CHAPTER ONE

GENERAL INTRODUCTION

1.1.   Introduction

 Obstetric ultrasonography is the use of medical ultrasound in pregnancy, in which sound waves are used to create real-time visual images of the developing embryo or fetus in the mother’s uterus.

The procedure is a standard part of prenatal care in many countries, as it can provide a variety of information about the health of the mother, the timing and progress of the pregnancy, and the health and development of the embryo or fetus.

  The International Society of ultrasound in obstetrics and Gynaecology recommends that pregnant women have routine obstetric ultrasounds between 18 weeks and 22 weeks gestational age in order to confirm pregnancy timing, to measure the fetus so that growth abnormalities can be recognized quickly later in pregnancy, and to diagnose congenital malformations and multiple pregnancies (twins). (Salomon, LJ; Alfirevic, Z; Berghella, V; Bilardo, C; Hernandez-Andrade, E; Johnsen, SL; W (2010).

Additionally, the ISUOG recommends that pregnant women have obstetric ultrasounds between 11 weeks and 13 weeks 6 days gestational age in countries with resources to perform them (the nucal scan).

Performing an ultrasound at this early stage of pregnancy can more accurately confirm the timing of the pregnancy and can also diagnose multiple fetuses and major congenital abnormalities at an earlier stage. ( Salomon, LJ; Alfirevic, Z; Bilardo, CM; Chalouhi, GE; Ghi, T; Kagan, KO; Lau, TK; Papageorghiou, AT; Raine-Fenning, NJ; Stirnemann, J; Suresh, S; Tabor, A; Timor-Tritsh, IE; Toi, A; Yeo, G (2013).

Research shows that routine obstetric ultrasound before 24 weeks gestational age can significantly reduce the risk of failing to recognize multiple gestations and can improve pregnancy dating to reduce the risk of labor induction for post-dates pregnancy.

There is no difference, however, in perinatal death or poor outcomes for babies. (Whitworth, M; Bricker, L; Mullan, C (2015).

Ultrasonography (Also known as ultrasound) is vital for the health care of women. Most women in Cameroon are still ignorant of the value of this tool, especially those in rural areas.

Many factors such as level of education, Cost of purchasing and training sonographers, low level of development, government policies, training of medical health care workers, insufficient infrastructures are all seen to influence the knowledge of Cameroon women on ultrasound.

1.2. Background of the study

Medical Imaging is indispensable for successful medical practice. It embodies various imaging modalities, with ultrasonography also known as ultrasound being one of them. The use of ultrasound (US) was introduced in the 1950s for medical diagnosis and there have been tremendous increases in the technology of this imaging tool.

Ultrasonography is a medical diagnostic imaging modality, which uses sound waves of frequency greater than 20 kilohertz (20 KHz). Sound waves are non-ionizing radiations unlike X- Rays, gamma rays, alpha particles, or neutrons.

Ultrasound is being generated with the help of the ultrasound machine, using the piezoelectric principle. (Kathryn AG. Ultrasound in obstetrics and Gynaecology; 2014.)

The medical applications of ultrasound are varied, ranging from obstetric and Gynaecological ultrasound scans, breast ultrasound in women to testicular, thyroid, abdominopelvic, Doppler, cardiac and musculoskeletal ultrasound: Diagnosing a wide variety of diseases such as cystic lesions, fibroids, masses, abscesses collection, to mention the few.

US use is generally up till date considered to be safe and has tremendous benefits to women considering their physiologic and also radiation effects related issues. 

Ultrasound use in women is dominant in the areas of obstetrics and gynaecology, breast imaging, and also musculoskeletal, thoracic and abdominal imaging. Women can do an ultrasound scan to diagnose lumps in the breast, to evaluate pregnancy status (obstetrics), to evaluate the pelvic organs and the related structures in the pelvis .( Joshua T, Boniface M, Odile FZ : 2013)

The benefits and rational for the wide advocate of ultrasound use in women are because ultrasound use is relatively cheap and easily affordable and accessible, ultrasound scans are done in real-time, there is no use of ionizing radiations such as X- Rays with side effects, sectional images obtained give detailed information about the structure scanned, requires minimal patient preparations such as a filled urinary bladder for pelvic US and will also effectively diagnose soft tissue problems better than two-dimensional plain radiography.( Kathryn AG. Ultrasound in Obstretrics and Gynecology : 2014.)

Despite these numerous benefits of ultrasound in women, studies reveal that ultrasound awareness among women in Cameroon still remains low. This ignorance among women cuts across many African countries. Such ignorance has associated with the potential consequences.

