OJCD  Vol.11 No.1 , March 2021
Barriers and Enablers That Influence Utilization of Ultrasound Screening Services among Antenatal Women in Kajiado and Kisii Counties Kenya
Abstract: Background: The World Health Organization recommends to have all pregnant women to undergo an obstetric ultrasound scan before 24 weeks gestation. However, this has been a challenge as a result of limited access to appropriate Point of Care Ultrasound Screening (POCUS) services in lower levels of developing countries’ Health Systems, cost of care, skills gap among care providers and unclear regulatory policy frameworks. Obstetric Ultrasound scan helps to confirm viability of a pregnancy, gestational age, multiple pregnancies and it also helps rule out fetal abnormalities early enough. Methods: One year after intervention, a cross-sectional study was carried in the two pilot counties of Kisii (rural) and Kajiado (peri-urban). This followed after selected midwives in the two counties were trained on basic obstetric ultrasound screening for ANC women. A total of 366 women who were either in their last phases of pregnancy or had delivered within three months before the survey were interviewed. Cumulatively, the 36 midwives had screened 1,250 mothers out of whom 18 high risk pregnancies were identified. Open Data Kit (ODK) was used to collect quantitative data and analysed using STATA version 15. Descriptive statistics were used to summarize the data test associations between variables. Bivariate and logistic regression was used to identify predictive variables, and ORs with 95% confidence intervals used to measure the strength of the associations. Findings: Slightly more than a third (36%) of the women had recently delivered. In total, Kisii (rural county) had a representation of 59% of the respondents. Half of the respondents were aged between 25 - 34 years, 55% of the women interviewed were housewives while 48% had secondary level of education. Only 21% of the women had undergone routine ultrasound screening before 24 weeks of gestation with the average distance travelled by majority (45%) of the respondents to access the POCUS service being 3 - 5 km. The need to confirm a pregnancy’s gestation was the major (68.1%) motivator for seeking the service in the two pilot counties. Employment status, household income, education level, pregnancy gestation and distance to the facility had a statistical significance (P < 0.05) with ultrasound utilization. Highest education level, pregnancy gestation and distance to the nearest ultrasound screening facility were found to significantly predict the likelihood of utilizing the ultrasound services (P < 0.05). The initial training and continuous hands-on coaching of midwives by TOTs contributed a lot to acquisition of the desired basic obstetric ultrasound screening skills. Conclusion: Women in developing countries are eager to access obstetric ultrasound screening services but for limited opportunities and sustainable implementation frameworks on Point of Care Ultrasound Screening (POCUS) services. Training and continuous coaching of frontline health professionals are critical in deployment of POCUS but there is limited access to standardised training content.
Cite this paper: Matiang’i, M. , Joosse, K. , Ngunju, P. , Kiilu, C. , Harkx, R. , Hangelbroek, M. and Omogi, J. (2021) Barriers and Enablers That Influence Utilization of Ultrasound Screening Services among Antenatal Women in Kajiado and Kisii Counties Kenya. Open Journal of Clinical Diagnostics, 11, 1-17. doi: 10.4236/ojcd.2021.111001.

[1]   FIGO (2015) Best Practice in Maternal-Fetal Medicine. International Journal of Gynecology and Obstetrics, 128, 80-82.

[2]   WHO (2018) Midwives Are Essential to the Provision of Quality of Care, in All Settings, Globally.

[3]   Holmlund, S., Ntaganira, J., Edvardsson, K., Lan, P.T., Sengoma, J.P.S., Åhman, 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.

[4]   Wanyonyi, S., Mariara, C., 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.

[5]   Downe, S., Finlayson, K., Oladapo, O., Bonet, M. and Gülmezoglu, A.M. (2018) What Matters to Women during Childbirth: A Systematic Qualitative Review. PLoS ONE, 13, e0194906.

[6]   Kenya National Bureau of Statistics (2019) 2019 Kenya Population and Housing Census Volume 1: Population by County and Sub-County.

