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Ali S, Byamugisha J, Kawooya MG, Kakibogo IM, Ainembabazi I, Biira EA, Kagimu AN, Migisa A, Munyakazi M, Kuniha S, Scheele C, Papageorghiou AT, Klipstein-Grobusch K, Rijken MJ. Standardization and quality control of Doppler and fetal biometric ultrasound measurements in low-income setting. Ultrasound Obstet Gynecol 2023; 61:481-487. [PMID: 37011080 DOI: 10.1002/uog.26051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/27/2022] [Accepted: 08/01/2022] [Indexed: 06/19/2023]
Abstract
OBJECTIVE The aim of this study was to determine the quality of fetal biometry and pulsed-wave Doppler ultrasound measurements in a prospective cohort study in Uganda. METHODS This was an ancillary study of the Ending Preventable Stillbirths by Improving Diagnosis of Babies at Risk (EPID) project, in which women enroled in early pregnancy underwent Doppler and fetal biometric assessment at 32-40 weeks of gestation. Sonographers undertook 6 weeks of training followed by onsite refresher training and audit exercises. A total of 125 images for each of the umbilical artery (UA), fetal middle cerebral artery (MCA), left and right uterine arteries (UtA), head circumference (HC), abdominal circumference (AC) and femur length (FL) were selected randomly from the EPID study database and evaluated independently by two experts in a blinded fashion using objective scoring criteria. Inter-rater agreement was assessed using modified Fleiss' kappa for nominal variables and systematic errors were explored using quantile-quantile (Q-Q) plots. RESULTS For Doppler measurements, 96.8% of the UA images, 84.8% of the MCA images and 93.6% of the right UtA images were classified as of acceptable quality by both reviewers. For fetal biometry, 96.0% of the HC images, 96.0% of the AC images and 88.0% of the FL images were considered acceptable by both reviewers. The kappa values for inter-rater reliability of quality assessment were 0.94 (95% CI, 0.87-0.99) for the UA, 0.71 (95% CI, 0.58-0.82) for the MCA, 0.87 (95% CI, 0.78-0.95) for the right UtA, 0.94 (95% CI, 0.87-0.98) for the HC, 0.93 (95% CI, 0.87-0.98) for the AC and 0.78 (95% CI, 0.66-0.88) for the FL measurements. The Q-Q plots indicated no influence of systematic bias in the measurements. CONCLUSIONS Training local healthcare providers to perform Doppler ultrasound, and implementing quality control systems and audits using objective scoring tools in clinical and research settings, is feasible in low- and middle-income countries. Although we did not assess the impact of in-service retraining offered to practitioners deviating from prescribed standards, such interventions should enhance the quality of ultrasound measurements and should be investigated in future studies. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S Ali
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Ernest Cook Ultrasound Research and Education Institute (ECUREI), Mengo Hospital, Kampala, Uganda
| | - J Byamugisha
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - M G Kawooya
- Ernest Cook Ultrasound Research and Education Institute (ECUREI), Mengo Hospital, Kampala, Uganda
| | - I M Kakibogo
- Antenatal and Maternity Unit, Kagadi Hospital, Kagadi District, Uganda
| | - I Ainembabazi
- Antenatal and Maternity Unit, Kagadi Hospital, Kagadi District, Uganda
| | | | - A N Kagimu
- Ernest Cook Ultrasound Research and Education Institute (ECUREI), Mengo Hospital, Kampala, Uganda
| | - A Migisa
- Ernest Cook Ultrasound Research and Education Institute (ECUREI), Mengo Hospital, Kampala, Uganda
| | - M Munyakazi
- Ernest Cook Ultrasound Research and Education Institute (ECUREI), Mengo Hospital, Kampala, Uganda
| | - S Kuniha
- Department of Radiology, Mulago Hospital Complex, Kampala, Uganda
| | - C Scheele
- Division of Woman and Baby, Department of Obstetrics, Birth Center Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A T Papageorghiou
- Nuffield Department of Women's and Reproductive Health, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - K Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - M J Rijken
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Division of Woman and Baby, Department of Obstetrics, Birth Center Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
