Effect of USAID-funded obstetric ultrasound service interventions on maternal and perinatal health outcomes at primary healthcare facilities in Ethiopia: a propensity score matching analysis.

ABSTRACT

OBJECTIVE: A dimensional shift in the health service delivery in the primary healthcare setting is required to raise maternal and child well-being. This study aimed to evaluate the effect of US Agency for International Development-funded obstetric ultrasound service on maternal and perinatal health outcomes at Ethiopia's primary healthcare facilities. DESIGN: We employed a quasi-experimental study design. SETTING: The study was conducted in primary health centres located in four regions of Ethiopia. PARTICIPANTS: We used 2 years' data of 1568 mothers from 13 intervention and 13 control primary health centres. Data were obtained from Vscan, antenatal care (ANC), delivery and postnatal care registers. INTERVENTION Use of portable obstetric ultrasound service during pregnancy. OUTCOME MEASURES: The primary outcome variables include complete four ANC visits, referral during ANC, delivery in a health facility and having postnatal care and continuum of care. The secondary outcome variable was perinatal death. RESULTS: With the kernel matching approach, we have found that having four or more ANC visits was decreased after the intervention (average treatment effect (ATE) -0.20; 95% CI -0.23 to -0.09), and the rest of the indicators, including referral during ANC (ATE 0.01; 95% CI 0.15 to 0.34), institutional delivery (ATE 0.24; 95% CI 0.15 to 0.34) and postnatal care (ATE 0.26; 95% CI 0.10 to 0.37), were significantly raised because of the intervention. Similarly, we have found that perinatal death dropped considerably due to the intervention. CONCLUSION: The findings show a consistent increase in maternal health service use because of the introduction of obstetric ultrasound services at the primary health centre level. Furthermore, early detection of complications and following referral for specialty care were found to be high. The consistent rise in maternal health service use indicators calls for additional trial to test the effect of obstetric ultrasound service in other locations of the country. Furthermore, evaluating the predictive values, sensitivity and specificity of the obstetric ultrasound service is important.