ULTRASONOGRAPHY AS AN AID TO DIAGNOSIS AND TREATMENT IN A RURAL AFRICAN HOSPITAL: A PROSPECTIVE STUDY OF 1,119 CASES
J.-P. STEINMETZ AND J.-P. BERGER Departement de Chirurgie, Centre Hospitalier, Clamecy, France; Fondation de Jumelage, ´ Hopital Le Samaritain, Vevey,Switzerland ˆ
Abstract. The aim of this study was to assess the utility of ultrasonography in a rural African hospital in Cameroon with scarce resources. A prospective questionnaire was administered and completed for each of the 1,119 consecutive cases included in the study. Among these 1,119 cases, the diagnosis made by clinicians and by echography could be veriﬁed by another means for 323 patients.Ultrasonography showed abnormal ﬁndings in 78% of the cases. In the group of 323 patients in which the diagnosis made by echography could be veriﬁed, it was correct in 95.4% of the cases, erroneous in 4.6% of the cases, judged useful for diagnosis in 67.8% of the cases, and not contributive in 27.6% of the cases. Ultrasonography was judged useful when treatment was decided upon in 62% of thecases. This study demonstrated the value of ultrasonography in the context of a developing country and the conditions by which its use could be delineated. More than half of the world’s population does not have access to at least some form of radiologic examination.1 In industrialized countries, ultrasonography has become a classic tool. Meanwhile, developing countries are lagging increasingly farbehind. Ultrasonography has been recommended for developing countries by the World Health Organization (WHO)2 since it is a technique that provides images immediately, is relatively inexpensive, can be carried out on an out-patient basis, and has no side effects. Much has been written about the interest stimulated by ultrasonography in developing countries,3–5 on the economic implications of visualdiagnosis in the Third World,6,7 or on speciﬁc pathologies, often tropical, in which ultrasonography has proven its worth.8 However, few studies have sought to determine the overall beneﬁt that ultrasonography could provide as an aid to diagnosis and treatment.9–11 Within the framework of a support program established by a Swiss hospital for a hospital in Cameroon, the possibility of providing anultrasound scanner to complement the existing radiology unit was considered. In view of the introduction of a new technology of diagnosis in a hospital in a developing country, it was decided to conduct a prospective study to assess the usefulness of ultrasonography in diagnosis and treatment. This study was carried out in keeping with the local economic situation, in which as for all complementaryexaminations, ultrasonography implies an additional cost for the patient or his or her family since there is no health insurance system, and was based upon a prospective protocol established before the ultrasound scanner was installed.
MATERIALS AND METHODS
Patients. The study was carried out at the Ad Lucem Hospital of Banka-Bafang in western Cameroon. This private institution (400 beds,four doctors) is the main hospital in the Haut-Nkam Department (200,000 inhabitants). The study was reviewed and approved by the hospital staff and the Swiss Jumelage Foundation Council. All patients provided oral informed consent before participating in the study. This hospital received its ultrasound scanner in November 1991 free of charge as part of the technical support of the SamaritainHospital. It was a multi-purpose machine (ALO-
KA 256; Aloka, Inc., Tokyo, Japan), as recommended by the WHO, equipped with two linear probes of 3.5 and 5 MHz. For a period of 16 months (November 1991–February 1993), 1,547 ultrasonographies were performed; 1,119 of these were used for the study. Examinations carried out for teaching purposes, and those for which the evolution could not be followed-up...