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Mogren, Ingrid
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Holmlund, S., Ntaganira, J., Edvardsson, K., Lan, P. T., Semasaka Sengoma, J. P., Kidanto, H. L., . . . Mogren, I. (2018). Health professionals' experiences and views on obstetric ultrasound in Rwanda: A cross-sectional study. PLoS ONE, 13(12), Article ID e0208387.
Open this publication in new window or tab >>Health professionals' experiences and views on obstetric ultrasound in Rwanda: A cross-sectional study
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2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 12, article id e0208387Article in journal (Refereed) Published
Abstract [en]

Objectives: Implementation of ultrasound in antenatal care (ANC) in low-income countries has been shown to increase pregnant women’s compliance with ANC visits, and facilitate detection of high-risk pregnancies. In Rwanda, as in other low-income countries, access to ultrasound has increased significantly, but lack of training is often a barrier to its use. The aim of this study was to investigate Rwandan health professionals’ experiences and views of obstetric ultrasound in relation to clinical management, resources and skills.

Methods: A cross-sectional questionnaire study was undertaken between November 2016 and March 2017, as part of the CROss Country UltraSound Study (CROCUS). Data were collected at 108 health facilities located in both rural and urban areas of Rwanda, including provincial, referral, district and private hospitals as well as health centres. Participants were obstetricians (n = 29), other physicians (n = 222), midwives (n = 269) and nurses (n = 387).

Results: Obstetricians/gynecologists/other physicians commonly performed ultrasound examinations but their self-rated skill levels implied insufficient training. Access to ultrasound when needed was reported as common in hospitals, but available to a very limited extent in health centres. The vast majority of participants, independent of health profession, agreed that maternity care would improve if midwives learned to perform basic ultrasound examinations.

Conclusions: Barriers to provision of high quality ultrasound services include variable access to ultrasound depending on health facility level and insufficient skills of ultrasound operators. Physicians in general need more training to perform ultrasound examinations. Implementation of a general dating ultrasound examination seems to be a relevant goal as most health professionals agree that pregnant woman would benefit from this service. To further improve maternity care services, the possibility of educating midwives to perform ultrasound examinations should be further explored.

Place, publisher, year, edition, pages
PUBLIC LIBRARY SCIENCE, 2018
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-154875 (URN)10.1371/journal.pone.0208387 (DOI)000452204800030 ()30513102 (PubMedID)2-s2.0-85057761963 (Scopus ID)
Available from: 2019-01-04 Created: 2019-01-04 Last updated: 2019-01-04Bibliographically approved
Rurangirwa, A. A., Mogren, I., Ntaganira, J., Govender, K. & Krantz, G. (2018). Intimate partner violence during pregnancy in relation to non-psychotic mental health disorders in Rwanda: a cross-sectional population-based study. BMJ Open, 8(7), Article ID e021807.
Open this publication in new window or tab >>Intimate partner violence during pregnancy in relation to non-psychotic mental health disorders in Rwanda: a cross-sectional population-based study
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2018 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 7, article id e021807Article in journal (Refereed) Published
Abstract [en]

