SonoGlobalHealth: What Ultrasound does in Uganda to prevent MTCT of HIV #FOAMed #FOAMus

A friend of mine, William Cherniak – a family medicine resident in Canada at the University of Toronto-  has been working on a project. Not just any project, but a global impact project with the help of KIHEFO (Kigezi Healthcare Foundation) and his own group that he created called TO-the World. What is this project, you ask? Well, it was to show how minimizing maternal to child transmission (MTCT) of HIV can be helped by simply having and letting the women know in the region that a portable ultrasound has arrived. This project will be presented at Global Health 2013

Screen Shot 2013-08-29 at 5.50.19 PM

The project in brief: “In
 alignment
 with 
the 
WHO 2010 
guidelines 
for
 MTCT elimination and 
the
 Ugandan 
government’s
 adoption
 of plan
B+; KIHEFO,
 in
 collaboration 
with
 TO
– the
WORLD,
 designed
 a structured maternal
 health
camp [sMHC]
 centered on providing
 expectant
 mothers in
 rural
 Uganda with a 
free
 obstetric
ultrasound [OBU]. The
 four‐pronged
 approach
 of
 MTCT
 elimination 
was
 followed 
in
 the
 design
 of 
the 
sMHC. In 
one 
day, 
45 
women rotated 
through
 registration, 
pre‐test
 counseling, 
testing
 for 
HIV 
and 
Syphilis, 
family
 planning,
 obstetric
 ultrasound 
and, 
for
the 
women 
identified 
as
 being 
high 
risk
 by 
triage, 
dental 
and/or 
medical 
services. 
Each
 woman
 received 
fansidar, 
multivitamins,
 folic
acid
 and
 filled 
in 
a 
pre‐ designed
questionnaire.
 In 
total,
10 women
 identified 
themselves 
as 
being 
HIV+
 at 
registration, surprisingly 
only 
half 
were currently being 
treated 
with 
ARVs. 

An 
additional 
two 
women
 were 
diagnosed 
as 
being 
HIV+ 
during 
the 
health
camp.

 All
 women 
received 
counseling
 and
 were
 started
 on
 ARVs for 
life. Only 
7 
women 
had 
ever 
previously 
had 
an 
OBU, 
and
all
 45 
women 
verbally 
identified 
that 
the 
reason 
for
 attending 
the 
antenatal 
health
camp 
was 
to 
receive 
a 
free 
OBU.” – Now that is just amazing. The power of what a portable ultrasound can have on a community in fighting MTCT of HIV. Bring the ultrasound, and they will come – that is your way to start the healthcare and assessment they need.

They continue to state how they hope to solve the problem of high maternal death and high infant death rates: ” Solving
 the 
Problem
– Ultrasound
 and 
Outreach 
to 
Reduce
 Maternal 
Mortality. As
 stated 
above, 
the 
leading 
causes
 of 
maternal
 mortality 
include  hemorrhage, 
eclampsia, 
obstructed 
labor,
 infections,
 and
 birth 
defects. 

Studies 
have 
shown 
that 
obstetric 
ultrasound
 imaging 
can 
prevent 
most outcomes
 by 
providing 
early 
diagnosis 
and 
intervention. 

By 
providing useful 
information 
such 
as 
whether 
or 
not 
the 
mother 
is 
carrying 
twins, 
has 
an 
ectopic 
pregnancy 
or 
otherwise a 
mother 
and
her
 partner 
can
 make
 an 
informed 
decision 
about 
whether 
or 
not 
to 
deliver 
at 
home 
with 
untrained
 professionals, or 
a
 health
center where 
they 
can receive 
life‐saving
 treatment. Furthermore, 
the 
World 
Health 
Organization
 (2003)
 recognizes 
ultrasound 
technology 
as 
ideally 
suited
 to 
low
 and 
middle 
income countries, 
as 
it 
is
 relatively 
low‐cost, 
low
 input, 
and
 easily 
maintained
 and 
transported. 

Additionally, 
studies
 conducted
 on
 the 
use 
of 
ultrasound 
technology 
in 
two 
rural 
hospitals 
in 
Rwanda
 have 
indicated 
that 
after 
an 
initial
 training 
period,
 an 
ultrasound
 program 
led 
by 
local 
health 
care 
providers 
can 
be 
sustainable
 and 
lead 
to
 accurate 
diagnoses. Ultrasound 
imaging 
is 
beneficial 
to 
rural 
populations 
as 
it 
is 
a
 simple 
a
nd non‐invasive
 procedure. This
 helps 
to 
reduce levels 
of 
fear 
from 
women 
who 
have previously maintained 
their 
cultural
 preferences 
for 
receiving 
treatment 
and
 giving 
birth 
with 
untrained 
birth 
attendants 
in 
their 
local
 villages.

