article · Current Problems in Diagnostic Radiology
Access to obstetric ultrasound in low- and middle-income countries can support early detection of high-risk pregnancies, yet specialised sonographers are scarce. To address this gap, a two-week training programme in basic obstetric ultrasound, followed by twelve weeks of oversight, was delivered to healthcare workers with no previous scanning experience across the Democratic Republic of Congo, Guatemala, Kenya, Pakistan, and Zambia. Quality control was assessed by expert trainers who reviewed scanning parameters and diagnostic accuracy against predetermined criteria. Across the twelve-week pilot, forty-one trainees conducted 3,801 examinations comprising 32,480 individual images. Reviewers rated 94.8 percent of the images as satisfactory, and trainee diagnoses showed 99.4 percent concordance with expert evaluations. These findings demonstrate that frontline healthcare staff can be successfully trained to perform reliable basic obstetric ultrasound screening in resource-limited settings.
Maternal and neonatal complications are leading causes of mortality in low-resource environments. Demonstrating that non-specialist healthcare personnel can reliably capture diagnostic-grade ultrasound images and accurately detect high-risk conditions means health systems can screen pregnant women closer to their communities. This offers a practical mechanism to expand antenatal screening coverage without requiring immediate access to fully trained sonographers.
This applied and tested model could enable the deployment of structured clinical training programmes and standardised quality-control frameworks for healthcare providers and non-governmental organisations in low-resource settings. Ultrasound device manufacturers and global health training organisations could package these protocols alongside portable ultrasound hardware to accelerate clinical adoption. The model is already field-tested in five countries, indicating readiness for broader operational scaling.
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Prior studies have suggested that obstetrical (OB) ultrasound in low- and middle-income countries has aided in detection of high-risk conditions, which in turn could improve OB management. We are participating in a cluster-randomized clinical trial of OB ultrasound, which is designed to assess the effect of basic OB ultrasound on maternal mortality, fetal mortality, neonatal mortality, and maternal near-miss in 5 low-income countries. We designed a 2-week course in basic OB ultrasound, followed by 12 weeks of oversight, to train health care professionals with no prior ultrasound experience to perform basic OB ultrasound to screen for high-risk pregnancies. All patients with high-risk pregnancies identified by the trainees were referred to higher-level health facilities where fully trained sonographers confirmed the diagnoses before any actions were taken. Although there have been several published studies on basic OB ultrasound training courses for health care workers in low- and middle-income countries, quality control reporting has been limited. The purpose of this study is to report on quality control results of these trainees. Health care workers trained in similar courses could have an adjunctive role in ultrasound screening for high-risk OB conditions where access to care is limited. After completion of the ultrasound course, 41 trainees in 5 countries performed 3801 ultrasound examinations during a 12-week pilot period. Each examination was reviewed by ultrasound trainers for errors in scanning parameters and errors in diagnosis, using predetermined criteria. Of the 32,480 images comprising the 3801 examinations, 94.8% were rated as satisfactory by the reviewers. There was 99.4% concordance between trainee and reviewer ultrasound diagnosis. The results suggest that trained health care workers could play a role in ultrasound screening for high-risk OB conditions.
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DOI: 10.1067/j.cpradiol.2016.11.001
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