Retrospectives multicenter evaluation of the rousg program's impact on antenatal care in Nepal

Abstract

Abstract: Introduction: The Rural Obstetric Ultrasound Program (ROUSG) was introduced to enhance early detection and referral through ultrasound screening during the 24th week of gestation. The objectives of the study were to assess the effectiveness of the ROUSG program in enhancing antenatal care (ANC) visits, promoting facility-based deliveries, identifying complications during pregnancy, and reducing maternal and perinatal mortality. Methods: A retrospective study was conducted in seven health facilities of Kailari Rural Municipality, Kailali District, Nepal. ANC records of women aged 20-49 were compared across 12 months before and after the implementation of ROUSG. Data was analyzed using SPSS 29.0. Descriptive statistics and inferential tests (t-test, Chi-square, Fisher’s Exact), with significance set at p ≤ 0.05. Results: There were no significant changes in service utilization, with the attendance rate at the first ANC visit slightly decreasing from 8.7% to 7.7% and facility deliveries remaining stable at 51.2% and 50.7%. However, detection of complications improved, including malpresentation (1.1% to 1.9%), abortion (1.6% to 2.1%), and hypertension (1.1% to 2.3%). The number of assisted deliveries increased significantly, and referrals for complications also rose. Maternal mortality remained at zero, and neonatal mortality stayed low throughout the study period. Conclusion: The ROUSG program improved the detection of pregnancy-related complications but did not significantly increase early ANC attendance or facility-based deliveries. This suggests that diagnostic tools alone are not enough to change maternal care-seeking behaviors in Nepal. Persistent barriers such as cultural norms, transportation challenges, and inadequate counseling continue to limit service utilization. Key Words: antenatal visit, health facility delivery, maternal and neonatal mortality, pregnant mother, Rural obstetric ultrasound program (ROUSG)