Health professionals’ experiences and views on obstetric ultrasound in Tanzania: A cross-sectional study

Abstract

Abstract Background Obstetric ultrasound has been suggested to play an important role in increasing antenatal care attendance in low-income countries. The overall aim of this study was to explore health professionals’ perspectives on different aspects of obstetric ultrasound in Tanzania. More specifically, we wanted to investigate self-reported skills in performing ultrasound examinations and what health professionals thought could improve access to and utilisation of obstetric ultrasound in the clinical setting. Material and Methods Data collection took place between November and December 2017 using a questionnaire based on previous qualitative research results from the CROss Country UltraSound Study (CROCUS Study). In total, 17 healthcare facilities from national, regional and district levels, in five urban and semiurban municipalities in the Dar-es-Salaam region were included. A total of 636 health professionals participated in the study (physicians, n=307 and midwives/nurses, n=329). Results Most health professionals in this study agreed or strongly agreed that obstetric ultrasound was decisive in the clinical management of pregnancy. Compared to midwives/nurses, a greater proportion of physicians rated their skills as intermediate or high regarding basic ultrasound examinations. Most health professionals reported no skills or low-level skills for assessing cervical length, the fetal heart: 4 chamber view, aorta, and pulmonary artery, and Doppler: umbilical artery. Access to and utilisation of obstetric ultrasound was generally believed to be improved with more and better ultrasound machines along with more training. Compared to midwives/nurses, physicians were significantly more likely to agree or strongly agree that utilisation would improve however, with more ultrasound machines (OR 2.13; 95% CI 1.26 – 3.61), better quality of ultrasound machines (OR 2.27; 95% CI 1.10 – 4.69), more training for health professionals currently performing ultrasound (OR 2.11; 95% CI 1.08 – 4.17), and more physicians trained in ultrasound (OR 2.51; 95% CI 1.30 – 4.87). Conclusions Provision of obstetric ultrasound examinations in Tanzania would likely improve with more and better-quality ultrasound machines, more training for health professionals currently performing ultrasound, and overall, more physicians trained in ultrasound use. To increase the accessibility and utilisation of obstetric ultrasound in maternity care in Tanzania, training for midwives in basic obstetric ultrasound use is warranted.