Portable AI Ultrasounds curbing maternal mortality in Sierra Leone

Treezer Michelle Atieno

Every woman has the right to receive excellent care before, during, and after pregnancy. The World Health Organization (WHO) recommends having at least one routine ultrasound before the 24th week of pregnancy to ensure a positive pregnancy experience.

Providing high-quality antenatal care (ANC) and safe delivery services also improves perinatal health outcome.

“One significant role of ultrasound is confirming the gestational age accurately, especially in situations where women might not recall their exact conception dates. This not only reduces unnecessary interventions but also minimizes adverse maternal outcomes, such as mortality, ” says Khadija Tolo, a Community Health Worker (CHW) at Yele Health Centre in Sierra Leone.

Maternal conditions directly impact perinatal outcomes, and up to 37% of patients are potentially misdiagnosed. The incorporation of ultrasound services in their care can correct this.

“Ultrasound services can also help identify conditions that might otherwise be missed, leading to adverse outcomes like placenta previa, adherent placenta, undiagnosed multiple pregnancies, and malpresentations. This recognition can result in life-saving interventions for up to half of pregnant women.” adds Khadija.

Currently, portable point-of-care ultrasound technology is now being utilized in various low-income countries worldwide, contributing to improved maternal care. Africa is not left out. Sierra Leone in West Africa has adopted Baby Checker, an AI ultrasound solution which can be accessed through smartphones.

“Baby Checker is an artificial intelligence software that detects different potential pregnancy risks by any community health worker, midwife or nurse in primary healthcare,” says Enya Seguin, the developer of Baby Checker. “We have pioneered Artificial Intelligence for fetal ultrasound screening. With the novel technology, pregnant women in underserved communities can have safer pregnancies through improved maternal health screening.” she adds.

According to Enya, Ultrasound imaging is considered a more challenging medical equipment, even by medical professionals. A lot of training is required. That’s because ultrasound imaging is a moving image that is created by the accurate and knowledge-driven placement of the ultrasound probe on the specified part of the body. Since such human capacity is scarce in low-resource settings like Sierra Leone, maternal and antenatal health is being deprived from the benefits that ultrasound imaging can offer when preventing maternal and antenatal complications.

“While clinicians can now travel everywhere with portable ultrasounds, there’s still the challenge of inadequate medical persons who are trained to operate the machines. That is where AI comes in. When you plug in the probe to your phone, you open the BabyChecker app and it reads the images for you.

“With AI, it analyzes and interprets potential complications. The target user, who is a midwife, nurse or a community health worker who has never held an ultrasound before, can simply do six sweeps across the abdomen and wait. After a few seconds, the AI reveals the gestational age, the fetal presentation and the placenta location.” explains Enya.

Since the adoption of this AI technology in Sierra Leone, over 100 CHWs have utilized it in the very remote areas in the country. Zainab Husla, a CHW in Mafay Manowo Maternal & Child Health Post is among the group of CHWs that are using BabyChecker. “BabyChecker helps us know how the child is doing in the mother’s womb. Whether doing fine or not. If the baby is fine, then it’s okay. If not, then we refer for further care,” she says while adding that she checks about 15 to 25 women in a day.

The HCWs also link referrals for continuous care. “We refer immediately and follow up with the patient and the referral hospital. They, in turn, contact us if the woman needs follow-up attention at the Peripheral Health Unit (PHU).” says Zainab.

“The introduction of BabyChecker in Mafay in Manowo Maternal & Child Health Post has truly transformed our prenatal care experience. When I first learned about it, I was a bit skeptical, but now I can’t express how grateful I am. The technology has allowed for more comprehensive and early screenings.

“During my last check-up, the AI detected a minor complication that could have escalated without intervention. CHW Zainab Husla was able to refer me for further medical attention in time.” Says Tenneh Jolloh adding that the medical team addressed the issue promptly, ensuring her well-being and that of her unborn child.

In Gbonkolenken Chiefdom, Khadija, a CHW at Yele Community Health Center receives about 22 pregnant women daily. “BabyChecker determines potential risky pregnancies and deliveries. It Identifies gestational age, fetal abnormalities, twins, placenta position, fetal lie, and a viable pregnancy.” she says. In regard to its usage, Khadija describes it as “an easy-to-use device with a very simple tutorial and clear instructions”.

