Maternal health care professionals' experiences and views on the use of obstetric ultrasound in Rwanda: A cross-sectional study.
Clinical guidelines
Commercialisation
Epidemiology
Gynecologists
Health professionals
Medicalisation
Midwives
Nurses
Obstetricians
Obstetrics
Pregnancy
Questionnaire
Rwanda
Ultrasonography
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
10 Aug 2021
10 Aug 2021
Historique:
received:
01
03
2021
accepted:
12
07
2021
entrez:
11
8
2021
pubmed:
12
8
2021
medline:
13
8
2021
Statut:
epublish
Résumé
This study, undertaken in Rwanda, aimed to investigate health professionals' experiences and views on the following topics: current clinical guidelines for ultrasound from second trimester at the clinic, regional and national levels, and adherence to clinical guidelines; medically indicated ultrasound examinations; non-medical use of ultrasound including ultrasounds on maternal request; commercialisation of ultrasound; the value of ultrasound in relation to other clinical examinations in pregnancy; and ultrasound and medicalisation of pregnancy. A cross-sectional design was adopted. Health professionals providing antenatal care and delivery services to pregnant women in 108 health facilities were invited to complete a survey, which was developed based on the results of earlier qualitative studies undertaken as part of the CROss Country Ultrasound Study (CROCUS). Nine hundred and seven health professionals participated: obstetricians/gynecologists (3.2%,) other physicians (24.5%), midwives (29.7%) and nurses (42.7%). Few physicians reported the existence of clinical guidelines at clinic, regional or national levels in Rwanda, and guidelines were moderately adhered to. Three obstetric ultrasound examinations were considered medically indicated in an uncomplicated pregnancy. Most participants (73.0%) were positive about obstetric ultrasound examinations on maternal request. Commercialisation was not considered a problem, and the majority (88.5%) agreed that ultrasound had contributed to medicalisation of pregnancy. Findings indicate that clinical guidelines for the use of obstetric ultrasound are limited in Rwanda. Non-medically indicated obstetric ultrasound was not considered a current problem at any level of the healthcare system. The positive attitude to obstetric ultrasound examinations on maternal request may contribute to further burden on a maternal health care system with limited resources. It is essential that limited obstetric ultrasound resources are allocated where they are most beneficial, and clearly stated medical indications would likely facilitate this.
Sections du résumé
BACKGROUND
BACKGROUND
This study, undertaken in Rwanda, aimed to investigate health professionals' experiences and views on the following topics: current clinical guidelines for ultrasound from second trimester at the clinic, regional and national levels, and adherence to clinical guidelines; medically indicated ultrasound examinations; non-medical use of ultrasound including ultrasounds on maternal request; commercialisation of ultrasound; the value of ultrasound in relation to other clinical examinations in pregnancy; and ultrasound and medicalisation of pregnancy.
METHODS
METHODS
A cross-sectional design was adopted. Health professionals providing antenatal care and delivery services to pregnant women in 108 health facilities were invited to complete a survey, which was developed based on the results of earlier qualitative studies undertaken as part of the CROss Country Ultrasound Study (CROCUS).
RESULTS
RESULTS
Nine hundred and seven health professionals participated: obstetricians/gynecologists (3.2%,) other physicians (24.5%), midwives (29.7%) and nurses (42.7%). Few physicians reported the existence of clinical guidelines at clinic, regional or national levels in Rwanda, and guidelines were moderately adhered to. Three obstetric ultrasound examinations were considered medically indicated in an uncomplicated pregnancy. Most participants (73.0%) were positive about obstetric ultrasound examinations on maternal request. Commercialisation was not considered a problem, and the majority (88.5%) agreed that ultrasound had contributed to medicalisation of pregnancy.
CONCLUSIONS
CONCLUSIONS
Findings indicate that clinical guidelines for the use of obstetric ultrasound are limited in Rwanda. Non-medically indicated obstetric ultrasound was not considered a current problem at any level of the healthcare system. The positive attitude to obstetric ultrasound examinations on maternal request may contribute to further burden on a maternal health care system with limited resources. It is essential that limited obstetric ultrasound resources are allocated where they are most beneficial, and clearly stated medical indications would likely facilitate this.
Identifiants
pubmed: 34376210
doi: 10.1186/s12913-021-06758-w
pii: 10.1186/s12913-021-06758-w
pmc: PMC8356395
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
789Subventions
Organisme : Vetenskapsrådet
ID : E0267201
Informations de copyright
© 2021. The Author(s).
Références
Soc Sci Med. 2013 Sep;93:55-63
pubmed: 23906121
Glob Health Action. 2017;10(1):1350451
pubmed: 28764602
Reprod Health. 2018 Jul 20;15(1):129
pubmed: 30029609
J Ultrasound Med. 2008 Apr;27(4):541-59; quiz 560-3
pubmed: 18359908
PLoS One. 2013 Oct 30;8(10):e78450
pubmed: 24205234
BMC Pregnancy Childbirth. 2015 Aug 27;15:195
pubmed: 26311437
Glob Health Action. 2016 Jul 22;9:31062
pubmed: 27452066
BJOG. 2018 Nov;125(12):1591-1599
pubmed: 29782696
Semin Perinatol. 2013 Oct;37(5):295-300
pubmed: 24176149
Midwifery. 2016 Nov;42:46-53
pubmed: 27788415
PLoS One. 2018 Dec 4;13(12):e0208387
pubmed: 30513102
Nurs Ethics. 2009 Sep;16(5):637-46
pubmed: 19671649
Cochrane Database Syst Rev. 2017 Jun 13;6:CD007529
pubmed: 28613398
Obstet Gynecol. 2016 Dec;128(6):e241-e256
pubmed: 27875472
J Obstet Gynecol Neonatal Nurs. 2008 May-Jun;37(3):315-28
pubmed: 18507602
Trop Med Int Health. 2016 Jul;21(7):895-906
pubmed: 27125579
Ultrasound Q. 2015 Dec;31(4):285-9
pubmed: 26656991
Int J MCH AIDS. 2020;9(1):103-120
pubmed: 32123634
BMC Pregnancy Childbirth. 2015 Nov 20;15:304
pubmed: 26589489
BMC Pregnancy Childbirth. 2014 Oct 22;14:363
pubmed: 25336335
Ultrasound Obstet Gynecol. 2011 Sep;38(3):267-71
pubmed: 21584892
Arch Public Health. 2015 Sep 07;73(1):36
pubmed: 26347809
Ultrasound Obstet Gynecol. 2013 Jan;41(1):102-13
pubmed: 23280739
BMJ Open. 2019 Sep 22;9(9):e031761
pubmed: 31548354
Sex Reprod Healthc. 2018 Jun;16:1-5
pubmed: 29804752
Glob Health Action. 2015 Oct 29;8:28405
pubmed: 26519131