Achieving universal access to obstetric ultrasound in resource constrained settings: A narrative review.

OBJECTIVES: The potential benefits and challenges of achieving universal access to obstetric ultrasound services in resource constrained settings were reviewed, with a view to making some recommendations to address the huge burden of avoidable maternal and child morbidity and mortality. KEY FINDINGS: In most resource-poor settings of the world, antenatal ultrasound is available only to a privileged few in urban centres, while the majority of the population living in rural areas have little or no access to diagnostic imaging services. There is also the extreme shortage of sonographers and doctors with specialist training in sonography. A comprehensive regulation must be put in place to achieve maximum benefits and to ensure quality assurance; appropriate use and application of ethics and training must be comprehensive. CONCLUSION: Ultrasound service provision, in resource-scarce settings, has the potential to improve access and quality of health care services in areas like the point of care ultrasound service provision and in the fields of obstetrics and gynaecology. A comprehensive regulation must be put in place to achieve maximum benefits and to ensure quality assurance. IMPLICATIONS FOR PRACTICE: Making ultrasound technology available and affordable in resource scare settings has the potential to improve access to diagnostic imaging services and reduce avoidable maternal and child death in resource constrained settings.

Prediction of Normal Ovulation by Sonographic Folliculometry Involving Natural Cycles among Women in Ojo, Southwest Nigeria.

BACKGROUND: Accurate prediction of ovulation is important in the management of female infertility. AIM: To determine the sonographic sensitivity of reduction in follicular size and disappearance of ovarian follicle as predictors of imminent ovulation. METHODS: This was a longitudinal study involving 100 women between the ages of 18 and 35 years. Transvaginal sonography with 6.5 MHz probe frequency was performed with a General Electric (RT 2800) ultrasound machine. Dominant follicles were identified and measured in both the longitudinal and transverse planes and their disappearance was monitored prior to ovulation. Laboratory luteinizing hormone test strips were used to test serum samples collected daily from each patient to confirm the time of ovulation. RESULTS: Pre-ovulation follicular size among the subjects was in the range of 18-36 mm while the mean follicular size was 26.78 ± 4.03 mm. Prior to ovulation, disappearance and reduction in follicular size was noted in 59% and 41% of subjects, respectively. Luteinizing hormone test was also positive and peaked prior to ovulation in 92% of the subjects among whom follicles disappeared in 37% while their size reduced in 55%. There was no statistically significant difference between sonographic and laboratory findings (p > 0.05). Age, height, weight and body mass index do not have significant influence (p > 0.05) on follicular size and ovulation. CONCLUSION: Sonographic observation of complete disappearance of a dominant follicle and reduction in follicular size of surrogate follicles after follicular rupture appeared to be a reliable predictor of imminent ovulation.

Observer variability in sonographic measurement of kidney sizes among children in Benin City, Nigeria / Variabilidad del observador en las mediciones sonográficas del tamaño del riñón entre los niños en Benin City, Nigeria

AIM: To assess the level of inconsistency in replicating sonographic kidney size measurements in a population of healthy Nigerian children. SUBJECTS AND METHODS: In this prospective cross-sectional study, convenience sampling technique was used to select a sample of Nigerian children. Both consent from participants and ethical approval from the local authority were obtained before the study commenced. Three radiologists carried out the replicate sonographic measurements using a DP-1100 mechanical sector scanner with a 3.5 MHz convex probe. All examinations were done with subjects in the supine oblique position. Longitudinal and transverse scans were performed. Renal lengths and widths were measured from the longitudinal scans while thickness was measured from the transverse scans. Renal volumes were calculated with the ellipsoid formula. Analysis of variance, Student's t-test, Pearson's correlation coefficient and z-test were used to test the statistical significance of results. SPSS version 17.0 was used in the analysis of results while statistical significance of all results was tested at p < 0.05. RESULTS: Mean intra-observer measurement errors in replicate sonographic measurements of kidney sizes ranged from 0.36-0.43 cm, 0.22-0.63 cm, 0.37-0.52 cm and 5.93-9.62 ml for kidney length, width, thickness and volume, respectively. Mean inter-observer measurement errors were in the range of 0.29 0.48 cm, 0.18-0.23 cm, 0.34-1.82 cm and 5.92-7.28 ml for length, width, thickness and volume, respectively. Mean intra-observer errors were not statistically significant (p > 0.05) but mean interobserver errors were (p < 0.05). Differences in all measurement errors of right and left kidney length, width, thickness and volume were not statistically significant (p > 0.05). Measurement errors correlated weakly with kidney sizes. Observer errors in renal length were not significantly different from what was reported among Caucasians (p > 0.05) whereas that of volume was (p < 0.05). CONCLUSION: Errors in replicate sonographic kidney size measurements obtained by a single observer were less than errors in the same measurements by different observers; therefore, replicate sonographic measurements by a single observer were more consistent in this population.

