Obstetric Ultrasound Capacity Assessment in the Context of an Outbreak of Zika Virus Infection: Tools and Operational Guidance

MCSP supports programming in maternal, newborn, and child health, immunization, family planning and reproductive health, nutrition, health systems strengthening, water/sanitation/hygiene, malaria, prevention of mother-to-child transmission of HIV, and pediatric HIV care and treatment. The program tackles these issues through approaches that also focus on household and community mobilization, gender integration, and digital health. In the context of an outbreak of Zika virus infection, the quality of ultrasound assessment is highly dependent on the skills of the sonographer or sonologist and the technical capacity of their equipment. The World Health Organization (WHO) and the Pan American Health Organization (PAHO) have recommended routine ultrasound for pregnant women living in areas of autochthonous transmission of Zika virus. However, challenges in identifying congenital Zika syndrome (CZS) before childbirth may impede healthcare providers' ability to provide appropriate care to pregnant women with Zika virus infection. The United States Agency for International Development (USAID) called on its implementing partners to perform a rapid, five-country capacity assessment of both ultrasound providers and ultrasound equipment. The goal of this assessment was to generate actionable information for country governments and other implementing partners to improve referral pathways for pregnant women with Zika virus infection. To facilitate the implementation of this capacity assessment, four tools were created: the Ultrasound Clinical Practice Interview, the Ultrasound Clinical Provider Interview, the Ultrasound Service Delivery Observation, and the Ultrasound Equipment and Environment of Care Assessment. These tools are designed to assess staffing, referral practices, and client volume, as well as components of examinations for clients with suspected or confirmed Zika virus infection. The tools also assess obstetric ultrasound examination based on clinical observation and the type and functionality of ultrasound equipment, image storage and sharing capacity, and environmental and infection control practices. Prior to an assessment visit, clear objectives, an analysis plan, and a results dissemination plan should be outlined and agreed upon by all involved parties. Formal ethics approval should be sought for all human subjects research, and a non-human subjects research determination may be obtained for quality improvement activities. In the absence of an ethics approval permitting such data collection, no names, other personal identifiers, or other information from clients/client records nor product bar codes from equipment should be collected for the assessment database. The confidentiality of all participating facility staff and their clients must be ensured, and all assessment participants should provide consent for participation before all assessment activities.