Dr. Michael Silverman: The ‘magic’ of ultrasound encourages women to attend prenatal care in rural Uganda

In Uganda, close to 6,000 women die annually from pregnancy-related complications and up to one third of women deliver their babies at home without a skilled birth attendant. Many women also unknowingly pass HIV onto their children.

Dr. Michael Silverman, division chair chief of infectious diseases at Schulich Medicine & Dentistry, along with his colleagues at Bridge to Health Medical and Dental, and Kigezi Healthcare Foundation (KIHEFO) set out to find a way to encourage more pregnant women in rural Uganda to attend prenatal care. The aim is to diagnose and address pregnancy complications that could be fatal to mother and baby, and to screen for HIV, and begin treatment to prevent the mother from passing the infection on to her child.

The idea was put forward that perhaps giving women the option to see their unborn baby through the use of portable ultrasound, might provide an enticing reason for women to attend the clinic.

“Our hypothesis was that if we could offer free ultrasounds, so that women could see their unborn baby, more women would come forward and attend the antenatal clinic,” explained Dr. Michael Silverman, also a scientist at Lawson Health Research Institute and senior author on the research study. “Who doesn’t want to see their unborn baby? It’s like magic.”

Dr. Silverman, alongside Dr. William Cherniak, Executive Director at Bridge to Health, and Dr. Geoffrey Anguyo, Executive Director at KIHEFO found that radio advertising for free ultrasounds in rural Uganda increased the number of pregnant women who attended modern medical care by 490 per cent.

In the developing world, women do not present for antenatal care for a variety of reasons. “It may be against their cultural beliefs, or they may view modern medicine as irrelevant,” says Dr. Cherniak. “As a result, many of these women are unaware of pregnancy complications and deliver at home without a trained health care professional.”

Common pregnancy complications include the baby being turned the wrong way, the placenta being in the wrong place or even expecting twins. Another complication is the transmission of infectious diseases from the mother to child. In Africa, the biggest risk is the transmission of HIV, Hepatitis B or syphilis which can be transmitted from the mother to the baby and cause chronic infection of the baby, birth defects or death. Undiagnosed maternal malaria can also lead to severe complications.

The use of portable ultrasound machines is extremely beneficial. “Portable ultrasounds allow you to screen for serious anatomical problems, like the baby being positioned the wrong way. When women present to the clinic for an ultrasound, we can also screen them for the infections which can lead to severe complications, and offer treatments,” says Dr. Silverman, also Chair/Chief of Infectious Diseases at London Health Sciences Centre, St. Joseph’s Health Care London and Western. “Portable ultrasound machines are fairly inexpensive to maintain and it’s easy to train people to perform a simple obstetric ultrasound.”

The study found that the method of advertising was important. When advertising free ultrasounds by word-of-mouth, there was no significant increase in the number of women who attended antenatal care. “It appears that the message about free ultrasounds was not spreading. Many people did not believe it was true that they could see their unborn baby,” says Dr. Cherniak.

The researchers therefore decided to advertise free ultrasounds by radio with the hope that the message would be taken more seriously and spread farther. Radios are common in Ugandan households. As a result, almost six times the number of women attended the antenatal care clinics. This increase was particularly great in women who had previously seen a traditional healer. Amongst these women, attendance increased almost ninefold when ultrasound was advertised on the radio.

With an increase in the number of women who present for antenatal care, the research team hopes that health providers can show expecting mothers that modern care is safe, friendly and trustworthy. “We want to demonstrate to expecting mothers that antenatal care is safe and beneficial, and see if this encourages them to continue attending, particularly when they are in labour,” says Dr. Cherniak

The study, “Effectiveness of advertising availability of prenatal ultrasound on uptake of antenatal care in rural Uganda: A cluster randomized trial”, is published in PLoS ONE. The study was funded by Bridge to Health Medical and Dental, and also supported by Cole Engineering, Lebovic Enterprises, Rotary International and Rotary Club of Scarborough North.