Accuracy of Home-Based Ultrasonographic Diagnosis of Obstetric Risk Factors by Primary-Level Health Care Workers in Rural Nepal
| Autor: | Naoko Kozuki, Steven C. LeClerq, Karin J. Blakemore, Joanne Katz, Christine Bird, James M. Tielsch, Ram K. Ghimire, Sharma Paudel, Subarna K. Khatry, Luke C. Mullany |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Rural Population Obstetric risk Nurse Midwives Pregnancy Trimester Third MEDLINE Primary level Article Ultrasonography Prenatal Young Adult 03 medical and health sciences 0302 clinical medicine Nepal Nursing Pregnancy Risk Factors Health care medicine Humans Maternal Health Services 030212 general & internal medicine 030219 obstetrics & reproductive medicine business.industry Obstetrics and Gynecology medicine.disease Home Care Services Home based Pregnancy Complications Feasibility Studies Nurse-Midwives Female Rural Health Services Medical emergency Task shifting Ultrasonography business |
| Zdroj: | Obstetrics & Gynecology. 128:604-612 |
| ISSN: | 0029-7844 |
| DOI: | 10.1097/aog.0000000000001558 |
| Popis: | 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.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.A total of 804 women contributed to the analysis. Each auxiliary nurse-midwife's κ 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.With limited training, primary-level health care workers in rural Nepal can accurately diagnose selected third-trimester obstetric risk factors using ultrasonography. |
| Databáze: | OpenAIRE |
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