Attitude towards Prenatal Ultrasound
Generally, majority (71.5%) of the participants had a positive attitude towards prenatal ultrasound scan. This could be due to the care provided by health workers, the affordable cost of ultrasound scans, and the fact that the majority of participants obtained information about ultrasound scans from health workers. Furthermore, some participants' desire to know the sex of the baby, and the baby's well-being may have influenced their attitude toward obstetric sonography. This finding is consistent with a study conducted in Nigeria, in which 73.1% of antenatal women believed that ultrasounds should be performed on all pregnant women [23]. This study is higher than the study conducted Gedeo region, Ethiopia where 69.5% had positive attitude toward obstetric ultrasound [24] and also higher than study conducted in Iran where the majority of pregnant women had a negative attitude [10].
In this study, 78.7% of women believed that obstetric ultrasound is safe for pregnant women. This finding is in line with the study conducted in Jeddah, where 78.9% believed in the safety of obstetric ultrasonography during pregnancy[10]. Similar studies from Tanzania and India supported the current finding [3, 25]. In this study, majority (87.3%) of women believed that obstetric ultrasound is an essential investigation during pregnancy. This finding is in line with study conducted in Kano, Nigeria, where 93.8% of participants understood the necessity of obstetric ultrasound for pregnant women [26]. This study is higher than finding in Gedeo, where 71.8% of participants understood the necessity of obstetric ultrasound [24].
According to the findings of this study, 17.3% of pregnant women feel that obstetric ultrasonography can result in congenital abnormalities, which is in line with the study done in Gedeo, Ethiopia[24]. This is greater than the result in Jeddah, which only 5.5% of mothers believe that obstetric ultrasonography causes fetal abnormalities [2].The difference could be attributed to the respondents' sociocultural background and educational level. Lower than in Iran and Uganda, where 53.3% and 78% of pregnant women, respectively, believed that ultrasound scanning was harmful to the fetus [4, 27]. This could be because of the time of research and the sociodemographic backgrounds of the study participants. In this study, the negative attitude that was reported by few participants were possibly related to what was wrongly perceived as harmful effects of ultrasound such as causing cancer, discomfort, and hurting the baby. This is in line with findings of previous studies [3, 4] but contradicts with the findings of another related study [26].
Concerning the sex determination of the unborn child, 87.6% of women responded that they would prefer to know the sex of their fetus, which is in line with a study conducted in Gedeo Ethiopia, where 83.5% of pregnant women, respectively desired to know the sex of their fetus [24]. This result is higher than that of a survey conducted in Puducherry, India, where 79.6% of expectant women prefer to know their child sex [28]. This variation might be due to the time, setting of the study, and sociocultural background of the participants.
In this study, 77% of pregnant women felt comfortable during ultrasound examination, which was lower than the result of study conducted in Gedeo, Ethiopia where 83% felt comfortable during ultrasound scanning. This may be associated with the issue of privacy during the procedure as it is one of the elements of respectful maternity care. It is greater than the Ugandan study, in which just 48% of pregnant women felt at ease during an obstetric ultrasound examination. The variance could be attributed to the previous repeated ultrasonic exposure status and the normalization of the discomfort as part of the scan [4].
The negative attitude that was reported by few participants were possibly related to what was wrongly perceived as harmful effects of ultrasound such as causing cancer, discomfort, and hurting the baby.
Practices towards Obstetric Ultrasound
The participants’ practices towards obstetric ultrasound scan were generally good, as opposed to the finding reported by Maniragena and his colleagues [4]. In this study, most (53.1%) participants had done once, 35.5% had done twice and 11.4% had done three and more times of ultrasound scan for the current pregnancy. 39.4% had no ultrasound scan done for the current pregnancy before which most likely due to the perceived poor services characterized by long waiting time, being attended by student and lack of privacy which discourages women from attending obstetric ultrasound routinely. This is in line with the finding of a similar study[4] in which long waiting time before the scans was a major reason of dissatisfaction with obstetric ultrasound by pregnant women.
More than 30% of the participants had not done any ultrasound scan for the previous. This is in line with the finding of similar study [4, 29]. Despite the fact that numerous ultrasound facilities are available in the country, the large proportion of participants who had not had any ultrasound scans for previous pregnancies may be related to inadequacies in other health centers in the city regarding the usage of ultrasound scans since most had been referred to hospital from other health centers for further management.
