Quality of ultrasound images by midwives implementing ultrasound scanning services during antenatal clinics within selected healthcare facilities of Zambia

Background: Limited access to ultrasound services in low and middle-income countries (LMICs) prompts the development of an intensive training program for midwives. The aim of this study was to evaluate the quality of ultrasound images produced by midwives and assess their competency in gestational a...

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Main Authors: Shown Haluzani, Agripa Lungu, Mweetwa Mudenda, Arnold Hamapa, Catherine Mkandawire, Abraham Kaluba, Oswell Khondowe, Mushelelwa Mutale, Karren Imasiku, Muyereka Nyirenda, Osbert Nkolola, Lackson Kasonka, Felix Simute, Angel Mwiche, Evarist Njelesani, Peter Mwaba, C. Viner Alexandra, David Lissauer, Mubambe Mulaya, Desire Kabamba, John Mathias Zulu, Lydia Hangulu
Format: Article
Language:English
Published: Elsevier 2024-12-01
Series:WFUMB Ultrasound Open
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Online Access:http://www.sciencedirect.com/science/article/pii/S2949668324000259
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author Shown Haluzani
Agripa Lungu
Mweetwa Mudenda
Arnold Hamapa
Catherine Mkandawire
Abraham Kaluba
Oswell Khondowe
Mushelelwa Mutale
Karren Imasiku
Muyereka Nyirenda
Osbert Nkolola
Lackson Kasonka
Felix Simute
Angel Mwiche
Evarist Njelesani
Peter Mwaba
C. Viner Alexandra
David Lissauer
Mubambe Mulaya
Desire Kabamba
John Mathias Zulu
Lydia Hangulu
author_facet Shown Haluzani
Agripa Lungu
Mweetwa Mudenda
Arnold Hamapa
Catherine Mkandawire
Abraham Kaluba
Oswell Khondowe
Mushelelwa Mutale
Karren Imasiku
Muyereka Nyirenda
Osbert Nkolola
Lackson Kasonka
Felix Simute
Angel Mwiche
Evarist Njelesani
Peter Mwaba
C. Viner Alexandra
David Lissauer
Mubambe Mulaya
Desire Kabamba
John Mathias Zulu
Lydia Hangulu
author_sort Shown Haluzani
collection DOAJ
description Background: Limited access to ultrasound services in low and middle-income countries (LMICs) prompts the development of an intensive training program for midwives. The aim of this study was to evaluate the quality of ultrasound images produced by midwives and assess their competency in gestational age assessment using femur length. Methods: A cross-sectional study conducted in 11 healthcare facilities across four districts in Zambia involved the evaluation of 928 images captured during the implementation of the Training in Ultrasound to Determine Gestational Age (TUDA) program in 2021. TUDA, collaboration under the DIPLOMATIC Study, trained 24 midwives intensively for 14 days, followed by eight weeks of supervised scanning. Image assessment utilized the Sarries four-point tool, and statistical analyses included descriptive and inferential statistics. Results: Midwives achieved an 87.95 % competency level in basic ultrasound scans for gestational age determination using femur length. Assessment by four evaluators showed an average proportion of good-quality images also at 87.95 %. There were no statistically significant differences among assessors, indicating consistency in evaluations. Trainers and radiographers exhibited different average proportions of good-quality images at 91.5 % and 83.9 %, respectively, with no statistically significant differences observed between them.Furthermore, analysis of image quality revealed significant variation among different facilities. Specifically, in Chipata, 24.32 % of scans were classified as poor quality, while in George Clinic, only 2.30 % were considered poor quality. A Chi-square test indicated a substantial correlation between health facility and image quality (χ2 = 15.99, p = 0.025). However, no significant correlations were found between image quality and factors such as work experience, age group, or gender. Conclusion: This study provides critical evidence for successfully training midwives to competent produce high-quality ultrasound images for determining gestational age. These findings are essential for guiding interventions aimed at enhancing ultrasound service delivery and ensuring consistent, high-quality healthcare outcomes, because this is critical for effective prenatal care in Zambia. This has high potential to improve prenatal care. Recommendation: Zambia needs to train more midwives to provide routine ultrasound services during Antenatal Care (ANC) which may ultimately reduce preterm and still births. We recommend the inclusion of ultrasound scanning in-service and pre-service training and establishment of standardized protocols and guidelines for ultrasound scanning services during antenatal clinics.
