CITATION: Fetal imaging and diagnosis services in developing countries – A call to action
J.A. Akinmoladun, D.O.C. Anumba
Tropical Journal of Obstetrics and Gynaecology Vol 36, No 1 (2019)
Fetal congenital anomalies are among the leading causes of perinatal death or survival with disability worldwide. Their accurate antenatal detection employing a range of fetal imaging techniques enables parental choices to be made and for postnatal care of affected babies to be planned. While such prenatal care is well developed in developed countries of the world, it remains poor in many low‑ and middle‑income countries (LMICs). This review article examines the scope of the problem and proffers strategies for service organization and fetal imaging that will improve care in LMIC settings.
Low level of health education and lack of adequate antenatal care. In most of sub-Saharan Africa, only 30% of pregnant women in the urban areas have access to an obstetric US service, whereas in rural areas, this figure is estimated to be much less at about 6%, similar to most other developing countries. This is because most women, especially those in the rural areas, are ignorant of the availability of prenatal screening for anomalies, some of the reasons being that they have limited access to adequate antenatal care and appropriate health education.
In the developing countries, some studies suggest that some women, especially in the rural areas, do not attend antenatal facilities because of deeply held cultural beliefs and/or tribal traditions surrounding the nature of pregnancy and childbirth. Some believe that pregnancy disclosure could lead to unwanted religious or spiritual complications. Some viewed pregnancy as a normal life event rather than a medical condition, therefore saw no reasons for antenatal care.
Some regulatory bodies do not support the routine use of US in a low-risk population. In Nigeria, as an example of a country in sub‑Sahara Africa, there are no national guidelines for prenatal screening, the request often being made on the initiative of the clinical care provider.
The knowledge of the child’s gender before birth has led to the abortion of many unborn daughters in some parts of the world, most notably in Asia, with significant imbalance in gender ratios. This has informed the reticence of many healthcare planners to promote fetal anomaly screening because of the risk that surreptitious gender determination can lead to gender selection.
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