OBJETIVO: Evaluar el nivel de inconsistencia cuando se repiten las mediciones sonográficas del tamaño del riñón en una población de niños nigerianos saludables. SUJETOS Y MÉTODOS: En este estudio prospectivo transversal, se utilizó la técnica de muestreo por conveniencia para seleccionar una muestra de niños nigerianos. Antes de comenzar el estudio, se obtuvo tanto el consentimiento de los participantes como la aprobación ética de la autoridad local. Tres radiólogos llevaron a cabo la repetición de las mediciones sonográficas mediante un escáner de sector mecánico DP-1100 con una sonda convexa de 3.5 MHz. Todos los exámenes se realizaron con sujetos en posición supina oblicua. Se realizaron escaneos longitudinales y transversales. La longitud y el ancho renales fueron medidos a partir de los escaneos longitudinales, mientras que el espesor se midió a partir de los escaneos transversales. Los volúmenes renales se calcularon con fórmula elipsoide. El análisis de varianza, la prueba t de Student, el coeficiente de correlación de Pearson, y la prueba Z, fueron utilizados para probar la significación estadística de los resultados. El programa SPSS versión 17.0 fue utilizado en el análisis de los resultados mientras que la significación estadística de los resultados fue probada en p < 0.05. RESULTADOS: Los errores intraobservadores promedio en la repetición de las mediciones sonográficas de los tamaños de riñón variaron de 0.36-0.43 cm, 0.22-0.63 cm, 0.37-0.52 cm, 5.93-9.62 mL en cuanto a longitud, ancho, espesor y volumen, respectivamente. Los errores interobservadores promedio de medición estuvieron en un rango de 0.29-0.48 cm, 0.18-0.23 cm, 0.34-1.82 cm y 5.92-7.28 mL de longitud, ancho, espesor y volumen, respectivamente. Los errores intraobservadores promedio no fueron estadísticamente significativos (p > 0.05) pero los errores interobservadores fueron (p < 0.05). Las diferencias en todos los errores de medición del riñón derecho e izquierdo en relación con la longitud, ancho, espesor y volumen, no fueron estadísticamente significativos (p > 0.05). Los errores de medición guardaron una débil correlación con los tamaños del riñón. Los errores de observador en relación con la longitud renal no fueron significativamente diferentes de lo que se informó entre los caucásicos (p > 0.05), mientras que el resultado para el volumen fue (p < 0.05). CONCLUSIÓN: Los errores en la repetición de las mediciones sonográficas del tamaño del riñón obtenidas por un solo observador, son menos que los errores en las mismas mediciones por diferentes observadores. Por lo tanto, las mediciones sonográficas repetidas por un único observador eran más consistentes entre esta población.

Sonographic biometry of spleen among school age children in Nsukka, Southeast, Nigeria.

BACKGROUND: Normative value of spleen size among school age children is important for objective assessment of the spleen. OBJECTIVES: This study was aimed at determining sonographically the normal limits of the spleen size according to age, sex, and somatometric parameters among school age children. METHODS: A cross sectional study was done on 947 apparently healthy subjects (496 boys and 451 girls) aged 6 - 17 years. The subjects were recruited from some primary and secondary schools within Nsukka metropolis and also from out patients in the study centre. A pilot study was done to determine the intra- and inter rater reliability of sonographic measurements of the spleen. The sonographic examination was performed on Shenzhen DP-1100 machine with 3.5 and 5 MHz convex transducers. Spleen sizes were obtained with the subject in a right lateral decubitus position. RESULTS: Measurement of spleen length was reliable while measurement of spleen width was less reliable within and between sonographers. Dimensions of the spleen were not statistically different in boys and girls (p > 0.05). Height correlated best with spleen dimensions. CONCLUSIONS: Normogram of the spleen size with respect to height is important in the determination of some pathology associated with changes in its size.