Factors associated with Attitude toward Prenatal ultrasound
In this study, women with experience of pregnancy are more likely to have a positive attitude than women with no previous experience of pregnancy. This might be because they already understand the facts about the examination either from the healthcare providers or from the result of ultrasound examinations and this might help them to believe the positive impact of obstetric ultrasound and experience of previous pregnancy plays a significant role to increase the knowledge, and health care providers also participate in improving attitude among multiparous women through their routine follow up during pregnancy. This is in line with the finding of study conducted in Jeddah by H. Abduljabbar et al [2]and in Turkey by G. Ultrason et al [30].
This study showed that history of congenital anomaly had a statistically significant association with attitude of prenatal ultrasound. Those respondents with a history of congenital anomaly birth were 4.82 times more likely had positive attitude of prenatal ultrasound than their counterparts. This might be because of the perceived fear of pregnancy with congenital anomaly and they are interested to check the status of pregnancy.
Current study found out that pregnant women who were government employed had more than two times positive attitude of prenatal ultrasound than housewife. This is in line with the finding of study conducted in Jeddah by H. Abduljabbar et al [2]. This could be because of government employed women have more chances to receive information and share experience with others.
In this study, pregnant women with previous ultrasound exposure for reasons other than pregnancy are more likely to have a positive attitude than women with no previous experience of ultrasound scan. This might be because they already understand the facts about the procedures either from the healthcare providers or from the result of ultrasound examinations and this might help them to believe the positive impact of obstetric ultrasound. This is in line with study conducted in Gedeo by W. Molla et al [24].
Factors associated with practice toward prenatal ultrasound
The finding of this study showed that there was a strong association between participants’ knowledge of prenatal ultrasound and the practice of prenatal ultrasound. Mothers who had good knowledge were two times more likely to practice prenatal ultrasound than their counterparts. This finding is in line with the results of different studies conducted in developing nations, at a peri-urban health centers in Uganda [18] and Nigeria[31] and also study conducted in Jima, Ethiopia [8]. This may be due to the fact that those women with a good knowledge of prenatal ultrasound knew its purposes and they are eager and readily go for it. This suggests that as pregnant women's understanding of obstetric ultrasonography increases, more women will use it, resulting in earlier detection and care of obstetric issues and, in the long run, a reduction in prenatal mortality. This could be explained by the fact that as knowledge about ultrasound increases, so does belief in the power of obstetric ultrasonography to predict pregnancy outcomes and help deflect undesirable outcomes.
Poor knowledge of prenatal ultrasound and a negative attitude toward the scan influence their decision to undergo an obstetric ultrasound examination, which may result in prenatal screening and diagnosis rejection. This, in turn, may result in a low practice of obstetric ultrasonography(24). Since its introduction into clinical care, obstetric ultrasound has come to play a prominent role in obstetrics, and there is no doubt that the benefits of obstetric ultrasound technology have led to improvements in pregnancy outcomes [24, 32].
As a result, ensuring that all prenatal women have obstetric ultrasound scans, as recommended by WHO, can help to avoid and treat obstetric problems and have a better pregnancy outcome. Obstetric care providers should provide proper obstetric care, which includes regular obstetric ultrasound scans, as well as raise awareness about the positive effect of ultrasound scans on pregnancy outcomes for all antenatal women, with a focus on pregnant mothers who do not have ultrasound scans to address their lack of knowledge and attitude toward ultrasound scans.
Women’s exposure of ultrasound for reason other than pregnancy was another explanatory variable that was significantly associated with the practice of prenatal ultrasound. In this study, pregnant women with experience of exposure of ultrasound scan for reason other than pregnancy are more likely utilize prenatal ultrasound than women with no previous experience of ultrasound scan AOR = 1.893(95%CI: 1.211–2.960). It was consistent with the study done in Gedeo [24]. This might be because they already understand the facts about the procedures, its importance in the diagnosis and hear about side effect issues either from the healthcare providers or from the result of ultrasound examinations and this might help them to believe the positive impact of obstetric ultrasound.
The finding of this study showed that pregnant women with history of congenital anomaly birth were 2.44 times more likely to practice prenatal ultrasound than those with no bad obstetric history. This might be because of the perceived fear of pregnancy with congenital anomaly, interested to check the status of pregnancy and they were familiar with importance of ultrasound in identifying congenital anomalies of the fetus during the pregnancy period.
Finding of present study showed that government employed women were more than two times practice prenatal ultrasound than those who were housewife. It was consistent with the study done in King Abdulaziz University Hospital, Jeddah by Hassan S. Abduljabbar et al [2] This could be because employed women have more opportunities to obtain information and discuss their experiences with others, so they visit ANC earlier than others and use prenatal ultrasound during their pregnancy.