Feasibility and effects of the Mimba Yangu (My Pregnancy) project in improving routine prenatal ultrasound by nurses-midwives in rural Kenya: A before-after study

Abstract

Introduction Point-of-care ultrasound delivered by nurses and midwives has the potential to improve the quality of antenatal care. The 2016 World Health Organizations Antenatal Care Guidelines recommend one ultrasound below 24 weeks of gestational age for every pregnant woman, however programming is facing difficulties. Here we report on the feasibility, effects and acceptability of the Mimba Yangu implementation research project in Kenya using point-of-care ultrasound supported by digital training and supervision. Methods We conducted a quasi-experimental trial including 28 primary care facilities in Kilifi County, Kenya between April 2021 and March 2022. Fourteen facilities received the ultrasound intervention composed of i) a task-shifting approach where ultrasound was delivered by nurses-midwives using portable ultrasound devices (Lumify^TM) connected to a tablet and ii) a unique digital platform to facilitate distant support. Hybrid training of 32 nurse-midwives was provided based on a nationally derived and agreed curriculum including theoretical and hands-on components by an academic team of obstetricians and radiologists. Data collection used i) exit interviews with pregnant women and those who had delivered within the last six months, and ii) data abstraction from the health facility records and Kenyan health management information system, and iii) in-depth interviews with nurse-midwives and health care managers. We descriptively analyzed data and used a difference-in-difference analysis based on a generalized linear model to assess the effect of the intervention on the number of antenatal visits. Results The intervention was successfully and consistently implemented during a nine-month period in all 14 health facilities with 2,799 pregnant women. Interviews with trained nurse-midwives indicated that the intervention was relevant, acceptable, and feasible. In intervention facilities, 50.4% of women received at least one ultrasound compared to 19.2% in the comparison facilities, where women were referred to other facilities for their ultrasound. Furthermore, our analysis suggested a non-significant change of 10.5% in ANC 4+ visits in the intervention compared to comparison facilities. Conclusion Our analysis provides evidence of the feasibility, acceptance and relevance of providing ultrasound at primary care level delivered by nurse-midwives. Scaling-up will demand policy reforms to allow task-sharing at national and sub-national levels and embedding the approach in basic nursing/midwifery education.