A Training Program for Obstetrics Point-of-Care Ultrasound to 514 Rural Healthcare Providers in Kenya
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Date
2023
Authors
Wachira, James
Matheka, Duncan Mwangangi
Masheti, Sheila Ayesa
Githemo, Grace Kirigo
Shah, Sachita
Haldeman, Matthew S.
Ramos, Mena
Bergman, Kevin
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Medical Education
Abstract
Background Ultrasound is a crucial and efective diagnostic tool in medicine. Recent advancements in technology
have led to increased use of point-of-care ultrasound (POCUS). Access to ultrasound equipment and training programs in low-and middle-income countries (LMICs) is limited. Despite the World Health Organization (WHO) recommendations for universal antenatal ultrasounds, POCUS for reproductive health applications has not been widely used
in LMICs. We describe here the feasibility of implementation of a training of obstetrics point-of-care ultrasound (OB
POCUS) for high-risk conditions in rural public healthcare facilities in Kenya with partnership from Butterfy Network,
Global Ultrasound Institute, and Kenyatta University.
Methods As part of the initiation of a large-scale implementation study of OB POCUS, clinician trainees were
recruited from rural Kenyan hospitals for participation in a series of fve-day POCUS workshops held between September and December 2022. Trainers provided brief didactic lessons followed by hands-on training with live models
and at regional clinical sites for 5 OB POCUS applications. Instructor-observed assessment of students’ scanning
and image interpretation occurred over the training period. Assessment of knowledge and confdence was performed via an online pre-test and post-test as well as Objective Structured Clinical Examination (OSCE) was administered at course completion.
Results Five hundred and fourteen mid-level Health Care Providers (HCPs) in Kenya were trained over a threemonth period through in-person didactic sessions, bedside instruction, and clinical practice over a 5-day period
with a trainer: trainee ratio of approximately 1:5. Out of the 514 trained HCPs, 468 were from 8 rural counties with poor
maternal and neonatal outcomes, while the remaining 46 were from nearby facilities. OB POCUS topics covered
included: malpresentation, multiple gestation, fetal cardiac activity, abnormalities of the placenta and amniotic fuid
volume. There was marked improvement in the post training test scores compared to the pretest scores.
Conclusion Our implementation description serves as a guide for successful rapid dissemination of OB POCUS training for mid-level providers. Our experience demonstrates the feasibility of a short intensive POCUS training to rapidly establish specifc POCUS skills in eforts to rapidly scale POCUS access and services. There is a widespread need
for expanding access to ultrasound in pregnancy through accessible OB POCUS training programs. An implementation study is currently underway to assess the patient and systems-level impact of the training.
Description
Article
Keywords
Reproductive health, Ultrasound, Education, Butterfy IQ probes, OB POCUS, Hand-held ultrasound
Citation
Wachira, J., Matheka, D. M., Masheti, S. A., Githemo, G. K., Shah, S., Haldeman, M. S., ... & Bergman, K. (2023). A training program for obstetrics point-of-care ultrasound to 514 rural healthcare providers in Kenya. BMC Medical Education, 23(1), 922.