LONDON, UK – In Kenya, the Central Intelligence Agency (CIA) estimates that 26.1 babies die for every 1,000 live births. Globally, at least 66 mothers die every hour during childbirth, and 1.9 million babies are stillborn annually. Many of these deaths could be prevented with ultrasound screening. While an ultrasound facility may be just a 10-minute drive away in a developed country, pastoral women living in Kenya's arid regions may not find one within 100 kilometers.
Portable point-of-care ultrasound (PoCUS) technology, about the size of a beard trimmer, has the potential to transform access to healthcare. The handheld probe can connect to a tablet or mobile phone and produce images instantly with minimal training. Dr Gitemo, a lecturer in medical-surgical nursing and pre-clinical sciences at Kenyatta University, highlighted its importance in an interview with The Borgen Project: “There are no emergency services at ground level, so early decision-making at lower levels is crucial.Dr Gitemo added: “PoCUS speeds up on-site decision making. It takes ultrasound out of the hospital radiology department.. “
The Importance of Ultrasound During Pregnancy
Ultrasound screening identifies high-risk pregnancies, enabling doctors to plan and mitigate the associated risks. Yet, two-thirds of pregnant women worldwide do not have access to basic medical imaging facilities. In disadvantaged regions, maternal mortality remains a harsh reality. In 2020, low- and middle-income countries accounted for 95% of maternal deaths.
Midwives and experienced nurses serve as the cornerstone of maternal care, using manual techniques such as palpation and auscultation to monitor the fetal heartbeat and position in the uterus, but without ultrasound technology they cannot accurately assess key indicators of a healthy pregnancy, such as amniotic fluid volume, gestational age, umbilical blood flow and the presence or absence of an ectopic pregnancy.
The World Health Organization (WHO) recommends that ultrasound examinations be incorporated into routine antenatal care by the 24th week of pregnancy, but 70 years later, uptake remains limited, even though the technology was first used in medicine in 1956.
Portable technology changes the game
In low- and middle-income countries (LMICs), the high cost of traditional scanners and training has hindered widespread adoption of ultrasound technology. To address this challenge, Dr. Gitemo's team trained 500 nurses in the eight Kenyan counties with the highest maternal and neonatal mortality rates to use the portable scanner.
After a five-day training session on identifying high-risk signs of pregnancy, local health workers were able to spot abnormalities earlier and make more effective decisions. Six months after the training, one clinic reported zero fetal deaths.For a midwife, seeing exactly what they feel with their fingers through an ultrasound is enlightening and, as it is a more advanced technique, allows them to make an informed decision quickly.” says Dr. Gitemo.
“In an ideal world, the ultrasound would be performed by a frontline clinician and they would be able to act immediately on the results, without the need to refer someone else for an ultrasound,” says Dr. Alice Papageorgiou, professor of fetal medicine at the University of Oxford. At Intelligent Ultrasound, a British medical technology manufacturer, Dr. Papageorgiou's team has developed a PoCUS device that costs just 5% of the cost of larger professional ultrasound machines.
The software that powers the portable scanner, ScanNav FetalCheck, uses artificial intelligence (AI) to predict a baby's delivery date. Intelligent Ultrasound's AI is trained on millions of pregnancy images to accurately determine gestational age, a key indicator for prenatal care that assesses the natural development of a fetus inside the womb. Researchers are currently testing the device in Kenya, Ghana, South Africa, Uganda and Rwanda.
AI Pushes the Boundaries
“Globally, ultrasound is the most important imaging modality during pregnancy, but in practice, wider adoption has been limited by a shortage of operators capable of acquiring images and interpreting the necessary images,” said Dr. Papageorgiou. By integrating ultrasound with artificial intelligence, the device reduces training costs and addresses the shortage of first-level trained clinicians. On-screen prompts further simplify operation of PoCUS technology for frontline healthcare workers.
Dr. Papageorgiou asserts that AI systems trained on large, diverse datasets are robust across ethnicities and can avoid the biases often found in generative AI. “At the moment, all our results suggest that the robot appears to be colour blind, whether we're scanning women in Africa, India or Europe,” he says.
Dr. Gitemo acknowledges that technological advances are an undeniable path to growth, but stresses the need for human oversight. “AI can only be a game changer if it is put into the hands of qualified midwives and healthcare professionals. “We have to remember that we're not just dealing with a pregnancy, we're dealing with a human being,” she says. How do the pregnant women feel about it? “They're very happy about it,” says Dr Gitemo. “They now travel far and wide to see their babies swimming in their bellies,” she concludes.
Future outlook
Portable ultrasound technologies like PoCUS are revolutionizing maternal healthcare in Kenya and beyond, offering a glimpse into a future where distance doesn't limit access to critical prenatal care. Moreover, as training and integration of AI expands, more healthcare providers will be able to make timely, informed decisions that could save countless lives. The continued deployment of this technology promises not only to close gaps in access to healthcare, but also to improve the quality of care for pregnant women in remote and underserved areas.
– Soham Mitra
Soham is based in London, UK and focuses on technology and global health at The Borgen Project.
Photo: Unsplash
