Imagine a world where every expectant mother can access essential antenatal care regardless of location or socio-economic status. Unfortunately, for many women in low- and middle-income countries (LMICs), this is not the reality. In these regions, maternal healthcare faces significant challenges, leaving many women without the critical care they need. Irene de Vries, a maternal and newborn advisor at KIT Royal Tropical Institute, sheds light on these issues in her presentation, “Beyond Medical Effectiveness: What Patients, Providers, and Health Systems Need.”

The Challenges in Maternal Healthcare

Maternal mortality remains a pressing issue, with approximately 830 women dying daily from preventable causes related to pregnancy and childbirth. The majority of these deaths occur in underserved, remote regions where access to essential antenatal care (ANC) services is limited.

“Various factors influencing accessibility make that in many resource-poor settings, antenatal ultrasound is only available to a privileged view, often in urban centres. These factors include but are not limited to distances to facilities, lack of skilled ultrasonographers, lack of scans, infrastructure and inadequate power, poverty and need to pay health illiteracy, and cultural beliefs in traditional norms that affect access,” De Vries elaborated in the BabyChecker Webinar. These challenges highlight the urgent need for innovative solutions that can bring essential services closer to those who need them most.

Global Inequalities in Access to Ultrasound

The World Health Organization (WHO) recommends that pregnant women receive at least one ultrasound scan before 24 weeks of gestation. This early ultrasound can help estimate gestational age, detect fetal anomalies, and identify multiple pregnancies. However, due to the barriers mentioned above, these recommendations often need to be fulfilled in low-resource settings.

De Vries highlighted the need to deploy solutions that facilitate task shifting and bring services closer to the community. “Innovations that facilitate task shifting and bring services closer to the community, like BabyChecker, can address some of these barriers, but they remain barriers that need to be considered and addressed if we truly want to contribute to universal health coverage. That’s why we collaborate with Delft Imaging to co-design implementation studies that contribute to appropriate and holistic implementation,” she said.

Quality of Care Approach

De Vries underscores the importance of a holistic approach to implementing new technologies. According to the Donabedian model, quality of care is defined by the interplay between structure, process, and outcomes. This approach ensures that innovations like BabyChecker can be introduced and effectively integrated into existing healthcare systems.

“We collaborated with Delft Imaging to co-design implementation studies that contribute to appropriate and holistic implementation. This means it’s not only about the structure that is being provided, being the device and training of providers in using the device, but also about the processes around care provision referrals and quality control in order to achieve the best outcomes,” Irene said, discussing how KIT assisted with ensuring that BabyChecker’s deployment was comprehensive and aligned with the needs of the communities it serves in Sierra Leone.

Training and Counseling

Effective use of new technologies requires comprehensive training for healthcare providers. De Vries shares insights from a study conducted by Amie Koroma in Sierra Leone, which found that some healthcare workers relied too heavily on BabyChecker, potentially at the expense of other essential skills. Proper training ensures that BabyChecker complements rather than replaces standard maternal

Addressing Referral Barriers

Barriers to referral for ultrasound-diagnosed complications present another challenge. De Vries cites a “First-Look” study, which found that 29% of women referred for further care did not attend their appointments due to various barriers, including community disapproval, previous negative experiences, and logistical issues like cost and transportation.

Ensuring Quality and Control

Equipping community providers with point-of-care ultrasound devices like BabyChecker can be empowering, but it also raises concerns about potential misuse and the need for proper supervision and guidelines. De Vries stresses the importance of continuous medical education and robust regulatory frameworks to ensure quality care.

“Community providers and health system factors interfere with medical innovations (like BabyChecker). Implementation studies are needed to ensure these factors are studied and addressed to ensure we achieve universal health coverage and deliver holistic quality care,”

Conclusion

The deployment of BabyChecker in LMICs is a promising development in the fight against maternal mortality. By making ultrasound technology more accessible and easier to use, BabyChecker can potentially improve maternal health outcomes through timely interventions. However, a comprehensive approach that includes training, system strengthening, and addressing cultural barriers is essential for these benefits to be fully realised.

Watch Irene De Vries’s presentation in the BabyChecker Webinar here: