A Longitudinal Point-Of-Care Ultrasound Training Program For Pre-Natal Care Providers In Zanzibar

Hall EA, Matilsky D,  Zang R, Ali Habibu A, Henwood PC, Wong A, DeanAJ.


Maternal and newborn health are of critical importance due to the high morbidity and mortality borne by these groups worldwide.

In Zanzibar, Tanzania, a pregnant woman has an approximately 1/200 chance of dying from pregnancy and the child has a 6% chance of dying in infancy.

Ultrasound is a safe, non-invasive tool that has wide ranging uses in the evaluation and management of pregnancy.

The objective of this study was to analyze the feasibility and effectiveness of a point-of-care ultrasound training program for clinicians providing antepartum obstetrical care for patients in a remote area of Zanzibar.


The training program was collaboratively developed by the Ministry of Heath of Zanzibar (MOH) and the PURE organization (Point-of-care Ultrasound in Resource-limited Environments).

The study group, selected by the MOH, consisted of 13 practitioners (2 doctors, 3 clinical officers, 8 midwives). Trainees received an initial 10-day point-of-care obstetrical ultrasound course consisting of lectures and hands-on practice.

The trainees then received 6 months of direct supervision of hands-on scanning, image review and bedside education at their practice sites by an experienced emergency physician and obstetric sonologists.

Trainees were given written and practical exams, and were expected to complete at least 75 proctored ultrasounds.


85% of the participants had no prior ultrasound experience.

During the 6-month course, trainees completed 1,338 ultrasound exams (average 99 exams per trainee with a range of 42-128 and median of 109).

Written exam scores improved from a mean of 33.7% (95% CI 28.6-38.8%) at pre-course assessment to 77.5% (95% CI 71-84%) at course completion (P<0.0001).

Practical exam mean scores improved from 70.6% at course midpoint (95% CI 61.4-79.8%) to a 82.9% at final course evaluation (95% CI 76.8-89%) (P < 0.0005).

Five of the 13 trainees completed all training requirements including 75 proctored ultrasound exams.


Trainees improved significantly on all measures after this ultrasound training program.

Approximately 40% of the participants completed all requirements. Reasons for this relatively low completion rate are unclear, but reflect the challenges of introducing new clinical practices in this type of setting.

Further study is needed to determine trainees’ long-term retention of ultrasound skills, whether successful trainees become trainers for other providers, the clinical uses of ultrasound in this setting, and the impact of the program on clinical practice and health outcomes.

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