Assessing the Diagnostic Imaging needs for Five Selected Hospitals in Uganda

Abstract

Introduction: Uganda has limited health resources. It is important to measure the need for imaging in order to set policy and plan for imaging services. Objectives: The first specific objective was to develop and apply four imaging needs indices on a case study basis, in five selected Ugandan hospitals. The indices were: Imaging Load (IL), Imaging Burden (IB), Type Specific Imaging Burden (TSIB), and Disease Specific Imaging Burden (DSIB). The second objective was to explore the perceptions of the patient, referring clinician, and radiologist regarding the values, meaning, and objective of imaging in patient care. Materials and Methods: This was a cross-sectional survey employing triangulation methodology, conducted in 5 Ugandan hospitals over a period of 3 years during 2005 - 2008. The subjects were divided into four clusters: Obstetrics and gynecology (obs/gynae), surgery, internal medicine, and pediatrics. For the quantitative component of the study, data from case notes was used to calculate the indices. The qualitative component explored the non-measurable aspects of imaging needs from the clinician's, radiologist's, and patient's perspective. Results: A total of 1961 patient case notes were studied. The IB was 460 per 1000 hospital patients per year. The highest TSIB was for ultrasound at 232 per 1000 hospital patients per year, followed by 191 patients for general X-ray. The majority of the patients interviewed had special desires, expectations, and misconceptions. Conclusions: There is a high IB of 460 per thousand patient populations per year, mainly due to ultrasound. The majority of the patients have perceptions, misconceptions, beliefs, and values which influence the need for imaging. There is a need to address the medical and non-tangible imaging needs of the patient and to counteract imaging-related misconceptions and over-expectations. Public awareness of the value, capabilities, limitations, and adverse effects of various imaging modalities need to be addressed to ensure that the patients make informed imaging choices and readily avail themselves of interventions in situations when imaging is crucial, for example in suspected high-risk pregnancy.