[7]   Aziz Ali, S., Ahmed Dero, A., Aziz Ali, S. and Bano Ali, G. (2018) Factors Affecting the Utilization of Antenatal Care among Pregnant Women: A Literature Review. Journal of Pregnancy and Neonatal Medicine, 2, 41-45.

[8]   Kyei-Nimakoh, M., Carolan-Olah, M. and McCann, T.V. (2017) Access Barriers to Obstetric Care at Health Facilities in Sub-Saharan Africa—A Systematic Review. Systematic Reviews, 6, 110.

[9]   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.

[10]   Andersson, M. (2014) Assessing the Cultural Potential of Ecological Sanitation in Improving Waste Management and Food Security in the Taita Hills, Kenya. Sustainability (Switzerland), 10, 847-854.

[11]   Lassi, Z.S., Musavi, N.B., Maliqi, B., Mansoor, N., de Francisco, A., Toure, K. and Bhutta, Z.A. (2016) Systematic Review on Human Resources for Health Interventions to Improve Maternal Health Outcomes: Evidence from Low- and Middle-Income Countries. Human Resources for Health, 14, 10.

[12]   Ikeako, L.C., Ezegwui, H.U. and Onwudiwe, J.E. (2014) Attitude of Expectant Mothers on the Use of Ultrasound in Pregnancy in a Tertiary Institution in South East of Nigeria. Annals of Medical and Health Science Research, 4, 949-953.

[13]   Sippel, S., Muruganandan, K., Levine, A. and Shah, S. (2011) Review Article: Use of Ultrasound in the Developing World. International Journal of Emergency Medicine, 4, 72.

[14]   Stanton, K. and Mwanri, L. (2013) Global Maternal and Child Health Outcomes: The Role of Obstetric Ultrasound in Low Resource Settings. World Journal of Preventive Medicine, 1, 22-29.

[15]   Shah, S.P., Epino, H., Bukhman, G., Umulisa, I., Dushimiyimana, J.M.V., Reichman, A. and Noble, V.E. (2009) Impact of the Introduction of Ultrasound Services in a Limited Resource Setting: Rural Rwanda 2008. BMC International Health and Human Rights, 9, Article No. 4.

[16]   Blaivas, M., Kuhn, W., Reynolds, B. and Brannam, L. (2005) Change in Differential Diagnosis and Patient Management with the Use of Portable Ultrasound in a Remote Setting. Wilderness & Environmental Medicine, 16, 38-41.[38:CIDDAP]2.0.CO;2

[17]   Vinayak, S., Sande, J., Nisenbaum, H. and Nolsøe, 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 and Biology, 43, 2125-2132.

[18]   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., Liechty, E.A., Garces, A.L., Krebs, N.F., Michael Hambidge, K., Chomba, E., Mwenechanya, M., Carlo, W.A., Tshefu, A., Lokangaka, A., Bose, C.L., Koso-Thomas, M., Miodovnik, M. and McClure, E.M. (2018) Factors Influencing Referrals for Ultrasound-Diagnosed Complications during Prenatal Care in Five Low and Middle Income Countries. Reproductive Health, 15, Article No. 204.

[19]   Åhman, A., Kidanto, H.L., Ngarina, M., Edvardsson, K., Small, R. and Mogren, I. (2016) “Essential But Not Always Available When Needed”—An Interview Study of Physicians’ Experiences and Views Regarding Use of Obstetric Ultrasound in Tanzania. Global Health Action, 9, Article No. 31062.

[20]   Usman, B.O., Idris, S.H. and Umar Abdulaziz, O.A.A. (2020) Factors Affecting Utilization of Obstetric Ultrasound: A Study of Semi-Urban Pregnant Women in a Developing Nation. Sahel Medical Journal, 23, 82-87.

[21]   Ohagwu, C.C., Abu, P.O., Odo, M.C. and Chiegwu, H.U. (2010) Maternal Perception of Barriers to Utilization of Prenatal Ultrasound in Prenatal Care in the Northern Part of Nigeria. Clinics in Mother and Child Health, 7, 1-5.