Institutionalization of limited obstetric ultrasound leading to increased antenatal, skilled delivery, and postnatal service utilization in three regions of Ethiopia: A pre-post study

Hailemariam Segni Abawollo; Mesele Damte Argaw; Zergu Taffesse Tsegaye; Ismael Ali Beshir; Asfaw Adugna Guteta; Atrie Fekadu Heyi; Birhan Tenaw Mengesha; Tsega Teferi Mamo; Zenawork Kassa Gebremedhin; Heran Demissie Damte; Mengistu Asnake Kibret; Binyam Fekadu Desta

doi:10.1371/journal.pone.0281626

Institutionalization of limited obstetric ultrasound leading to increased antenatal, skilled delivery, and postnatal service utilization in three regions of Ethiopia: A pre-post study

PLoS One. 2023 Feb 15;18(2):e0281626. doi: 10.1371/journal.pone.0281626. eCollection 2023.

Affiliations

¹ USAID Transform: Primary Health Care Activity, JSI Research & Training Institute Inc., Addis Ababa, Ethiopia.
² USAID Surveillance for Malaria Elimination Activity, PATH, Addis Ababa, Ethiopia.
³ USAID Transform: Primary Health Care Activity, Pathfinder International, Addis Ababa, Ethiopia.

Abstract

Background: A minimum of one ultrasound scan is recommended for all pregnant women before the 24th week of gestation. In Ethiopia, there is a shortage of skilled manpower to provide these services. Currently, trained mid-level providers are providing the services at the primary healthcare level. The aims of this study were to compare antenatal care 1 (ANC1), antenatal care 4 (ANC4), skilled birth attendance (SBA), and postnatal care (PNC) service utilization before and after institutionalizing Vscan limited obstetric ultrasounds at semi-urban health centers in Ethiopia.

Methods: A pre and post intervention observational study was conducted to investigate maternal and neonatal health service utilization rates before and after institutionalizing Vscan limited obstetric ultrasound services, between July 2016 and June 2020. The data were extracted from 1st August- 31st December 2020.

Results: The observed monthly increase on the mean rank of first ANC visits after the introduction of Vscan limited obstetric ultrasound services showed a statistically significant difference at KW-ANOVA H (3) = 17.09, P = 0.001. The mean rank of fourth ANC utilization showed a statistically significant difference at KW- ANOVA H (3) = 16.24, P = 0.001. The observed mean rank in skilled birth attendance (SBA) showed a statistically significant positive difference using KW-ANOVA H (3) = 23.6, P<0.001. The mean rank of increased utilization in postnatal care showed a statistically significant difference using KW-ANOVA H (3) = 17.79, P<0.001.

Conclusion: The introduction of limited obstetric ultrasound services by trained mid-level providers at the primary healthcare level was found to have improved the utilization of ANC, SBA, and postnatal care (PNC) services. It is recommended that the institutionalization of limited obstetric ultrasound services be scaled up and a further comparative study between facilities with and without ultrasound services be conducted to confirm causality and assess effects on maternal and perinatal outcomes.

Copyright: © 2023 Abawollo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Observational Study
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Delivery, Obstetric
Ethiopia
Female
Health Services Accessibility*
Humans
Infant, Newborn
Institutionalization
Maternal Health Services*
Parturition
Pregnancy
Prenatal Care
Ultrasonography, Prenatal

Grants and funding

The USAID Transform: Primary Health Care project is a technical assistance program to support the Government of Ethiopia. The project is funded by the United States Agency for International Development (USAID), under cooperative agreement number of AID-663-A-17-00002 and is managed by Pathfinder International and JSI Research & Training Institute Inc. in Ethiopia. The project purchased Vscan limited obstetric ultrasound machines which were distributed with seed supplies to 100 health centers. The cost of basic ultrasound training was also covered by the project. In addition, the project covered the cost of data collectors. The funder provided support in the form of salaries for authors HSA, MDA, ZTT, IAB, AAG, AFH, BTM, TTM, ZKG, HDD, MAK, and BFD. This technical report is made possible by the generous support of the American people through USAID. However, the funding body had no role in the study design, data collection, analysis, decision to publish, or preparation of the manuscript.