KAMPALA, Uganda (WOMENSENEWS)–A low-cost maternal ultrasound system that began as a class project by a group of college students at the University of Washington in Seattle is to be tested by midwives in Uganda, a country with one of the world’s highest maternal mortality rates.
Around 10 Ugandan midwives will be selected to participate in the field test project. The experiment will evaluate whether the device matches the midwives’ needs and skills.
The device is designed to enable midwives to detect conditions that can complicate pregnancies and birth, such as multiple births, breech births–when the fetus’ head is pointing upward–and blockage of the birth canal by the placenta. Midwives spotting these high-risk conditions in time could refer women to hospitals with facilities to handle them.
"We aim to make an easy-to-learn and easy-to-use device, and the opinions of midwives are crucial to our design process," said Alexis Hope, a graduate student in the university’s department of human centered design and engineering. "We hope to use the results of the field test to improve on our design and then return to Uganda with a better device to test again."
The student-designed device connects an ultrasound probe to a laptop computer with a touch-sensitive screen. Students have reduced the number of controls required to allow for easier operation than the type of display set up found in doctors’ offices and hospitals.
The notebook has big, touchable buttons, which make it easy to adjust the controls for a clearer image. It also has a built-in system that provides assistance to the midwives and suggests ways to make the scan image better.
To reduce the cost of the device, the students wrote their own software. The device costs about $3,500. Ultrasound machines usually cost $15,000 to $60,000, a prohibitive amount for many African health care providers.
It could also reduce the need for costly remote interpretation and diagnosis.
High Death Rate
The pregnancy-related death rates among Ugandan women stand at 430 per 100,000 live births, according to the World Health Organization. In Sweden, by contrast, the maternal mortality rate is only five deaths per 100,000 live births.
The students’ project began in the summer of 2009, when Dr. Rob Nathan, a University of Washington assistant professor of radiology, approached Beth Kolko, also a fellow professor of human centered design and engineering.
Nathan had a pilot project in Uganda that was attempting to show that ultrasound technology could reduce maternal mortality by allowing midwives to refer women with high-risk pregnancies to hospitals for delivery and treatment. But what if midwives could have good diagnostic equipment to help them make that assessment?
Last winter, one of Kolko’s classes–Concepts in Human-Computer Interaction–teamed up with computer science lecturer Ruth Anderson, teacher of a course called Designing Technologies for Resource-Constrained Environments. That’s how five students set out to design a low-cost maternal ultrasound for use in the developing world.
"We got thrown into it after hearing a brief presentation by Dr. Nathan about what he was looking for," said Hope, one of the graduate students. "We sort of jumped at the challenge."
The project evolved into a senior-level research project in computer science and engineering. More graduate students in the human centered design and engineering department joined the group, many using the project to earn research credits.
The ultrasound unit was tested in November by Seattle-area midwives, including ones with little or no ultrasound experience. They were able to complete tasks similar to the Ugandan midwives’ expected tasks.
Grant Aids Research
In November, the students won a $100,000 Bill and Melinda Gates Foundation Grand Challenges Explorations grant, which are designed to help scientists around the world explore ways to improve health in developing countries. The grant will help the team research how to make a cheaper, simpler ultrasound device.
"The Gates grant came through after we had done some initial testing with Seattle-area midwives. It is allowing us to take the critical next step of taking it to the field," Hope said.
Receiving the Gates Foundation grant "was very relieving," said team member Wayne Gerard. "We were not sure where we were going to get funding to travel to Uganda. We’re also honored to have such a great foundation backing us. But mostly it is great to know that we have some funds to test our device."
The ultrasound device can’t be expected to work miracles on Uganda’s maternal mortality problem though.
Janet Obuni, chairperson of the Uganda Nurses and Midwives Union, based in Entebbe City in Uganda, says even when midwives identify rural women as having high-risk pregnancies, often all they can do is refer them to regional hospitals, which may be many miles away and difficult for the women to reach.
Given the relatively sparse health facilities in Uganda, the average distance to a government health unit is 4.6 kilometers, or almost three miles, which often must be covered by foot, according to the 2010 Uganda National Household Survey.
In the rural district of Kyenjojo, midwife Rose Baguma says when high-risk pregnancies are detected by physical examination, most mothers cannot afford the $3 taxi fare to Buhinga Regional Referral Hospital, more than 36 miles away.
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Raymond Baguma is a full-time journalist with The New Vision newspaper in Uganda. He also has a blog at: http://www.rbaguma.blogspot.com.
For more information:
Mobile Midwives’ Ultrasound:
Grand Challenges in Global Health, Bill and Melinda Gates Foundation:
While anything that will improve the health of mothers is welcome the resources that go into the development of this ultrasound device would be better used elsewhere. Breech babies and twins are easily diagnosed by careful feeling or palpation of the pregnant woman’s abdomen. Midwives know how to do this (although U.S.-trained doctors tend to rely more on ultrasound than on hands-on examination). Placenta previa usually has symptoms of bleeding before a woman goes into labor that alert the midwife to a high risk pregnancy. As the Ugandan midwife quoted in the article points out, the cost of transportation to the hospital (let alone the cost of a cesarean section) are unaffordable.
That is the real problem that no ultrasound machine can fix.