Implementing fetal anomaly ultrasound screening programs in developing countries: strategies, challenges, lessons and recommendations from Ibadan, Nigeria

Abstract

Background: Early detection and correction of birth defects when possible are the current major interventions available for limiting their morbidities and mortalities. Despite several limitations, our hospital, a tertiary health institution in a low-resource setting commenced fetal anomaly ultrasound (US) screening programme in 2012. This paper documents the strategies used in its successful implementation, the health-system bottle necks, the solutions, lessons learnt and recommendations for other intending centres. Methods: T h e preceding situation, strategic s involved in commencement t of an ultrasound screening programme, training of personnel, equipment installation, screening principles and process as well as pathway to fetal anomaly ultrasound scan were systematically documented. The coverage level and uptake proportions were also calculated. Results: A total of 1,786 pregnant mothers presented in the antenatal clinic over the three-year period covered in this report. One-third (595) of pregnant women presented for prenatal USS screening for fetal anomaly. Among those screened, 55 (9%) were found not to be eligible. All eligible patients counselled for prenatal US screening agreed to do the screening given a total of54 0 women screened (up-take among eligible-patients was 100%). There were a total of 42 anomalies detected given the proportion of women with anomalies s to be 7.8% among the population screened. Conclusion and Recommendations: The process of commencing comprehensive fetal anomaly US screening in our institution has reinforced the need for proper training of personnel, multi-specialty inclusion and continuous institutional support. An MRI machine with at least a 1.Tesla