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van Tetering AAC, van Meurs A, Ntuyo P, van der Hout-van der Jagt MB, Mulders LGM, Nolens B, Namagambe I, Nakimuli A, Byamugisha J, Oei SG. Study protocol training for life: a stepped wedge cluster randomized trial about emergency obstetric simulation-based training in a low-income country. BMC Pregnancy Childbirth 2020; 20:429. [PMID: 32723330 PMCID: PMC7388496 DOI: 10.1186/s12884-020-03050-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 06/09/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Globally perinatal and maternal mortality rates remain unacceptably high. There is increasing evidence that simulation-based training in obstetric emergencies is associated with improvement in clinical outcomes. However, the results are not entirely consistent. The need for continued research in a wide variety of clinical settings to establish what works, where and why was recommended. The aim of this study is to investigate the effectiveness of an emergency obstetric simulation-based training program with medical technical and teamwork skills on maternal and perinatal mortality in a low-income country. METHODS A stepped wedge cluster randomized trial will be conducted at the medium to high-risk labour ward at Mulago Hospital, Kampala, Uganda, with an annual delivery rate of over 23,000. The training will be performed using a train-the-trainers model in which training is cascaded down from master trainers to local facilitators (gynaecologists) to learners (senior house officers). Local facilitators will be trained during a four-day train-the-trainers course with an annual repetition. The senior house officers will be naturally divided in seven clusters and randomized for the moment of training. The training consists of a one-day, monodisciplinary, simulation-based training followed by repetition training sessions. Scenarios are based on the main local causes of maternal and neonatal mortality and focus on both medical technical and crew resource management skills. Kirkpatrick's classification will be used to evaluate the training program. Primary outcome will be the composite of maternal and neonatal mortality ratios. Secondary outcome will comprise course perception, evaluation of the instructional design of the training, knowledge, technical skills, team performance, percentage of ventouse deliveries, percentage of caesarean sections, and a Weighted Adverse Outcome Score. DISCUSSION This stepped wedge cluster randomized trial will investigate the effect of a monodisciplinary simulation-based obstetric training in a low-income country, focusing on both medical technical skills and crew resource management skills, on patient outcome at one of the largest labour wards worldwide. We will use a robust study design which will allow us to better understand the training effects, and difficulties in evaluating training programs in low-income countries. TRIAL REGISTRATION ISRCTN98617255 , retrospectively registered July 23, 2018.
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Affiliation(s)
- A A C van Tetering
- Department of Obstetrics and Gynaecology, MUMC+, Maastricht, The Netherlands.
| | - A van Meurs
- Department of Obstetrics and Gynaecology, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - P Ntuyo
- Department of Obstetrics and Gynaecology, Makerere University and Mulago National Referral Hospital, Kampala, Uganda
| | - M B van der Hout-van der Jagt
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - L G M Mulders
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - B Nolens
- Department of Obstetrics and Gynaecology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - I Namagambe
- Department of Obstetrics and Gynaecology, Makerere University and Mulago National Referral Hospital, Kampala, Uganda
| | - A Nakimuli
- Department of Obstetrics and Gynaecology, Makerere University and Mulago National Referral Hospital, Kampala, Uganda
| | - J Byamugisha
- Department of Obstetrics and Gynaecology, Makerere University and Mulago National Referral Hospital, Kampala, Uganda
| | - S G Oei
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Mitchell S, Moses E, Pedersen H, Sekikubo M, Mwesigwa D, Singer J, Biryabarema C, Byamugisha J, Money D, Ogilvie G. O18.5 Examining hpv prevalence and uptake of cervical cancer screening among hiv positive and negative women participating in a pilot rct in uganda comparing self-collection based hpv testing to via. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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McDonald M, Byamugisha J, Dougherty A, Esau W, Spire K. Development of a bidirectional exchange between OBGYN residents at the
