Implementation and evaluation of a pilot antenatal ultrasound imaging programme using tele-ultrasound in Ethiopia

Abstract

Introduction: Ultrasound imaging is an important aspect of antenatal care, though access to antenatal ultrasound imaging is limited in many developing countries. The objective of this study was to evaluate a pilot programme which aimed to improve access to antenatal ultrasound for rural Ethiopians through enhanced training of healthcare providers (including midwives, nurses and clinical officers) with support remotely provided by obstetricians using a tele-ultrasound platform.

Methods: Thirteen healthcare providers in the North Shoa Zone in Ethiopia completed training to enable them to perform antenatal ultrasound with the remote supervision of an obstetrician via a tele-ultrasound platform. Pregnant women attending an antenatal appointment at two facilities were offered an antenatal ultrasound exam performed by one of the healthcare providers. Image interpretations between obstetricians and healthcare providers were compared. Participants and healthcare providers were invited to complete a questionnaire regarding their experience with tele-ultrasound, and participants, healthcare providers and obstetricians were interviewed regarding their experience with the tele-ultrasound pilot programme.

Results: 2795 pregnant women had an antenatal ultrasound exam. Of 100 exams randomly selected to assess concordance between healthcare providers' and obstetricians' image interpretations, concordance ranged from 79% to 100% for each parameter assessed. 99.4% of participants surveyed indicated that they would recommend antenatal ultrasound using tele-ultrasound to friends and family. Themes relating to participants' experiences of having a tele-ultrasound exam were reduced travel and cost, equivalence in quality of virtual care to in-person care and empowerment through diagnostic information.

Conclusion: Healthcare provider-performed antenatal ultrasound - supported by obstetricians via tele-ultrasound - showed high levels of concordance, was well-received by participants and provided rural Ethiopian women with enhanced access to antenatal imaging.

Keywords: Ethiopia; Telemedicine; antenatal care; global health; tele-ultrasound; ultrasound.

Figure 1.

A group of healthcare providers participate in a training session on using the ultrasound probe.

Figure 2.

A healthcare provider performs an antenatal ultrasound exam using a portable ultrasound probe (a). Images are transmitted in real-time to an obstetrician located at SlUCSH via a tele-ultrasound platform (b). The obstetrician, healthcare provider and patient can see and hear each other using the videoconferencing function of the tele-ultrasound platform, allowing the obstetrician to provide guidance to the healthcare provider on image acquisition and interpretation and allowing the obstetrician and patient to speak with each other.