“As a soon-to-be mother in a remote area like Gbonkolenken, accessing specialized medical services can be a challenge. However, with the introduction of BabyChecker, it feels like we have a skilled medical professional right here with us. The detailed imaging and analysis provided by the AI have now given me peace of mind. I can now confidently say that our pregnancies are in safer hands.” Says Mariatu Turray who attends ANC at Yele Community Health Center.

In an era of groundbreaking technological advancement, AI has emerged as a powerful tool with immense potential to transform global health equity, especially in low and middle-income countries.

According to Program for Appropriate Technology in Health (PATH), AI can support health workers with timely insights that inform better decisions and improve patient outcomes even in resource-constrained settings. At the health systems level, AI has the capacity to enhance interventions like disease surveillance, supply chain optimization, and diagnostics, thereby accelerating progress toward health for all.

While BabyChecker is a spectacular solution, its implementation in Sierra Leone has not been all rosy. “Access to enough funding has been a challenge. A lot of big companies now have received funding to develop AI, to work on ultrasound solutions. We need to collaborate because something as impactful as BabyChecker should be able to penetrate in all parts of Africa,” says Enya.

Fatou Musa, a CHW in Warema Health Centre says that most villages with the community health centers do not have internet or electricity. “It is good that BabyChecker does not need internet to process images. The ultrasound probe does not also require a separate charging port. Once you charge the smartphone, it is good to go.”

In 2017, Sierra Leone was among the top three countries in Africa with high maternal mortality. It recorded 1 maternal death in every 89 births in the country. In 2020, the maternal mortality rate dropped by nearly 60%.

Currently, Sierra Leone is one of the top countries in Africa with availability of antenatal care (ANC) services, family planning services, items (infusion pumps, blood warmers and rapid infusers) for offering safe blood transfusion and essential medicines like heat stable carbetocin, oxytocin, misoprostol, tranexamic acid, magnesium sulfate.

According to Integrated African Health Observatory (IAHO), Maternal Mortality remains a key issue affecting women of reproductive age across the African Region. Despite the global decline in the maternal mortality ratio (MMR) to 34.2% between 2000 and 2020, MMR is still a disaster in the Africa region. In West Africa, Cape Verde is the only country with low maternal mortality, estimated at 42 per 100000 live births. The rest of the countries are categorized either in high, very high or extremely high maternal mortality rates. Sierra Leone has moved from the very high category to the high category.

WHO records show that obstetric hemorrhage is the leading cause of maternal mortality in Africa. Other causes are hypertensive disorders during pregnancy, non-obstetric complications, pregnancy related infections and pregnancy with abortive outcomes.

Apart from an ultrasound screening, antenatal care (ANC) is also considered as a very crucial step in overcoming maternal mortality. According to Global Health Observatory, ANC coverage is an indicator of access and use of health care during pregnancy. The antenatal period presents opportunities for reaching pregnant women with interventions that may be vital to their health and wellbeing and that of their infants. Receiving antenatal care at least four times increases the likelihood of receiving effective maternal health interventions during the antenatal period. 

“Foetal scans here in Warema are now popular and this has resulted in more pregnant women attending antenatal care (ANC) and giving birth in health facilities. This increase in ANC attendance has made it easier for us to provide other health interventions like TT (Tetanus Toxoid), malaria checks and more,” Fatou noted.

In 2020, IAHO recorded that most women in West African countries attended four ANC visits that year. The average attendance was 60%. Sierra Leone ranked fifth in four ANC visits by pregnant women with 78.80%

“Through antenatal care visits, pregnant women can also access micronutrient supplementation, treatment for hypertension to prevent eclampsia, as well as immunization against tetanus. Antenatal care can also provide HIV testing and medications to prevent mother-to-child transmission of HIV. In areas where malaria is endemic, health personnel can provide pregnant women with medications and insecticide-treated mosquito nets to help prevent this debilitating and sometimes deadly disease,” a 2022 United Nations Children’s Fund (UNICEF) report stated.

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