Objectives To investigate the prevalence of non-psychotic mental health disorders (MHDs) and the association between exposure to all forms of intimate partner violence (IPV) during pregnancy and MHDs. Design Cross-sectional population-based study conducted in the Northern Province of Rwanda and Kigali city. Participants and settings Totally, 921 women who gave birth <= 13 months before being interviewed were included. Simple random sampling was done to select villages, households and participants. Community health workers helped to identify eligible participants and clinical psychologists, nurses or midwives conducted face-to-face interviews. The collected data were analysed using descriptive statistics and bivariable and multivariable logistic regression modelling Results The prevalence rates of generalised anxiety disorder, suicide ideation and post-traumatic stress disorder (PTSD) were 19.7%, 10.8% and 8.0%, respectively. Exposure to the four forms of IPV during pregnancy was highly associated with the likelihood of meeting diagnostic criteria for each of the non-psychotic MHDs investigated. Physical, psychological and sexual violence, showed the strongest association with PTSD, with adjusted ORs (aORs) of 4.5, 6.2 and 6.3, respectively. Controlling behaviour had the strongest association with major depressive episode in earlier periods with an aOR of 9.2. Conclusion IPV and MHDs should be integrated into guidelines for perinatal care. Moreover, community-based services aimed at increasing awareness and early identification of violence and MHDs should be instituted in all villages and health centres in Rwanda. Finally, healthcare providers need to be educated and trained in a consistent manner to manage the most challenging cases quickly, discreetly and efficiently.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2018
Keywords
mental health, intimate partner violence, intimate partner violence, pregnancy, non-psychotic mental health disorders
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-152901 (URN)10.1136/bmjopen-2018-021807 (DOI)000446181900164 ()29997142 (PubMedID)
Funder
Sida - Swedish International Development Cooperation Agency
Available from: 2018-10-30 Created: 2018-10-30 Last updated: 2018-10-30Bibliographically approved
Lindqvist, M., Persson, M. & Mogren, I. (2018). "Longing for individual recognition": pregnant women's experiences of midwives' counselling on physical activity during pregnancy. Sexual & Reproductive HealthCare, 15, 46-53
Open this publication in new window or tab >>"Longing for individual recognition": pregnant women's experiences of midwives' counselling on physical activity during pregnancy
2018 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 15, p. 46-53Article in journal (Refereed) Published
Abstract [en]

Objective: The aims to explore among pregnant women were their experiences of lifestyle counselling provided by a midwife in antenatal care, addressing health promotion with special focus on physical activity during pregnancy, and factors influencing the trustworthiness of counselling conducted by a midwife. Methods: This qualitative study collected data from 14 pregnant, primiparous or multiparous women in gestational week 35–36 using in-depth interviews. The data were collected in Sweden in 2015. Qualitative content analysis was applied. Results: The theme "Longing for fulfilment of individual needs and expectations" emerged during analysis, including four categories; "Being exposed to unsatisfying counselling"; "Appreciating supportive and trustworthy counselling"; "Wrestling with cultures", and "Dealing with physical activity in daily life". The results indicated that some participants experienced limited counselling that was characterized by lack of knowledge, support, and trustworthiness in the midwife. Other participants reported valuable encouragement and support by the midwife. Participants were longing for individual recognition instead of receiving general advice on physical activity that was designed for all pregnant women. Conclusions: Individual counselling on physical activity during pregnancy based on the participant's individual needs was desired. On the contrary, the participants could experience the midwife as having her own agenda, insufficient knowledge and primarily focusing on medical surveillance. There is a need of increased level of knowledge among midwives in antenatal care, regarding lifestyle and lifestyle change during pregnancy. This may enhance promotion of a healthy lifestyle for the pregnant woman during counselling.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Qualitative study, Midwife, Counselling, Pregnancy, Physical activity
National Category
Obstetrics, Gynecology and Reproductive Medicine Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:umu:diva-119566 (URN)10.1016/j.srhc.2017.12.003 (DOI)000424721100009 ()29389501 (PubMedID)
Note

First published in thesis in submitted form.

Available from: 2016-04-25 Created: 2016-04-25 Last updated: 2018-06-07Bibliographically approved
Mogren, I., Lindqvist, M., Petersson, K., Nilses, C., Small, R., Granåsen, G. & Edvardsson, K. (2018). Maternal height and risk of caesarean section in singleton births in Sweden D-A population-based study using data from the Swedish Pregnancy Register 2011 to 2016. PLoS ONE, 13(5), Article ID e0198124.
Open this publication in new window or tab >>Maternal height and risk of caesarean section in singleton births in Sweden D-A population-based study using data from the Swedish Pregnancy Register 2011 to 2016
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2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 5, article id e0198124Article in journal (Refereed) Published
Abstract [en]

