Accuracy of Home-Based Ultrasonographic Diagnosis of Obstetric Risk Factors by Primary-Level Health Care Workers in Rural Nepal

Naoko Kozuki, Luke C Mullany, Subarna K. Khatry, Ram K. Ghimire, Sharma Paudel, Karin Blakemore, Christine Bird, James M. Tielsch, Steven C. Leclerq, Joanne Katz

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To assess the feasibility of ultrasonographic task shifting by estimating the accuracy at which primary-level health care workers can perform community-based third-trimester ultrasound diagnosis for selected obstetric risk factors in rural Nepal. METHODS: Three auxiliary nurse-midwives received two 1-week ultrasound trainings at Tribhuvan University Teaching Hospital in Kathmandu. At a study site in rural Nepal, pregnant women who were 32 weeks of gestation or greater were enrolled and received ultrasound examinations from the auxiliary nurse-midwives during home visits. Each auxiliary nurse-midwife screened for noncephalic presentation, multiple gestation, and placenta previa. Deidentified digital ultrasonograms were stored and uploaded onto an online server, where certified sonologists and ultrasonographers reviewed the images and made their own diagnoses for the three conditions. Accuracy of auxiliary nurse-midwife diagnoses was then calculated. RESULTS: A total of 804 women contributed to the analysis. Each auxiliary nurse-midwife's statistic for diagnosis of noncephalic presentation was above 0.90 compared with the ultrasonogram reviewers. Sensitivity, specificity, and positive and negative predictive values were between 90% and 100% for all auxiliary nurse-midwives. For multiple gestation, the auxiliary nurse-midwives were in perfect agreement with both the ultrasonogram reviewers and maternal postpartum self-report. Two placenta previa cases were detected, and the ultrasonogram reviewers agreed with both. CONCLUSION: With limited training, primary-level health care workers in rural Nepal can accurately diagnose selected third-trimester obstetric risk factors using ultrasonography.

Original languageEnglish (US)
Pages (from-to)604-612
Number of pages9
JournalObstetrics and Gynecology
Volume128
Issue number3
DOIs
StatePublished - Sep 1 2016

Fingerprint

Nurse Midwives
Nepal
Health Status
Obstetrics
Primary Health Care
Placenta Previa
Third Pregnancy Trimester
Pregnancy
House Calls
Teaching Hospitals
Self Report
Postpartum Period
Pregnant Women
Ultrasonography
Mothers
Sensitivity and Specificity

ASJC Scopus subject areas

  • Medicine(all)
  • Obstetrics and Gynecology

Cite this

Accuracy of Home-Based Ultrasonographic Diagnosis of Obstetric Risk Factors by Primary-Level Health Care Workers in Rural Nepal. / Kozuki, Naoko; Mullany, Luke C; Khatry, Subarna K.; Ghimire, Ram K.; Paudel, Sharma; Blakemore, Karin; Bird, Christine; Tielsch, James M.; Leclerq, Steven C.; Katz, Joanne.

In: Obstetrics and Gynecology, Vol. 128, No. 3, 01.09.2016, p. 604-612.

Research output: Contribution to journalArticle

Kozuki, Naoko ; Mullany, Luke C ; Khatry, Subarna K. ; Ghimire, Ram K. ; Paudel, Sharma ; Blakemore, Karin ; Bird, Christine ; Tielsch, James M. ; Leclerq, Steven C. ; Katz, Joanne. / Accuracy of Home-Based Ultrasonographic Diagnosis of Obstetric Risk Factors by Primary-Level Health Care Workers in Rural Nepal. In: Obstetrics and Gynecology. 2016 ; Vol. 128, No. 3. pp. 604-612.
@article{b1b785d718f446a090f3ddca2a65b3c0,
title = "Accuracy of Home-Based Ultrasonographic Diagnosis of Obstetric Risk Factors by Primary-Level Health Care Workers in Rural Nepal",
abstract = "OBJECTIVE: To assess the feasibility of ultrasonographic task shifting by estimating the accuracy at which primary-level health care workers can perform community-based third-trimester ultrasound diagnosis for selected obstetric risk factors in rural Nepal. METHODS: Three auxiliary nurse-midwives received two 1-week ultrasound trainings at Tribhuvan University Teaching Hospital in Kathmandu. At a study site in rural Nepal, pregnant women who were 32 weeks of gestation or greater were enrolled and received ultrasound examinations from the auxiliary nurse-midwives during home visits. Each auxiliary nurse-midwife screened for noncephalic presentation, multiple gestation, and placenta previa. Deidentified digital ultrasonograms were stored and uploaded onto an online server, where certified sonologists and ultrasonographers reviewed the images and made their own diagnoses for the three conditions. Accuracy of auxiliary nurse-midwife diagnoses was then calculated. RESULTS: A total of 804 women contributed to the analysis. Each auxiliary nurse-midwife's statistic for diagnosis of noncephalic presentation was above 0.90 compared with the ultrasonogram reviewers. Sensitivity, specificity, and positive and negative predictive values were between 90{\%} and 100{\%} for all auxiliary nurse-midwives. For multiple gestation, the auxiliary nurse-midwives were in perfect agreement with both the ultrasonogram reviewers and maternal postpartum self-report. Two placenta previa cases were detected, and the ultrasonogram reviewers agreed with both. CONCLUSION: With limited training, primary-level health care workers in rural Nepal can accurately diagnose selected third-trimester obstetric risk factors using ultrasonography.",
author = "Naoko Kozuki and Mullany, {Luke C} and Khatry, {Subarna K.} and Ghimire, {Ram K.} and Sharma Paudel and Karin Blakemore and Christine Bird and Tielsch, {James M.} and Leclerq, {Steven C.} and Joanne Katz",
year = "2016",
month = "9",
day = "1",
doi = "10.1097/AOG.0000000000001558",
language = "English (US)",
volume = "128",
pages = "604--612",
journal = "Obstetrics and Gynecology",
issn = "0029-7844",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Accuracy of Home-Based Ultrasonographic Diagnosis of Obstetric Risk Factors by Primary-Level Health Care Workers in Rural Nepal

