Universal access to Obstetric ultrasound

One of Cedars’ main focus is the mitigation of maternal and child mortality, especially in the Sub Sahara Africa region. This is mainly done by employing the use of a crucial diagnostic tool, ultrasound technology so as to promote and advocate for early detection of fetal-maternal and perinatal conditions which causes preventable deaths. To create a sustainable local solution, Inspired by global Maternal and Child health focus, we embarked on a training/ knowledge transfer/ task shifting activities where we conduct hands-on training to non-radiologists/non-sonographers fon Point of care obstetrics ultrasound, especially in the remote and resource-limited areas where there is lack of radiologist/sonographers and technology to provide this service to these underserved communities.

While maternal, perinatal and neonatal mortality rates have declined since 1980, they still remain unacceptably high in the developing world. In 2017, approximately 810 women died from preventable causes related to pregnancy and childbirth. 94% of all maternal deaths occurred in the Low and lower-middle-income countries (WHO). High maternal-perinatal death rates not only impact the affected individual, but also affect the local community and the nation at large. 

Sierra Leone is still grappling with the worst health outcomes in the world. According to the current WHO reports, the Maternal Mortality rate stands at 1,165 deaths per 100,000 live births which are among the highest in the world. These unpleasant outcomes were worsened by the deadly Ebola epidemic outbreak which left more dent to the health care system. It is estimated that more than 7% of the health workforce was lost during Ebola. WHO reports some of the major barriers to health care to the people of Sierra Leone as inadequate (numbers and skills), demotivated and mal-distributed human resources for health, unstable commodities, and supplies, among others.

Ultrasound technology is the most widely employed imaging modality for evaluating fetal well-being and other maternal complications during pregnancy. The introduction of compact, portable and affordable units may allow more widespread use of this technology. It can be used in limited-resource regions like small health centers that don’t have stable electricity connection or good infrastructure since most of the maternal and child health services are offered in these bottom levels of care.

Due to the extreme shortage of sonographers/doctors trained in ultrasound, we implement training of frontline healthworkers such as nurses, midwives and community health officers to perform Point-of-care ultrasound (POCUS) to identify high-risk pregnancies who can then be referred to higher levels of care for further management. A key feature of POCUS is that it’s not a replacement for comprehensive ultrasound practice but a focused ultrasound examination, often in suboptimal conditions, with the goal being to identify high-risk patients. Therefore, POCUS training and practice need to reflect the nuances of the particular region it covers. The specific applications and training methodology are tailored to suit the local environment. There is also a crucial element which is employment of teleradiology (image transfer technology) to enhance consultations and report validation.

Universal access to Obstetrics Ultrasound through Point-of-Care ultrasound (POCUS) innovation is tailor-made for underserved and remote regions; these are remote settings, informal urban settings, or generally settings characterized by poor infrastructure, and poor health systems. Ideally, these are healthcare (low-level government) facilities equipped with