Caesarean section (CS) has short and long term adverse health consequences, and should therefore only be undertaken when necessary. Risk factors such as maternal age, maternal body mass index (BMI) and fetal weight have been extensively investigated in relation to CS, but the significance of maternal height has been less explored in Sweden. The aim was to investigate the significance of maternal height on risk of CS in a representative, population-based sample from Sweden, also taking into account confounders. Data on singleton births in the Swedish Pregnancy Register 2011 to 2016 were collected, including women with heights of 140 cm and above, constituting a sample of 581,844 women. Data were analysed with epidemiological and biostatistical methods. Mean height was 166.1 cm. Women born outside Sweden were significantly shorter than women born in Sweden (162.8 cm vs. 167.1 cm, p < 0.001). There was a decreasing risk of CS with increasing maternal height. This effect remained after adjustment for other risk factors for CS such as maternal age, BMI, gestational age, parity, high birth weight and country of birth. Frequency of CS was higher among women born outside Sweden compared with Swedish-born women (17.3% vs. 16.0%), however, in a multiple regression model country of birth outside Sweden diminished as a risk factor for CS. Maternal height of 178-179 cm was associated with the lowest risk of CS (OR = 0.76, CI95% 0.71-0.81), whereas height below 160 cm explained 7% of CS cases. BMI and maternal age are established factors involved in clinical assessments related to birth, and maternal height should increasingly enjoy a similar status in these considerations. Moreover, when healthcare professionals are counselling pregnant women, taller stature should be more emphasized as a positive indicator for successful vaginal birth to increase pregnant women's confidence in giving birth vaginally, with possible positive impacts for lowering CS rates.

Place, publisher, year, edition, pages
PUBLIC LIBRARY SCIENCE, 2018
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-150693 (URN)10.1371/journal.pone.0198124 (DOI)000433521800045 ()29813118 (PubMedID)
Available from: 2018-09-11 Created: 2018-09-11 Last updated: 2018-09-11Bibliographically approved
Timpka, S., Markovitz, A., Schyman, T., Mogren, I., Fraser, A., Franks, P. W. & Rich-Edwards, J. W. (2018). Midlife development of type 2 diabetes and hypertension in women by history of hypertensive disorders of pregnancy. Cardiovascular Diabetology, 17, Article ID 124.
Open this publication in new window or tab >>Midlife development of type 2 diabetes and hypertension in women by history of hypertensive disorders of pregnancy
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2018 (English)In: Cardiovascular Diabetology, ISSN 1475-2840, E-ISSN 1475-2840, Vol. 17, article id 124Article in journal (Refereed) Published
Abstract [en]

Background: Women with history of hypertensive disorders of pregnancy (HDP) are at increased risk of early onset cardiovascular disease and type 2 diabetes (T2D). We aimed to investigate the extent to which HDP is also associated with midlife development of T2D and hypertension above and beyond established risk factors.

Methods: We included parous women who attended population-based structured clinical visits at age 50 and 60 years in Sweden 1991-2013 (N = 6587). Women with prior diabetes mellitus, stroke, or ischemic heart disease at age 50 years were excluded. Data on reproductive history were collected from registries. To study the association between history of HDP and the between-visits development of T2D, hypertension, and clinical risk factors of cardio-metabolic disease (body mass index (BMI), blood pressure, and total cholesterol), we utilized multivariable adjusted regression models (logistic, log binomial, and linear regression, respectively). Models included data on outcome risk factors at age 50 years, e.g. BMI, 75 g 2 h oral glucose tolerance test result, and mean arterial pressure, respectively.

Results: Between ages 50 and 60 years, 5.8% of initially disease-free women developed T2D and 31.6% developed hypertension. History of HDP was associated with increased risk of developing T2D between age 50 and 60 years even when adjusting for risk factors, including BMI, at age 50 years (odds ratio (OR) 1.96, 95% confidence interval (CI) 1.29-2.98). By contrast, the higher risk of developing hypertension observed in women with history of HDP (relative risk (RR) 1.47, 95% CI 1.22-1.78) was attenuated when adjusted for risk factors (RR 1.09, 95% CI 0.94-1.25). Participants with a history of HDP had higher mean BMI and blood pressure at age 50 years, with levels roughly corresponding to those observed at age 60 years in unaffected women.

