Implementation of the INTERGROWTH-21^st gestational dating and fetal and newborn growth standards in Nairobi, Kenya: women’s experiences with ultrasound and newborn assessment

Figures & data

Table 1. Qualitative data collection methods.

	Timeframe & Data Collection Mode
	Pre-Implementation Phase		Implementation Phase 4-Months		Implementation Phase 12-Months
Patient Classification	In-depth Interview	Focus Group Discussion	In-depth Interview	Focus Group Discussion	In-depth Interview	Focus Group Discussion
Low-risk	-	2 (7,4)a	3	1 (8)a	2	1 (4)a
High-risk	3	1 (3)a	4	-	7	-
Gestational Dating Opt-Outs	-	-	2	-	3	-
TOTAL	3	14	9	8	12	4
	17		17		16

^aNumbers in parentheses indicate the number of participants in the FGD

Table 2. Demographics of participants.

Indicator of Interest	Pre-implementation	Implementation
	Baseline N = 17	4-months N = 17	12-months N = 16
Maternal age (years) N Mean (SD) Range n (%) 20–29 30–34 35–39 40+ No data	17 25.9 (4.2) 22–35 14 (82%) 2 (12%) 1 (6%) 0 (0%) 0 (0%)	17 26.4 (3.8) 20–34 14 (82%) 3 (18%) 0 (0%) 0 (0%) 0 (0%)	16 28.3 (4.9) 21–38 9 (56%) 4 (25%) 2 (13%) 0 (0%) 1 (6%)
Education n (%) Primary Secondary College University or higher No data	0 (0%) 3 (18%) 7 (41%) 6 (35%) 1 (6%)	0 (0%) 5 (29%) 6 (35%) 5 (29%) 1 (6%)	0 (0%) 2 (13%) 9 (56%) 4 (25%) 1 (6%)
Marital Status n (%) Married/partnered Single No data	14 (82%) 2 (12%) 1 (6%)	15 (88%) 2 (12%) 0 (0%)	16 (100%) 0 (0%) 0 (0%)
High risk status n (%) Yes No data	6 (35%) 0 (0)	4 (24%) 0 (0)	7 (44%) 0 (0)
Parity n (%) 0 1 2–4 5+ No data	0 (0%) 14 (82%) 2 (12%) 0 (0%) 1 (6%)	6 (35%) 5 (29%) 6 (35%) 0 (0%) 0 (0%)	0 (0%) 12 (75%) 3 (19%) 0 (0%) 1 (6%)
Any ANC attendance at JH n (%) Yes No	17 (100) 0 (0)	17 (100) 0 (0)	12 (75) 4 (25)

Table 3. Summary of facilitators and barriers to patients’ uptake and satisfaction with ultrasound.

Facilitators

Barriers

Positive provider attitude and interactions Respect for authority of and advice from provider Assessment of well-being of fetus Knowledge of sex of fetus (when applicable) Well-informed estimate of date of delivery No cost for gestational dating scan Perceived accuracy of newborn size measurements High quality newborn equipment (scales, disposable head circumference tapes)

Wait times for gestational dating ultrasound Lack of awareness about gestational dating ultrasound Late ANC initiation Need for approval from husband/partner/family for ultrasound Poor communication with providers – lack of understanding regarding information provided by ultrasound, why recommended Knowledge that patient would not receive a printed picture of gestational dating scan Financial obstacles to multiple obstetric ultrasounds