Project Lead(s): Sarah Namutamba
Globally, nearly 3 million newborns die every year and 2.6 million babies are stillborn.
Approximately 15% of all pregnancies have medical or obstetric complications that greatly increase the risk of mortality or severe morbidity for the mothers and newborns.
These pregnancy-related complications could be reduced if they were detected with obstetrical ultrasound earlier in pregnancy, before the onset of labour, allowing mothers to make informed decisions about delivery location.
This study was aimed at identifying whether an outreach model at the community level could increase the use of ultrasound scanning. If ultrasounds were done twice, the scans could identify women with abnormalities that needed referral to hospitals with emergency obstetric services.
The study area was the Bukooma sub-county, Luuka District, of eastern Uganda.
A total of 37 trained community health workers visited homes on a monthly basis and registered pregnant women.
A total of 1,300 women were tested for pregnancy by the community health workers and 1,111 women tested positive.
Later in pregnancy, these women were referred for free ultrasound scans, the first at 18 to 22 weeks and the last in the third trimester (32 to 40 weeks).
A total of 910 pregnant women underwent second-trimester ultrasound scanning and 850 pregnant women underwent third-trimester ultrasound scanning.
After delivery, mothers were being followed up, both by the community health workers (for counselling on maternal and newborn care practices) and by the research assistants (for pregnancy outcome data and delivery experiences).
The study results showed that 10% of women (n = 111) were identified on ultrasound as having high-risk pregnancies and all had a live birth outcome.
A total of 96 mothers were effectively referred to higher-level health facilities.
There were two neonatal deaths during the study time and two maternal deaths were registered in the study area, of which one was referred after ultrasound scanning and died at the referral health facility, due to anemia. The second mother who died did not receive ultrasound.
The study showed that it is possible to save lives and improve maternal health outcomes using an outreach model that encourages the use of ultrasound scanning to detect high-risk pregnancies.
Overall, the women had improved maternal and newborn care practices, as a result of the counselling and education provided by the community health workers.
The team intends to scale up the intervention to the entire district.
The team plans to engage the Ministry of Health and other organizations, such UNICEF, the World Health Organization (WHO), USAID, the United Nations Population Fund (UNFPA), the Preterm Birth Initiative (PTBi) and the University of California, San Francisco (UCSF), in organizing health interventions in the district through presentations in conferences, meetings, reports, policy briefs and brochures.