Conclusions: Women with history of HDP are not only at higher risk of cardiometabolic disease during their reproductive years, but HDP is also associated with midlife T2D development above and beyond established risk factors.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Hypertensive disorders of pregnancy, Preeclampsia, Gestational hypertension, Epidemiology, Type 2 diabetes, Hypertension
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-152256 (URN)10.1186/s12933-018-0764-2 (DOI)000444253900001 ()30200989 (PubMedID)
Funder
Swedish Research CouncilSwedish Heart Lung Foundation
Available from: 2018-10-04 Created: 2018-10-04 Last updated: 2018-10-04Bibliographically approved
Fagerli, T. A., Mogren, I., Adolfsson, A., Edvardsson, K., Åhman, A., Holmlund, S., . . . Eggebo, T. M. (2018). Midwives' and obstetricians' views on appropriate obstetric sonography in Norway. Sexual & Reproductive HealthCare, 16, 1-5
Open this publication in new window or tab >>Midwives' and obstetricians' views on appropriate obstetric sonography in Norway
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2018 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 16, p. 1-5Article, review/survey (Refereed) Published
Abstract [en]

Introduction: The primary aim of this study was to investigate midwives' and obstetricians' views on how many ultrasound examinations should be part of standard care during pregnancy in Norway. Material and methods: This study is a part of a larger study, the CROss-Country Ultrasound Study (CROCUS), an international investigation of midwives' and obstetricians' experiences of and views on the use of ultrasound. We distributed 400 questionnaires to respondents in all five health regions in Norway: 40 to municipal midwives, 180 to midwives working in hospitals and 180 to obstetricians. The questionnaire included specific questions about the appropriate number of examinations during pregnancy, examinations without medical indication, non-medical ultrasound, commercialisation and safety. Results: The response rate was 45%. Of the respondents, 58% reported satisfaction with the offer of one scheduled ultrasound examination during pregnancy, as recommended in the Norwegian guidelines. Health care professionals who used ultrasound themselves were significantly more likely to want to offer more ultrasound examinations: 52% of the ultrasound users wanted to offer two or more ultrasound examinations vs. 16% of the non-users (p < .01). The majority of obstetricians (80%) reported that pregnant women expect to undergo ultrasound examination, even in the absence of medical indication. Conclusion: The majority of Norwegian health care professionals participating in this study supported the national recommendation on ultrasound in pregnancy. Ultrasound users wanted to offer more ultrasound examinations during pregnancy, whereas non-users were generally content with the recommendation. The majority of respondents thought that commercialisation was not a problem at their institution, and reported that ultrasound is often performed without a medical indication. The ultrasound users thought that ultrasound is safe.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2018
Keywords
Ultrasonography, Health care professionals, Non-medical ultrasound, Safety
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-151072 (URN)10.1016/j.srhc.2017.12.006 (DOI)000440877700001 ()29804752 (PubMedID)2-s2.0-85044744044 (Scopus ID)
Available from: 2018-08-27 Created: 2018-08-27 Last updated: 2018-08-27Bibliographically approved
Edvardsson, K., Åhman, A., Fagerli, T. A., Darj, E., Holmlund, S., Small, R. & Mogren, I. (2018). Norwegian obstetricians' experiences of the use of ultrasound in pregnancy management: a qualitative study. Sexual & Reproductive HealthCare, 15, 69-76
Open this publication in new window or tab >>Norwegian obstetricians' experiences of the use of ultrasound in pregnancy management: a qualitative study
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2018 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 15, p. 69-76Article in journal (Refereed) Published
Abstract [en]

