Evaluation of large-scale implementation of obstetric point of care ultrasound in eight counties in Kenya using RE-AIM framework

Résumé

BACKGROUND: Obstetric Point-of-Care Ultrasound (O-POCUS) holds promise for strengthening maternal health services particularly in low- and middle-income countries (LMICs). However, its widespread use is hindered by limited provider training and resource constraints within health facilities. To address this gap, a large-scale O-POCUS program was implemented across eight counties of Kenya whereby 468 healthcare providers (HCPs) from 224 facilities were trained in five basic O-POCUS parameters. This study evaluated the reach, effectiveness, adoption, implementation, and maintenance of this program using the RE-AIM framework. METHODS: For this cross-sectional evaluation study, trained research staff conducted surveys and in-depth interviews with HCPs, stakeholders, and antenatal and postnatal care clients for one week from a random sample of about half of these facilities (n = 114) six months after O-POCUS introduction. A total of 249 HCPs, 2,292 antenatal and 1,704 postnatal clients were surveyed, and 96 HCPs/stakeholders and 114 clients were interviewed. Data were analyzed using descriptive and thematic methods and mapped onto the RE-AIM framework to assess program implementation. RESULTS: The findings revealed that O-POCUS was implemented across all 114 health facilities and 1937 (49%) of surveyed clients received a scan (reach). Over 80% of trained HCPs reported moderate to high confidence in performing key obstetric assessments, and 72% reported that O-POCUS influenced clinical decision-making including referrals (effectiveness). 41% of HCPs conducted more than 20 scans per month and 89% of the clients reported that they were likely to recommend O-POCUS to others (adoption). Lack of resources such as gel and paper towels were identified as major challenges (implementation), while 60% of HCPs reported the need for further training and mentorship (maintenance). CONCLUSION: These findings demonstrate successful large-scale implementation of O-POCUS in Kenya and provide valuable insights for policymakers and healthcare organizations seeking to implement similar O-POCUS programs in resource-limited settings. Continuous strengthening through mentorship, supportive supervision and resource provision is recommended for sustained success of O-POCUS in improving maternal healthcare.

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