Based on a study conducted by Joshua et al.2013, Out of a total of 200 women who were interviewed, 33 respondents (16.8%) on a total of 196 declared that they have never done US scan, 19(58.4%) on a total of 190 confessed having received no information on what ultrasound is all about.

About 34 women considered ultrasound to be unsafe as they believe that, ultrasound uses X- rays that can cause cancer. This really revealed that most women in Cameroon are really ignorant of the use of ultrasound. It is equally worth noting that in this study, most women were within the age group of 25- 29 years.( Joshua T, Boniface M, Odile FZ ,(2013)

Furthermore, based on the World Bank reports of 2014, concerning Cameroon, approximately 10% of youths in Cameroon lack formal education. A total of 30% of youths between the ages of 15- 24 years have not completed primary education and only 1% have completed secondary school, meanwhile, 55% are secondary school dropouts.( National Education Profile of Cameroon.) Education is vital because it exposes people to knowledge that can influence the view women to have about healthcare.

This gross ignorance has contributed to many complications in pregnancies such as stillbirths, fetal malformations, and infertility due to fibroids in women’s uterus, breast cancer, all clinical conditions that can be effectively and safely evaluated on ultrasound. Besides these consequences are broken relationships, frustrations, and unnecessary operations in these women and in some cases death.(Alfred A, Rabih C, Philipe J 2014)

1.3 Statement of the problem

The level of literacy is relatively low. Despite the increase in antenatal care uptake in Cameroon, the wide application of ultrasound among women especially expectant women is low. Only a few clinics and health centers in Cameroon do insist on ultrasound scanning.

The villages and generally rural areas are not also covered. Obstetricians and Gynaecologists, who request most ultrasound exams, do not properly educate these women. Nurses and midwives who frequently interact with women are equally ignorant of the value of ultrasound. 

This may be due to the nature and design of most of their educational curricula which do not include courses in Obstetrics and Gynaecology ultrasound, and the antenatal care in Cameroon hardly lay emphasis on the value of ultrasound use unlike in other African countries such as Sierra Leone.

Moreover, most government programs concerning women hardly emphasize the value of ultrasound use which may partly be due to negligence especially on medical imaging training in the country, and as such graduates from this field are not always given first place as regard recruitment and sensitization programs in this country.

In addition, despite enormous efforts made by the government to educate her citizens and also fulfill the Millennium Development Goals (MDGs) there are still cultural practices in Cameroon that contribute to such ignorance among women.

Most people still see educational training of the girl child as a waste of resources and the females should be reserved for marriage. This point is further solidified by the rationale for the Boko Haram crisis in the North of Cameroon, as to them, the girl child should not be educated.

In The case of Mutengene Health Care they don’t just get pregnant but they are mostly teenagers who get pregnant and most of them face some complications during labour and delivery due to short cervix preterm which if they had gone for an echography it would have been diagnoses and appropriate manage given immediately.

Couple with the fact that they are not educated and don’t have any idea of what an echography is all about while others are aware and don’t have the means to go for an echography due to poverty and some peer pressure while others think it’s a waste of money and others say it is harmful to the foetus since x-ray is used.

This knowledge gap motivated me the writer of this opinion paper whose main aim is to document on the ultrasound awareness among Cameroon women, with hopes that its outcome would positively influence policies in Cameroon, regarding the health care of women.

1.4.    Research Goals

This research project and its findings are believed to benefits the health care providers to create awareness for women on the importance of echography in other to reduce the risk of pregnancy complications thereby reducing maternal and neonatal mortality rate.

1.5   Research questions

Main Question:

• Do women know the importance of echography in pregnancy

Specific Question:

• What factor hinder the women from doing echography when requested at the ANC
• Do women know what echography is
• Do you know the importance of echography
• What factors hinder them from knowing the importance of echograpy

1.6 Research hypothesis

• Pregnant women have adequate knowledge of the importance of echography in pregnancy.
• Pregnant women know the factors associated with the awareness of echography

1.7 Research objectives

1.7.1 General objective.

• To investigate if pregnant women know the importance of echography

1.7.2 Specific Objectives:

• To evaluate the knowledge of pregnant women on the importance of echography
• To investigate factors that hinder them from doing echography
• To investigate on the level of awareness

ATTITUDE AND PRACTICE OF NURSES CARRYING OUT ASEPTIC TECHNIQUES IN THE BUEA REGIONAL HOSPITAL