Objective: To explore obstetricians' experiences and views of the use of obstetric ultrasound in clinical management of pregnancy. Methods: A qualitative interview study was undertaken in 2015 with obstetricians (N = 20) in Norway as part of the CROss Country Ultrasound Study (CROCUS). Results: Three categories developed during analyses. 'Differing opinions about ultrasound and prenatal diagnosis policies' revealed divergent views in relation to Norwegian policies for ultrasound screening and prenatal diagnosis. Down syndrome screening was portrayed as a delicate and frequently debated issue, with increasing ethical challenges due to developments in prenatal diagnosis. 'Ultrasound's influence on the view of the fetus' illuminated how ultrasound influenced obstetricians' views of the fetus as a 'patient' and a 'person'. They also saw ultrasound as strongly influencing expectant parents' views of the fetus, and described how ultrasound was sometimes used as a means of comforting women when complications occurred. The complexity of information and counselling' revealed how obstetricians balanced the medical and social aspects of the ultrasound examination, and the difficulties of 'delivering bad news' and counselling in situations of uncertain findings. Conclusion: This study highlights obstetricians' experiences and views of ultrasound and prenatal diagnosis in Norwegian maternity care and the challenges associated with the provision of these services, including counselling dilemmas and perceived differences in expectations between caregivers and expectant parents. There was notable diversity among these obstetricians in relation to their support of, and adherence to Norwegian regulations about the use of ultrasound, which indicates that the care pregnant women receive may vary accordingly.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Ethics, Norway, Obstetrics, Pregnant women, Prenatal diagnosis, Ultrasonography, Qualitative search
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-145366 (URN)10.1016/j.srhc.2017.12.001 (DOI)000424721100012 ()29389504 (PubMedID)
Available from: 2018-03-13 Created: 2018-03-13 Last updated: 2018-06-09Bibliographically approved
Rurangirwa, A. A., Mogren, I., Ntaganira, J., Govender, K. & Krantz, G. (2018). Quality of antenatal care services in Rwanda: assessing practices of health care providers. BMC Health Services Research, 18, Article ID 865.
Open this publication in new window or tab >>Quality of antenatal care services in Rwanda: assessing practices of health care providers
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2018 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 18, article id 865Article in journal (Refereed) Published
Abstract [en]

Background: Although most pregnant women in Rwanda visit antenatal care (ANC) clinics, little has been studied about the quality of services being provided. We investigated the ANC providers' (HCPs) current practices in relation to prevention, management and referral of maternal conditions as well as the information provided to pregnant women attending ANC services in Rwanda.

Methods: This facility-based, cross-sectional study included 312 ANC providers as participants and a review of 605 ANC medical records from 121 health centers. Data collection was performed using an interviewer-administered questionnaire and a structured observation checklist. For the analyses, descriptive statistics and bi-and multivariable logistic regression were used.

Results: Nurses and midwives in ANC services failed to report a number of pregnancy-related conditions that would need urgent referral to a higher level of health care. Midwives did somewhat better than nurses in reporting these conditions. There was no statistically significant difference in how nurses and midwives informed pregnant women about pregnancy-related issues. Ever been trained in how to manage a pregnant woman exposed to violence was reported by 14% of the participants. In 12, 13 and 15% of the medical records there was no report on tetanus immunization, anthelmintic treatment and syphilis testing, respectively.

Conclusion: The providers in ANC clinics reported suboptimal practices on conditions of pregnancy that needed urgent referral for adequate management. Information to pregnant women on danger signs of pregnancy, recommended medicines and tests do not seem to be consistently provided. Midwifery training in Rwanda should be expanded so that most of staff at ANC clinics are trained as midwives to help lower maternal and child mortality and morbidity.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Antenatal care, Quality of care, Antenatal care providers, Practices, Rwanda
National Category
Public Health, Global Health, Social Medicine and Epidemiology Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-154054 (URN)10.1186/s12913-018-3694-5 (DOI)000451124200001 ()30453996 (PubMedID)
Funder
Sida - Swedish International Development Cooperation Agency
Available from: 2018-12-19 Created: 2018-12-19 Last updated: 2018-12-19Bibliographically approved
Timpka, S., Fraser, A., Schyman, T., Stuart, J. J., Asvold, B. O., Mogren, I., . . . Rich-Edwards, J. W. (2018). The value of pregnancy complication history for 10-year cardiovascular disease risk prediction in middle-aged women. European Journal of Epidemiology, 33(10), 1003-1010
Open this publication in new window or tab >>The value of pregnancy complication history for 10-year cardiovascular disease risk prediction in middle-aged women
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2018 (English)In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 33, no 10, p. 1003-1010Article in journal (Refereed) Published
Abstract [en]

