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
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
Click to access 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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