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spelling doaj-art-eabcfe4648cf4909b548b06773b6c9f52025-08-20T02:38:46ZengElsevierWFUMB Ultrasound Open2949-66832024-12-012210005710.1016/j.wfumbo.2024.100057Quality of ultrasound images by midwives implementing ultrasound scanning services during antenatal clinics within selected healthcare facilities of ZambiaShown Haluzani0Agripa Lungu1Mweetwa Mudenda2Arnold Hamapa3Catherine Mkandawire4Abraham Kaluba5Oswell Khondowe6Mushelelwa Mutale7Karren Imasiku8Muyereka Nyirenda9Osbert Nkolola10Lackson Kasonka11Felix Simute12Angel Mwiche13Evarist Njelesani14Peter Mwaba15C. Viner Alexandra16David Lissauer17Mubambe Mulaya18Desire Kabamba19John Mathias Zulu20Lydia Hangulu21Lusaka Apex Medical University, Lusaka, Zambia; Corresponding author. P.O Box 31909, Lusaka, Zambia.University Teaching Hospital Women and New-born, Lusaka, ZambiaLusaka Apex Medical University, Lusaka, ZambiaLusaka Apex Medical University, Lusaka, ZambiaLusaka Apex Medical University, Lusaka, ZambiaLusaka Apex Medical University, Lusaka, ZambiaLusaka Apex Medical University, Lusaka, ZambiaMaina Soko Military Hospital, Lusaka, ZambiaMinistry of Health, Lusaka, ZambiaUniversity Teaching Hospital Women and New-born, Lusaka, ZambiaUniversity Teaching Hospital Women and New-born, Lusaka, ZambiaMinistry of Health, Lusaka, ZambiaUniversity Teaching Hospital Women and New-born, Lusaka, ZambiaUniversity Teaching Hospital Women and New-born, Lusaka, ZambiaLusaka Apex Medical University, Lusaka, ZambiaLusaka Apex Medical University, Lusaka, ZambiaMedical Research Council (MRC) Centre for Reproductive Health, The University of Edinburgh, Edinburgh, United KingdomMalawi-Liverpool-Wellcome Research Programme, Blantyre, Malawi; Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United KingdomLevy Mwanawasa University Teaching Hospital, Lusaka, ZambiaLevy Mwanawasa University Teaching Hospital, Lusaka, ZambiaLusaka Apex Medical University, Lusaka, ZambiaLusaka Apex Medical University, Lusaka, ZambiaBackground: Limited access to ultrasound services in low and middle-income countries (LMICs) prompts the development of an intensive training program for midwives. The aim of this study was to evaluate the quality of ultrasound images produced by midwives and assess their competency in gestational age assessment using femur length. Methods: A cross-sectional study conducted in 11 healthcare facilities across four districts in Zambia involved the evaluation of 928 images captured during the implementation of the Training in Ultrasound to Determine Gestational Age (TUDA) program in 2021. TUDA, collaboration under the DIPLOMATIC Study, trained 24 midwives intensively for 14 days, followed by eight weeks of supervised scanning. Image assessment utilized the Sarries four-point tool, and statistical analyses included descriptive and inferential statistics. Results: Midwives achieved an 87.95 % competency level in basic ultrasound scans for gestational age determination using femur length. Assessment by four evaluators showed an average proportion of good-quality images also at 87.95 %. There were no statistically significant differences among assessors, indicating consistency in evaluations. Trainers and radiographers exhibited different average proportions of good-quality images at 91.5 % and 83.9 %, respectively, with no statistically significant differences observed between them.Furthermore, analysis of image quality revealed significant variation among different facilities. Specifically, in Chipata, 24.32 % of scans were classified as poor quality, while in George Clinic, only 2.30 % were considered poor quality. A Chi-square test indicated a substantial correlation between health facility and image quality (χ2 = 15.99, p = 0.025). However, no significant correlations were found between image quality and factors such as work experience, age group, or gender. Conclusion: This study provides critical evidence for successfully training midwives to competent produce high-quality ultrasound images for determining gestational age. These findings are essential for guiding interventions aimed at enhancing ultrasound service delivery and ensuring consistent, high-quality healthcare outcomes, because this is critical for effective prenatal care in Zambia. This has high potential to improve prenatal care. Recommendation: Zambia needs to train more midwives to provide routine ultrasound services during Antenatal Care (ANC) which may ultimately reduce preterm and still births. We recommend the inclusion of ultrasound scanning in-service and pre-service training and establishment of standardized protocols and guidelines for ultrasound scanning services during antenatal clinics.http://www.sciencedirect.com/science/article/pii/S2949668324000259Gestational ageObstetric ultrasoundCompetencyIntense trainingMidwives
spellingShingle Shown Haluzani
Agripa Lungu
Mweetwa Mudenda
Arnold Hamapa
Catherine Mkandawire
Abraham Kaluba
Oswell Khondowe
Mushelelwa Mutale
Karren Imasiku
Muyereka Nyirenda
Osbert Nkolola
Lackson Kasonka
Felix Simute
Angel Mwiche
Evarist Njelesani
Peter Mwaba
C. Viner Alexandra
David Lissauer
Mubambe Mulaya
Desire Kabamba
John Mathias Zulu
Lydia Hangulu
Quality of ultrasound images by midwives implementing ultrasound scanning services during antenatal clinics within selected healthcare facilities of Zambia
WFUMB Ultrasound Open
Gestational age
Obstetric ultrasound
Competency
Intense training
Midwives
title Quality of ultrasound images by midwives implementing ultrasound scanning services during antenatal clinics within selected healthcare facilities of Zambia
title_full Quality of ultrasound images by midwives implementing ultrasound scanning services during antenatal clinics within selected healthcare facilities of Zambia
title_fullStr Quality of ultrasound images by midwives implementing ultrasound scanning services during antenatal clinics within selected healthcare facilities of Zambia
title_full_unstemmed Quality of ultrasound images by midwives implementing ultrasound scanning services during antenatal clinics within selected healthcare facilities of Zambia
title_short Quality of ultrasound images by midwives implementing ultrasound scanning services during antenatal clinics within selected healthcare facilities of Zambia
title_sort quality of ultrasound images by midwives implementing ultrasound scanning services during antenatal clinics within selected healthcare facilities of zambia
topic Gestational age
Obstetric ultrasound
Competency
Intense training
Midwives
url http://www.sciencedirect.com/science/article/pii/S2949668324000259
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