Women with a history of hypertensive disorders of pregnancy (HDP; preeclampsia and gestational hypertension) or delivering low birth weight offspring (LBW; < 2500 g) have twice the risk of cardiovascular disease (CVD). We aimed to study the extent to which history of these pregnancy complications improves CVD risk prediction above and beyond conventional predictors. Parous women attended standardized clinical visits in Sweden. Data were linked to registries of deliveries and CVD. Participants were followed for a first CVD event within 10 years from age 50 (n = 7552) and/or 60 years (n = 5360) and the predictive value of each pregnancy complication above and beyond conventional predictors was investigated. History of LBW offspring was associated with increased risk of CVD when added to conventional predictors in women 50 years of age [Hazard ratio 1.68, 95% Confidence interval (CI) 1.19, 2.37] but not at age 60 (age interaction p = 0.04). However, at age 50 years CVD prediction was not further improved by information on LBW offspring, except that a greater proportion of the women who developed CVD were assigned to a higher risk category (categorical net reclassification improvement for events 0.038, 95% CI 0.003, 0.074). History of HDP was not associated with CVD when adjusted for reference model predictors. In conclusion, a history of pregnancy complications can identify women with increased risk of CVD midlife. However, considered with conventional risk factors, history of HDP or having delivered LBW offspring did not meaningfully improve 10-year CVD risk prediction in women age 50 years or older.

Place, publisher, year, edition, pages
Springer, 2018
Keywords
Risk prediction, Myocardial infarction, Primary prevention, Stroke, Västerbotten Intervention Program
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-153715 (URN)10.1007/s10654-018-0429-1 (DOI)000445160700009 ()30062549 (PubMedID)
Funder
Swedish Research CouncilSwedish Heart Lung Foundation
Available from: 2018-11-27 Created: 2018-11-27 Last updated: 2018-11-27Bibliographically approved
Åhman, A., Edvardsson, K., Kidanto, H. L., Ngarina, M., Small, R. & Mogren, I. (2018). 'Without ultrasound you can't reach the best decision': midwives' experiences and views of the role of ultrasound in maternity care in Dar Es Salaam, Tanzania. Sexual & Reproductive HealthCare, 15, 28-34
Open this publication in new window or tab >>'Without ultrasound you can't reach the best decision': midwives' experiences and views of the role of ultrasound in maternity care in Dar Es Salaam, Tanzania
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2018 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 15, p. 28-34Article in journal (Refereed) Published
Abstract [en]

Objective: To explore Tanzanian midwives' experiences and views of the role of obstetric ultrasound in relation to clinical management of pregnancy, and in situations where maternal and fetal health interests conflict. Method: In 2015, five focus group discussions were conducted with midwives (N = 31) at three public referral hospitals in the Dar es Salaam region as part of the CROss Country Ultrasound Study (CROCUS). Results: Ultrasound was described as decisive for proper management of pregnancy complications. Midwives noted an increasing interest in ultrasound among pregnant women. However, concerns were expressed about the lack of ultrasound equipment and staff capable of skilful operation. Further, counselling regarding medical management was perceived as difficult due to low levels of education among pregnant women. Conclusion: Ultrasound has an important role in management of pregnancy complications. However, lack of equipment and shortage of skilled healthcare professionals seem to hamper use of obstetric ultrasound in this particular low-resource setting. Increased availability of obstetric ultrasound seems warranted, but further investments need to be balanced with advanced clinical skills' training as barriers, including power outages and lack of functioning equipment, are likely to continue to limit the provision of pregnancy ultrasound in this setting.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Pregnancy, Obstetric ultrasound, Prenatal diagnosis, Tanzania, Midwives, Qualitative study
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-145367 (URN)10.1016/j.srhc.2017.11.007 (DOI)000424721100006 ()29389498 (PubMedID)
Available from: 2018-03-13 Created: 2018-03-13 Last updated: 2018-06-09Bibliographically approved
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