ANDOVER, Mass. - Sub-Saharan Africa has the highest neonatal mortality rate (32 deaths per 1,000 live births in 2012) and accounts for 38 percent of neonatal deaths globally.1 Concomitantly, the maternal mortality rate is estimated at 500 deaths per 1,000,000 live births representing 162,000 maternal deaths annually.2 A recent study sponsored by Imaging the World (ITW), and funded in part by Royal Philips (NYSE: PHG, AEX: PHIA), demonstrated that providing pregnant women in rural Uganda access to ultrasound screenings resulted in a “magnet effect” on overall improved quality of maternal and newborn care.
The study, implemented at Nawanyago Health Centre III, showed increases in the number of women attending antenatal visits and in husbands taking a more active role in health choices surrounding pregnancy for the very first time. It also showed a near-doubling of newborns delivered by skilled health care workers.
The study was recently published in the Public Library of Science Journal (PLOS One): http://dx.plos.org/10.1371/journal.pone.0078450
“The availability of a low-cost, accessible and affordable ultrasound program may assist progress towards Millennium Development Goal 5 by encouraging women in a rural environment to come to a health care facility for skilled antenatal care and delivery assistance instead of utilizing more traditional methods,” said Peter van de Ven, general manager, Philips Healthcare Africa.
About Millennium Development Goal 5
Improving maternal health is Millennium Development Goal 5 (MDG) of the United Nations Millennium Declaration: a road map of goals to address poverty widely prevalent in the world’s developing nations. Two targets were selected to monitor progress towards MDG 5 by the 2015 deadline: 1) reducing the maternal mortality ratio by 75 percent and; 2) increasing the proportion of births attended by skilled health care personnel by 90 percent.
Ugandan women face a 1 in 49 lifetime risk of dying during childbirth. In the U.S., the lifetime risk is 1 in 2,400. While most Ugandan women go to a health clinic once to initially confirm their pregnancy, less than half return for additional antenatal care or for skilled deliveries. Additionally, while public health efforts have focused on encouraging women in Uganda to give birth with a skilled birth attendant in attendance, overall percentage of attended births has increased only slightly in the last few years.
“As a technology company dedicated to creating the future of health care, we are driven to help solve the world’s toughest clinical challenges through meaningful innovation,” said Gene Saragnese, executive vice president and chief executive officer of Philips Imaging Systems. “Supporting access to care in a country like Uganda means we have a chance to do things differently; to transform the dynamic and create solutions that work for those who will benefit the most.”
The Imaging the World / Philips Program
In 2010, a program was put in place by Imaging the World in collaboration with Philips to provide access to basic antenatal ultrasound at Nawanyago Health Centre III in Uganda. Under this program, midwives were trained in the Imaging the World ultrasound screening protocol and the resulting increase in antenatal care visits actually allowed for opportunities for maternal education regarding safe birthing and home care practices. Since program inception, researchers report detection of previously undiagnosed complications such as placenta previa, breech presentation, multiples, molar pregnancy and low fluid levels. All patients requiring hospital care were referred to district and regional hospitals.
In addition, to improve participation in ultrasound screenings, researchers observed positive clinical trends in other aspects of care including antenatal visits and newborn deliveries. The study published in PLOS described the “magnet effect” associated with the introduction of antenatal ultrasound in an undeveloped region such as Uganda.
An additional observation of the study found that husbands were interested in watching the ultrasound scan of their child and attending antenatal visits. This becomes increasingly important considering men are the family health care decision makers in Uganda.
This “magnet effect” of ultrasound has not been previously described, but has significant implications as the Philips/ Imaging the World ultrasound program is designed to be self-sustaining and scalable. Already, new sites have been opened up in Uganda and plans are underway to expand to additional locations in sub-Saharan Africa. Besides monitoring pregnancy, ultrasound has many other clinical applications that can improve overall general patient care. Although the early results of the program are exciting, there may be even greater benefits as the program evolves over time.
“The mission of Imaging the World is to make affordable, high quality ultrasound available in the most rural facilities around the world,” said Dr. Kristen DeStigter, vice-chair of the Department of Radiology at Fletcher Allen and co-founder of Imaging the World. “When women come to the clinic for routine antenatal care, they can be tested and treated for a variety of other conditions such as anemia, malaria, syphilis, worms or HIV, all of which will make their pregnancy safer. We are pleasantly surprised by the magnitude of the “magnet effect” of ultrasound at the point of care and are excited by the results. The technology actually became the catalyst for a system of integrated care that involves partnership, education on multiple levels, community outreach, quality assurance and collaboration. I think this technology-based system solution has the potential to make a huge impact on people's lives."
Through local and international partnerships, Philips also works to provide financing solutions, technical assistance and support to strengthen health systems, and a training framework to increase the output of trained and skilled health care professionals in all regions including African countries.
The number of antenatal visits and deliveries during the 42 months prior and 23 months post introduction of ultrasound at Nawanyago Health Centre III were evaluated. Comparison pre- and post-ultrasound was based on the average monthly visits. In addition, outcome for the Nawanyago Health Centre was compared to a clinical control site. Following the introduction of ultrasound, significant increases were seen in the number of deliveries and antenatal visits per month. The number of deliveries at the clinic increased by 60 percent (i.e., from an average of 28.1 pre-ultrasound to 45.6 post-ultrasound). The number of deliveries at a comparison clinic remained flat over this same time period. The average number of antenatal visits increased by 73 percent (i.e., from 133.5 to 231.0 post-ultrasound), with increases seen in all categories of antenatal visits.
“One difficulty the clinic has faced is getting women to return for all four recommended antenatal visits,” commented Dr. DeStigter. “After the ultrasound program was introduced, the number of women coming back for the full four visits recommended by the WHO nearly quadrupled. That represents a tremendous increase in the number of women getting appropriate care during pregnancy, especially during the latter stages.”
Imaging the World
Imaging the World (ITW) is changing global medicine through a revolutionary concept of integrating technology, training and community to bring medical expertise and high quality health care to remote and under-served areas worldwide. Due to the unavailability of advanced imaging technology, rural populations suffer needlessly. Without early diagnosis, many treatable diseases, especially maternal conditions, can quickly become critical, resulting in death or injury. Imaging the World has created a new sustainable model for ultrasound imaging, making basic life-saving diagnosis accessible in the poorest regions.
Additional information on Imaging the World can be found at http://imagingtheworld.org/.
1 The UN Inter-agency Group for Child Mortality Estimation (IGME), Levels and Trends in Child Mortality: Report 2013, UNICEF, New York, 2013.
2 WHO, UNICEF, UNFPA and World Bank, Trends in Maternal Mortality: 1990 to 2010. World Health Organization, Geneva, 2012.