Ancillary benefits of antenatal ultrasound: an association between the introduction of a low-cost ultrasound program and an increase in the numbers of women receiving recommended antenatal treatments

Abstract

Background: In June of 2010, an antenatal ultrasound program was introduced to perform basic screening examinations at a health care clinic in rural Uganda. The impact of the program on the existing antenatal care infrastructure including the proportion and number of women receiving recommended antenatal care at clinic visits was unknown. The aim of this study was to investigate the relationship between the advent of the ultrasound program and the proportion of women receiving recommended antenatal interventions at their clinic visits. Change in the absolute numbers of antenatal services provided was also assessed.

Methods: Records at the Nawanyago clinic were reviewed to determine the total numbers of women receiving specific interventions before and after the advent of the ultrasound program including HIV testing, intermittent preventive therapy for malaria, presumptive anti-parasitic treatment, and provision of iron and folate for anemia. The rate at which these interventions were provided (number of interventions per clinic visit) was also assessed. The differences in absolute numbers of antenatal interventions before and after the introduction of the ultrasound program were assessed using the Wilcoxon rank-sum test. Differences in intervention rate were assessed using negative binomial regression modeling.

Results: The mean monthly numbers of women receiving each of these interventions increased significantly with the greatest increase seen in numbers of women receiving anemia and deworming treatments at +113% and +102% respectively (p < 0.001). The intervention rate increased for anemia treatment, deworming treatment, and 2nd dose of intermittent preventive therapy for malaria. A slight decrease in intervention rate was observed for 1st dose of malaria treatment with a rate ratio of 0.88 (0.79 - 0.98, 95% CI). Intervention rate for HIV testing was not significantly changed.

Conclusion: The introduction of a low-cost antenatal ultrasound program at a health care clinic in rural Uganda was associated with increases in the number of women receiving specific recommended antenatal care interventions. Effect on intervention rates was mixed but showed an overall increase. The use of ultrasound in this context may provide a benefit to the maternal and neonatal health of the community.

Figure 1

Mean monthly numbers of women receiving specific antenatal interventions at the Nawanyago HC III are shown before and after the introduction of ultrasound. Statistically significant increases occurred following the introduction of the ultrasound screening program in the mean number of women receiving anemia treatment, deworming treatment, HIV testing, and IPT 1 and 2.

Figure 2

The number of antenatal interventions provided is plotted against the number of ANC visits. Increase in number of ANC visits was correlated with number of antenatal interventions provided, both pre and post ultrasound, this correlation was strongest for anemia treatment, HIV testing and deworming treatment.

Figure 3

The rate of antenatal intervention (number of antenatal treatments per antenatal clinic visit) is shown before and after the introduction of the ultrasound program. Significant increases were seen in the proportion of women receiving anemia treatment, deworming treatment, and IPT 2. A slight but statistically significant decline was observed in the rate of IPT 1 administration. HIV testing was increased but not to the level of statistical significance.