university of vermont and makerere university (Kampala, Uganda). Ann Glob Health 2015. [DOI: 10.1016/j.aogh.2015.02.603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Mitchell SM, Sekikubo M, Biryabarema C, Byamugisha J, Steinberg M, Christilaw J, Money DM, Ogilvie GS. P5.040 Integration of Gonorrhoea and Chlamydia Self-Collection Service Within an Existing Reproductive Health Programme in Kampala, Uganda. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.1084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lester F, Averbach S, Fortin J, Byamugisha J, Goldberg A, Kakaire O. M143 ACCEPTABILITY OF THE IUD AMONG WOMEN WHO OPTED OUT OF A RANDOMIZED CONTROLLED TRIAL OF INTRACESAREAN INSERTION OF THE COPPER-T 380A IN KAMPALA, UGANDA. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)61337-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Beversluis D, Musoke R, Mandima P, Nyamapfeni P, Chipato T, Mukasa JB, Byamugisha J, Mugerwa R, Morrison C, Salata RA. Incidence of major clinical outcomes in a cohort of Ugandan and Zimbabwean women with HIV-1 infection followed from seroconversion. Int J STD AIDS 2012; 23:111-4. [PMID: 22422685 DOI: 10.1258/ijsa.2011.011117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We conducted a prospective cohort study of 306 HIV-1-infected women, followed from seroconversion for median 6.4 years in Uganda (UG) and Zimbabwe (ZM) to describe the incidence of major clinical outcomes (MCOs), defined as World Health Organization stage 4 conditions and any tuberculosis (TB). In Uganda, 19 MCOs occurred in 13 participants at median 4.6 years and a median CD4 count of 213 cells/mm(3). In Zimbabwe, 29 MCOs occurred in 27 participants at median 4.0 years (P < 0.001 versus UG) and median CD4 count of 219 cells/mm(3) (P = 0.83 versus UG). MCO incidence was not statistically different (UG: 2.82 cases/100 person-years versus ZM: 2.45; P = 0.64) except for TB (UG: 0.59 versus ZM: 2.02 cases/100 person-years; P = 0.02). This significant difference in TB incidence is primarily due to a TB screening and isoniazid prevention therapy programme that was implemented in Uganda, but not in Zimbabwe, highlighting the importance of integrated TB screening and treatment within HIV programmes.
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Affiliation(s)
- D Beversluis
- Case Western Reserve University, Cleveland, OH 44106-5094, USA
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Andabati G, Byamugisha J. Microbial aetiology and sensitivity of asymptomatic bacteriuria among ante-natal mothers in Mulago hospital, Uganda. Afr Health Sci 2010; 10:349-52. [PMID: 21416036 PMCID: PMC3052809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Asymptomatic bacteriuria in pregnancy is associated with potential urinary and obstetric complications. However the prevalence aetiology and antimicrobial sensitivity patterns of asymptomatic bacteriurea among women attending ante-natal care in our Hospital is not known. OBJECTIVE To determine the prevalence and identify the aetiological agents associated with asymptomatic bacteriurea in antenatal mothers in Mulago Hospital. We also intended to determine the anti-microbial sensitivity patterns of the common uropathogen in this population METHODS We performed culture and anti-microbial sensitivity tests on urine samples from 218 consecutive ante-natal mothers in Mulago Hospital. All participants did not have any clinical symptoms attributable to urinary tract infection. RESULTS Twenty nine (13.3%) of the samples had significant bacterial growth and E.coli was the commonest isolate (51.2%). There was a high level (20-62%) of anti-bacterial resistance to the commonly used antibiotics. CONCLUSION Asymptomatic bacteriuria is common among ante-natal mothers in Mulago. E. Coli that is resistant to the most commonly used antibiotics is the commonest isolate."
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Affiliation(s)
- G Andabati
- Department of Obstetrics and Gynaecology, College of Health Sciences, Makerere University, Kampala, Uganda.
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