Retrospective Multifacility Evaluation of the Rural Obstetric Ultrasound Program's Impact on Antenatal Care

Area of Science:

• Maternal Health
• Obstetrics
• Public Health

Background:

• Rural women in Nepal face significant barriers to accessing antenatal care (ANC).
• The Rural Obstetric Ultrasound Program (ROUSG) was implemented to improve early detection of complications and timely referral by providing basic ultrasound services in rural health facilities.
• This study aimed to evaluate the impact of ROUSG on ANC attendance, complication detection, and perinatal outcomes.

Purpose of the Study:

• To assess the effectiveness of the ROUSG program in improving ANC attendance.
• To evaluate the impact of ROUSG on the detection of pregnancy-related complications.
• To determine the effect of ROUSG on perinatal outcomes and delivery management.

Main Methods:

• A retrospective comparative study design was employed.
• ANC records from seven health facilities in Kailari Rural Municipality were analyzed.
• Data from two 12-month periods, before and after ROUSG implementation, were compared for women aged 20-49.

Main Results:

• The ROUSG program led to a significant change in delivery methods, with fewer vaginal and more assisted deliveries (p=0.032).
• A higher proportion of complications, including malpresentation, hypertension, and abortion-related issues, were identified post-implementation.
• Early ANC attendance and facility-based deliveries showed no significant change; maternal and neonatal mortality remained low.

Conclusions:

• The ROUSG program enhanced diagnostic capabilities and altered delivery management but did not increase ANC attendance or facility deliveries.
• Ultrasound services strengthen diagnostic capacity for pregnancy complications in rural settings.
• Addressing persistent barriers like cultural norms, transportation, and inadequate counselling is crucial to improve maternal care-seeking behaviors.