Sonographic assessment of pregnancy co-existing with uterine leiomyoma in Owerri, Nigeria.

BACKGROUND: Uterine myomas co-existing with pregnancy could cause obstetric complications. OBJECTIVES: To assess sonographically the frequency of occurrence and effect of uterine myomas co-existing with pregnancy. METHODS: A longitudinal study was conducted during a period of 23 months. A convenience sample of 816 consecutive consenting pregnant women who met the inclusion criteria was evaluated during routine prenatal ultrasound scan. The women were referred for prenatal sonography. One hundred of the subjects who had myoma co-existing with pregnancy and another 100 subjects without myoma were selected for follow-up. These groups were followed up till delivery and obstetric complications and outcomes were documented. Any changes in size and growth rate of myoma were documented. RESULTS: Subjects with myoma co-existing with pregnancy were 12.3%. This was commoner with increasing maternal age. An increase was observed in myoma mean size from 60mm to 63mm from the 1(st) scan sequence to the 2(nd) scan sequence and a reduction from 63mm to 59mm in the 3(rd) scan sequence. Myoma growth rate was 0.667mm per week. Myomas in pregnancy especially large ones caused more complications during delivery when compared to pregnancies without myomas. CONCLUSION: Routine sonography is important in pregnancy management of uterine myomas co-existing with pregnancy.

Observer Variability in Sonographic Measurement of Kidney Sizes among Children in Benin-City, Nigeria.

AIM: To assess the level of inconsistency in replicating sonographic kidney size measurements in a population of healthy Nigerian children. SUBJECTS AND METHODS: In this prospective cross-sectional study, convenience sampling technique was used to select a sample of Nigerian children. Both consent from participants and ethical approval from the local authority were obtained before the study commenced. Three radiologists carried out the replicate sonographic measurements using a DP-1100 mechanical sector scanner with a 3.5 MHz convex probe. All examinations were done with subjects in the supine oblique position. Longitudinal and transverse scans were performed. Renal lengths and widths were measured from the longitudinal scans while thickness was measured from the transverse scans. Renal volumes were calculated with the ellipsoid formula. Analysis of variance, Student's t-test, Pearson's correlation coefficient and z-test were used to test the statistical significance of results. SPSS version 17.0 was used in the analysis of results while statistical significance of all results was tested at p < 0.05. RESULTS: Mean intra-observer measurement errors in replicate sonographic measurements of kidney sizes ranged from 0.36-0.43 cm, 0.22-0.63 cm, 0.37-0.52 cm and 5.93-9.62 ml for kidney length, width, thickness and volume, respectively. Mean inter-observer measurement errors were in the range of 0.29-0.48 cm, 0.18-0.23 cm, 0.34-1.82 cm and 5.92-7.28 ml for length, width, thickness and volume, respectively. Mean intra-observer errors were not statistically significant (p < 0.05) but mean inter-observer errors were (p < 0.05). Differences in all measurement errors of right and left kidney length, width, thickness and volume were not statistically significant (p > 0.05). Measurement errors correlated weakly with kidney sizes. Observer errors in renal length were not significantly different from what was reported among Caucasians (p > 0.05) whereas that of volume was (p < 0.05). CONCLUSION: Errors in replicate sonographic kidney size measurements obtained by a single observer were less than errors in the same measurements by different observers; therefore, replicate sonographic measurements by a single observer were more consistent in this population.

Incidence of occupational stress among medical radiographers: a population based zonal survey.

Biomechanical and psychosocial stresses are capable of destabilizing any health care professional. The current health sector reform in Nigeria, which lays emphasis on service delivery on a background of very few radiographers, may lead to an increase in stress level. This study investigated the incidence of occupational stress among radiographers in southeastern Nigeria. 50 self-completion questionnaires were delivered to radiographers in the southeastern Nigeria. The questionnaires included questions seeking information on the demographic profile of the radiographer, anatomical regions of biomechanical systems/stress and Visual Analogue Scale (VAS), which rated job satisfaction and anxiety levels. 32 questionnaires were returned and analyzed statistically. Biomechanical stress was observed in all anatomical regions studied. Job satisfaction rating was 61.3% and anxiety level was 45.3%. This study has provided a baseline stress level and prevalence among radiographers with which future studies in view of the on going health sector reform in Nigeria could be compared.