Sandrine Cyuzuzo Iribagiza2025-02-052025-02-052025-02-05https://dspace.ughe.org/handle/123456789/101Background: Globally, every two minutes, a woman dies during pregnancy or childbirth, with 70% of these deaths occurring in low-middle-income countries (LMICs), particularly in sub-Saharan Africa. While Rwanda has made significant progress in reducing maternal mortality rates, challenges such as inadequate healthcare infrastructure and limited access to services in rural areas persist. Obstetric ultrasound, a vital tool for monitoring pregnancies, remains largely inaccessible at the community level, with only 47% of women in Rwanda receiving a recommended ultrasound before 24 weeks of gestation. To address this gap, Partners in Health (PIH), initiated the decentralization of obstetric ultrasound services to health centers in 2022. In low middle income countries (LMCIs) specifically in sub-Saharan Africa, maternal mortality is 70% of all the death that occurs globally Research Aim: This study aimed to assess the impact of the decentralization of obstetric ultrasound services in Kirehe District, Rwanda. It explored the demographic profile of clients utilizing ultrasound services, changes in maternal complications among high-risk pregnancies pre- and post-decentralization, and healthcare providers' experiences with the new service provision. Methods: The study used in-depth interviews (IDIs) with healthcare providers and a retrospective cross-sectional study with electronic medical records (EMR) and maternal logbooks. The qualitative part involved interviews with five healthcare providers from five randomly selected health centers. The quantitative part utilized retrospective data from one year before and one year after the decentralization of ultrasound services, analyzing 3,563 pregnant women’s records from Kirehe District Hospital and 600 records from five health centers post-decentralization. Results: Qualitative findings revealed three key themes: improved diagnostic capabilities and access to care, financial challenges for patients, and staffing and training issues. Healthcare providers reported enhanced ability to detect pregnancy-related complications and reduced referrals to district hospitals. However, the cost of ultrasound services (2,000 Rwandan Francs) posed a financial barrier, as it is not covered by community-based health insurance. Additionally, the limited number of trained staff and the need for ongoing training and mentorship were highlighted. Quantitative results showed that the median age of participants was 31.95 years, with most pregnancies classified as low risk (60.65%). The proportion of high-risk pregnancies did not significantly change post- decentralization (χ² = 1.193, p = 0.274). In health centers, most ultrasound users were in the 20-34 age group, with only 7% classified as high-risk pregnancies. The primary reasons for ultrasound visits were routine checks (86.5%) and suspected complications (10.3%). Conclusion: Decentralization of obstetric ultrasound services in Kirehe District improved access and diagnostic capabilities but did not significantly alter the prevalence of high- risk pregnancies. Financial barriers and staffing challenges persist, underscoring the need for policy adjustments to include ultrasound services in community health insurance and for continuous professional development of healthcare providers. Future studies should directly capture patient experiences and evaluate quantitative health system efficiency metrics to further understand the impact of decentralizing ultrasound services on maternal health outcomes.enRwandaEast AfricaAfricaMaternal healthCare giverObstetricHealth facilitiesObstetric ultrasound servicestext::thesis