Sustainability: Various
 studies 
on
 obstetric 
ultrasound 
imaging 
as 
a 
sustainable 
and 
appropriate 
technology 
to 
developing
 nations, 
and 
its 
capacity 
to 
reduce 
rates 
of 
maternal 
mortality, 
have 
been 
conducted 
in 
rural
 regions
 of 
Rwanda, 
Botswana
 and 
Tanzania. 
In 
northern 
Tanzania, 
a 
study 
conducted 
amongst
 women
 who
 were
receiving 
ultrasound 
imaging
 for 
the 
first 
time 
indicated 
that 
the 
majority 
of 
women 
were 
satisfied 
with the 
information 
provided 
from 
the 
procedure, 
despite 
not 
initially  understanding 
its 
purpose. 
The 
ultrasound
 procedure
 provided 
women 
with 
the 
ability 
to 
see 
fetal 
positioning,
 fetal 
sex, 
and
 to 
recognize 
any 
potential
 pregnancy
complications. 
Information,
 particularly 
the 
latter, 
resulted 
in 
guiding
 treatment
 for 
the
woman’s
 particular birth
– helping 
her
 make
 an
 informed
 decision
 as 
to 
where
 and
 how 
she 
would
 deliver.
 This
 particular 
study
 in
 Tanzania 
concluded
 that
 the 
ultrasound 
imaging 
was 
useful
 in 
reducing 
the 
risk 
of
 maternal
 mortality, 
although
 the 
treatment 
should 
be 
accompanied 
by 
a 
thorough
 education 
campaign 
and 
consent program.”

The future? “Currently,
 TO
– the
WORLD 
is 
in 
the 
process 
of 
raising 
funds 
to 
purchase 
two 
portable 
ultrasound 
machines.  

These 
machines 
will 
be 
purchased 
locally 
in 
Uganda 
to 
ensure 
sustainability 
in 
maintenance 
and 
economic 
stimulus for 
the 
communities 
in 
which 
they 
serve. Multiple 
outreach 
camps
 will 
be 
conducted 
in 
2014 
with 
the 
previously 
designed 
model 
based 
on 
the 
WHO 
four‐pronged 
approach 
to 
MTCT 
elimination 
of 
HIV.

The WSJ actually spoke of what happens when an US machine is taken to a developing country – more antenatal visits!

Here is the video William made to support his cause:

1. Report
of
a
WHO
Technical
Consultation.
Towards
the
elimination
of
mother‐to‐child
transmission
of
HIV.

Accessed
March,
2013
at
http://www.who.int/hiv/pub/mtct/elimination_report/en/index.html
2. IRIN
Humanitarian
News
and
Analysis
–A
service
of
the
UN
office
for
the
coordination
of
human
affairs.

Accessed
March,
2013
at
http://www.irinnews.org/Report/96308/UGANDA‐Government‐
adopts‐new‐PMTCT‐strategy
3. WHO
Executive
Summary,
April 2012.
Use
of
Antiretroviral
Drugs
for
Treating
Pregnant
Women
and
Preventing
HIV
Infections
in
Infants.

Accessed
March,
2013
at
http://www.who.int/hiv/PMTCT_update.pdf
4. World
Health
Organization. Statistics
on
Maternal
Mortality
in
Uganda,
accessed
March,
2013
at
http://www.who.int/healthinfo/statistics/indmaternalmortality/en/index.html
5. Kigezi
Healthcare
Foundation
website,
accessed
March,
2012
at
www.kihefo.org
6. Maternal
Health:
Investing
in
the
Lifeline
of
Healthy
Societies
and
Economies.
Africa
Progress
Panel
Position
Piece.
September
2010.
7. Yaw
A.W.,
Alexander
T.O.,
and
Edward
T.D.
The
Role
of
Obstetric
Ultrasound
in
Reducing
Maternal
and
Perinatal
Mortality,
Ultrasound
Imaging
‐ Medical
Applications,
InTech,
Accessed
March,
2013.
Available
from:
http://www.intechopen.com/books/ultrasound‐imagingmedical‐applications/the‐
role‐of‐obstetric‐ultrasound‐in‐reducing‐maternal‐and‐perinatal‐mortality.
8. Shah
S.P.,
Epino
H.,
Bukhman
G.,
Umulisa
I.,
Dushimiyimana
J.M.,
Reichman
A.,
Noble
V.E.
Impact
of
the
introduction
of
ultrasound
services
in
a
limited resource
setting:
rural
Rwanda.
BMC
InternationalHealth
Human
Rights.
2009;27:9‐4
9. Firth
E.R.,
Mlay
P.,Walker
R.,
Sill
P.R.
Pregnant
women’s
beliefs,
expectations
and
experiences
of
antenatal
ultrasound
in
Northern
Tanzania.African
Journal
of
Reproductive
Health.
2011;
15(2):91‐
107

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