AU - Kozuki, Naoko

AU - Mullany, Luke C

AU - Khatry, Subarna K.

AU - Ghimire, Ram K.

AU - Paudel, Sharma

AU - Blakemore, Karin

AU - Bird, Christine

AU - Tielsch, James M.

AU - Leclerq, Steven C.

AU - Katz, Joanne

PY - 2016/9/1

Y1 - 2016/9/1

N2 - OBJECTIVE: To assess the feasibility of ultrasonographic task shifting by estimating the accuracy at which primary-level health care workers can perform community-based third-trimester ultrasound diagnosis for selected obstetric risk factors in rural Nepal. METHODS: Three auxiliary nurse-midwives received two 1-week ultrasound trainings at Tribhuvan University Teaching Hospital in Kathmandu. At a study site in rural Nepal, pregnant women who were 32 weeks of gestation or greater were enrolled and received ultrasound examinations from the auxiliary nurse-midwives during home visits. Each auxiliary nurse-midwife screened for noncephalic presentation, multiple gestation, and placenta previa. Deidentified digital ultrasonograms were stored and uploaded onto an online server, where certified sonologists and ultrasonographers reviewed the images and made their own diagnoses for the three conditions. Accuracy of auxiliary nurse-midwife diagnoses was then calculated. RESULTS: A total of 804 women contributed to the analysis. Each auxiliary nurse-midwife's statistic for diagnosis of noncephalic presentation was above 0.90 compared with the ultrasonogram reviewers. Sensitivity, specificity, and positive and negative predictive values were between 90% and 100% for all auxiliary nurse-midwives. For multiple gestation, the auxiliary nurse-midwives were in perfect agreement with both the ultrasonogram reviewers and maternal postpartum self-report. Two placenta previa cases were detected, and the ultrasonogram reviewers agreed with both. CONCLUSION: With limited training, primary-level health care workers in rural Nepal can accurately diagnose selected third-trimester obstetric risk factors using ultrasonography.

AB - OBJECTIVE: To assess the feasibility of ultrasonographic task shifting by estimating the accuracy at which primary-level health care workers can perform community-based third-trimester ultrasound diagnosis for selected obstetric risk factors in rural Nepal. METHODS: Three auxiliary nurse-midwives received two 1-week ultrasound trainings at Tribhuvan University Teaching Hospital in Kathmandu. At a study site in rural Nepal, pregnant women who were 32 weeks of gestation or greater were enrolled and received ultrasound examinations from the auxiliary nurse-midwives during home visits. Each auxiliary nurse-midwife screened for noncephalic presentation, multiple gestation, and placenta previa. Deidentified digital ultrasonograms were stored and uploaded onto an online server, where certified sonologists and ultrasonographers reviewed the images and made their own diagnoses for the three conditions. Accuracy of auxiliary nurse-midwife diagnoses was then calculated. RESULTS: A total of 804 women contributed to the analysis. Each auxiliary nurse-midwife's statistic for diagnosis of noncephalic presentation was above 0.90 compared with the ultrasonogram reviewers. Sensitivity, specificity, and positive and negative predictive values were between 90% and 100% for all auxiliary nurse-midwives. For multiple gestation, the auxiliary nurse-midwives were in perfect agreement with both the ultrasonogram reviewers and maternal postpartum self-report. Two placenta previa cases were detected, and the ultrasonogram reviewers agreed with both. CONCLUSION: With limited training, primary-level health care workers in rural Nepal can accurately diagnose selected third-trimester obstetric risk factors using ultrasonography.

UR - http://www.scopus.com/inward/record.url?scp=84981285657&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84981285657&partnerID=8YFLogxK

U2 - 10.1097/AOG.0000000000001558

DO - 10.1097/AOG.0000000000001558

M3 - Article

VL - 128

SP - 604

EP - 612

JO - Obstetrics and Gynecology

JF - Obstetrics and Gynecology

SN - 0029-7844

IS - 3

ER -