Ultrasound in regard to other existing obstetric imaging modalities like magnetic resonance imaging is non-invasive, cheaper and safe. It gives pregnant mothers the real-time images of their unborn babies1. Obstetric ultrasound is firmly embedded in ANC around the world. Clinical evidence suggests that it improves the effectiveness of the clinical management2.
Obstetric ultrasonography is important in determining the presence and location of the pregnancy, presence and viability of the embryo, estimating the age of pregnancy and the date of delivery, evaluation of the fetal presentation, placenta localization; amniotic fluid assessment, and assessing fetal anatomy3.
Socio-economic status and education have been shown to have an impact on the women’s perception towards obstetric ultrasound4.
Uganda has a low literacy rate with the central region especially Kampala district having the highest literacy rate while Karamoja and west Nile sub regions have the lowest literacy rate5. Uganda also has a 25% prevalence of teenage pregnancy with rural areas having a higher rate than urban areas6,7. The median age for the first pregnancy is 18 (± 2) years8.
Literature on pregnant women’s knowledge, attitude and practices towards obstetric ultrasound remains scarce in the major tertiary hospitals of Uganda like Mulago hospital.
Mulago hospital is a national referral hospital located in Kampala metropolitan, the most populated area in the central region of Uganda. The central region has diverse tribes dominated by baganda followed by banyankole, basoga and then bagisu 9, Other tribes including acholi, alur, bakiga, bafumbira, bakonzo, teso, lugbara, banyarwanda, madi and lango are the least frequent5,10. It also has diverse religious dominations. These, in their order from the most to the least dominant, include Catholics, Anglicans, Muslims, Pentecostals, Seventh Day Adventist, Jehovah’s Witness and Orthodox5.
Knowledge, attitude and practices of pregnant women towards obstetric ultrasound have been explored globally.
Several studies have revealed a good knowledge of pregnant women regarding the use of ultrasound during pregnancy11–14 which has been attributed to the wide use of ultrasound in health care as part of routine ANC and the unlimited access to information14. Some of these studies had a response rate of 100% and majority of their participants were within 21–30 years age group while few participants were aged 41 years and above2,11. These studies showed that pregnant women were aware of certain uses of ultrasound. These included assessing gestational age, estimating date of delivery and seeing abnormalities of the baby, monitoring growth of the baby, sex determination, detecting fetal anomalies, and confirming pregnancy or presence of multiple pregnancies11,13,15.
Main sources of information to the pregnant women regarding obstetric ultrasound revealed by various studies included health workers2,11,16, family, friends and mass media17. The information obtained from doctors avoids unnecessary misconceptions and information from friends usually lacks a scientific basis while those from media are generalized11.
Pregnant women experience antenatal ultrasound as a very safe procedure2,13,18. However, some women report doubts regarding safety of ultrasound2. They have considered that too many ultrasound scans may be harmful to the baby, could cause cancer and significant impairment to the mothers or their babies12,14,17. Many authors have recommended that there is need for health education regarding the safety of ultrasound to the public2,14. One study found out that most pregnant women did not know about diagnostic ultrasound safety during the prenatal period19.
Pregnant women have expressed a positive attitude and considered ultrasound as an essential component of ANC11,14,17,19−22. This has been attributed to friendly response of the health workers11. Many women want sonography and accept it uncritically when their doctors request for it. Others seek obstetric ultrasonography without referral by a clinician because of reliable results and high perceived indication of its necessity during their antenatal period as it could assist them in planning for their pregnancies14, 19.
Women’s practices towards obstetric ultrasound are influenced by the level of satisfaction they get. Long waiting time before the scans has been reported as a major reason of dissatisfaction with obstetric ultrasound by pregnant women23.
Some studies have revealed good practices of women towards obstetric ultrasound where most pregnant women had done the ultrasound scan for their previous and current pregnancies, most of whom had done it more than two times2,11,13. This was attributed to the wide availability of ultrasound facilities11. Women also accept doing a scan as requested by the health workers due to the perceived benefits they expect to get from the scan such as knowing baby’s sex, expected date of delivery and fetal well-being14.
Obstetric ultrasonography in ANC remains globally recognized as one of the ways through which maternal mortality can be reduced14.
The 2015 Uganda Demographic and Health Survey revealed that the major cause of death among pregnant women in Uganda is obstructed labor. Most causes of obstructed labor including fibroids, placenta preavia, among others can be detected by obstetric ultrasound scan before they can cause fatality.
According to World Health Orgnisation 24, it is recommended that the obstetric ultrasound scan should be done per antenatal visit. However, a study done at Mulago hospital revealed that the majority of pregnant women reported late for ANC because they were not well informed about the right time at which they should make their first antenatal visit and/or of the importance of early attendance at ANC25. However, knowledge, attitude, and practices of pregnant women towards obstetric ultrasound at Mulago hospital have not been previously explored. Therefore, this study was conducted to answer these questions: what knowledge did pregnant women at Mulago hospital have regarding obstetric sonography? What were their attitudes and practices towards obstetric sonography?
Therefore, the purpose of this study was to assess the knowledge, attitudes, and practices of pregnant women towards obstetric ultrasound at Mulago hospital. The information generated from the study could perhaps be used to improve the utilization of obstetric sonography by pregnant women, improving ANC in Mulago hospital and other health centers in Uganda as well as encouraging other related researches in the same field worldwide.
Several studies conducted worldwide have revealed that understanding pregnant women’s knowledge, perception, and attitudes towards obstetric ultrasonography is very important in improving ANC2,3,12−14 hence research in the same field especially where ultrasound has been newly introduced is warranted.