Routine antenatal ultrasound by nurse-midwives in rural Kenya: A pragmatic trial assessing feasibility and effects and of the Mimba Yangu (My Pregnancy) project

Claudia Hanson^1,2*Lucy Nyaga²Nidhi Leekha³Michaela Mantel⁴Sarah Kedenge^5,6Caroline Gitonga⁷Violet Naanyu⁸Jasmit Shah⁹Marleen Temmerman^10,2

• ¹Department of Global Public Health, Karolinska Institutet (KI), Stockholm, Stockholm, Sweden
• ²Centre of Excellence for Women and Child Health, Aga Khan University, Nairobi, Kenya
• ³Department of imaging & diagnostic Radiology, Aga Khan University, Nairobi,, Kenya
• ⁴The Health Associates GmbH, Berlin, Germany
• ⁵Philips East Africa Limited, Nairobi,, Kenya
• ⁶Philips Foundation, Nairobi, Kenya
• ⁷Philips Foundation, Nairobi,, Kenya
• ⁸School of Arts and Social Science, Moi University, Eldoret, Kenya
• ⁹Aga Khan University (Kenya), Nairobi, Kenya
• ¹⁰Dept of Obstetrics and Gynecology, Ghent University, Ghent, Belgium

Task-sharing of obstetric ultrasound between nurse-midwives and doctors has the potential to operationalise the World Health Organizations recommendation of one ultrasound below 24 weeks of gestational age for every pregnant woman. Here we report on the feasibility, acceptability and the effects of the Mimba Yangu (My Pregnancy) task-sharing approach in rural Kenya.We conducted a pragmatic trial including 28 primary care facilities between April 2021 and March 2022, assigned based on feasibility criteria. Fourteen facilities received the ultrasound intervention composed of i) task-sharing with nurse-midwives ii) using portable ultrasound devices (Lumify TM ) connected to a tablet and iii) a digital platform facilitating distant support. Hybrid training of 32 nurse-midwives was provided based on a nationally derived curriculum including theoretical and hands-on components by an academic team.We used i) in-depth interviews with nurse-midwives and health care managers, ii) exit interviews using a quantitative questionnaire with pregnant and recently delivered women, and iii) data abstraction from the health facility records. We descriptively analyzed data and used a difference-indifference analysis based on a generalized linear model to assess the effect of the intervention on the number of antenatal visits.The intervention was successfully and consistently implemented during a nine-month period in all 14 health facilities providing ultrasound to 2,799 pregnant women. Interviews with trained nursemidwives indicated that the intervention was relevant, feasible and acceptable. In intervention facilities, 50.4% of women received at least one ultrasound compared to 19.2% in the comparison facilities, where women were referred to other facilities for their ultrasound based on obstetrical risk factors.Our analysis provides evidence of the feasibility, acceptance and positive effects on service availability of providing ultrasound at primary care level delivered by nurse-midwives. Scalability and feasibility of such an intervention are critical to global health but will demand policy reforms to allow task-sharing at national and sub-national levels.