D., Bolamba, V.L., Fogleman, E.V., Saleem, S., Esamai, F., et al. (2018) Factors Influencing Referrals for Ultrasound-Diagnosed Complications during Prenatal Care in Five Low and Middle Income Countries. Reproductive Health, 15, Article No. 204.
https://doi.org/10.1186/s12978-018-0647-8
[5]
Dalmacion, G.V., Reyles, R.T., Habana, A.E., et al. (2018) Handheld Ultrasound to Avert Maternal and Neonatal Deaths in 2 Regions of the Philippines: An iBuntis® Intervention Study. BMC Pregnancy Childbirth, 18, Article No. 32.
https://doi.org/10.1186/s12884-018-1658-8
[6]
Vinayak, S., Sande, J., Nisenbaum, H. and Nolsoe, C.P. (2017) Training Midwives to Perform Basic Obstetric Point-of-Care Ultrasound in Rural Areas Using a Tablet Platform and Mobile Phone Transmission Technology—A WFUMB COE Project. Ultrasound in Medicine & Biology, 43, 2125-2132.
https://doi.org/10.1016/j.ultrasmedbio.2017.05.024
[7]
Holmlund, S., Ntaganira, J., Edvardsson, K., Lan, P.T., Semasaka Sengoma, J.P., Ahman, A., Small, R. and Mogren, I. (2017) Improved Maternity Care If Midwives Learn to Perform Ultrasound: A Qualitative Study of Rwandan Midwives’ Experiences and Views of Obstetric Ultrasound. Global Health Action, 10, Article ID: 1350451. https://doi.org/10.1080/16549716.2017.1350451
[8]
Magar, V., Gerecke, M., Dhillon, I. and Campbell, J. (2017) Women’s Contributions to Sustainable Development through Work in Health: Using a Gender Lens to Advance a Transformative 2030 Agenda. WHO.
https://www.who.int/bulletin/volumes/96/9/18-211607/en/
[9]
Mubuuke, A., Kiguli-Malwadde, E., Businge, F. and Byanyima, R. (2011) Utilisation of Obstetric Sonography at a Peri-Urban Health Centre in Uganda. Pan African Medical Journal, 7, 7-24. https://doi.org/10.4314/pamj.v7i1.69139
[10]
Solom, L., Bernard, J. and Vile, Y. (2004) First Trimester Ultrasound Should Be a Tailored Examination. Journal de Gynécologie Obstétrique et Biologie de la Reproduction, 33, 375-377.
[11]
Bentley, S., Hexom, B. and Nelson, B.P. (2015) Evaluation of an Obstetric Ultrasound Curriculum for Midwives in Liberia. Journal of Ultrasound in Medicine, 34, 1563-1568. https://doi.org/10.7863/ultra.15.14.08017
[12]
Stanton, K. and Mwanri, L. (2013) Global Maternal and Child Health Outcomes: The Role of Obstetric Ultrasound in Low Resource Settings.
http://pubs.sciepub.com/jpm/1/3/3/
[13]
ISUOG (2014) ISUOG Education Committee Recommendations for Basic Training in Obstetric and Gynecological Ultrasound. Ultrasound in Obstetrics & Gynecology, 43, 113-116. https://doi.org/10.1002/uog.13208
[14]
WHO (2016) World Health Organization Recommendations on Antenatal Care for a Positive Pregnancy Experience: Ultrasound Examination.
https://www.who.int/reproductivehealth/publications/maternal_perinatal_ health/anc-positive-pregnancy-experience/en/
[15]
Shah, S., Bellows, B.A., Adedipe, A.A., Totten, J.E., Backlund, B.H. and Sajed, D. (2015) Perceived Barriers in the Use of Ultrasound in Developing Countries. Critical Ultrasound Journal, 7, Article No. 11.
https://doi.org/10.1186/s13089-015-0028-2
[16]
Telly, S.Y., Leno, D.W.A., Camara, M.K., Hyjazi, Y. and Keita, N. (2017) Knowledge, Attitudes and Practices of Obstetrical Ultrasound in Conakry, Guinea. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 6, 585.
https://doi.org/10.18203/2320-1770.ijrcog20170387
[17]
Micks, T., Sue, K. and Rogers, P. (2016) Barriers to Point-of-Care Ultrasound Use in Rural Emergency Departments. Canadian Journal of Emergency Medicine, 18, 475-479. https://doi.org/10.1017/cem.2016.337
[18]
Edvardsson, K., Ntaganira, J., Ahman, A., Sengoma, J.P.S., Small, R. and Mogren, I. (2016) Physicians’ Experiences and Views on the Role of Obstetric Ultrasound in Rural and Urban Rwanda: A Qualitative Study. Tropical Medicine & International Health, 21, 895-906. https://doi.org/10.1111/tmi.12718