CHAPTER ONE

INTRODUCTION

1.1 Background to the study

Maternal health remains a major public health priority globally, particularly in low- and middle-income countries where pregnancy-related complications continue to contribute significantly to maternal and neonatal morbidity and mortality (WHO,2023). According to the World Health Organization (WHO). timely and adequate antenatal care is essential for the early identification, prevention and management of complications that may arise during pregnancy (WHO, 2016). Among the various components of antenatal care, ultrasound screening has become a key diagnostic and monitoring tool in modern obstetric practice (WHO, 2016).

Ultrasound screening is an important part of antenatal care all over the world. Globally, more than 90% of pregnant women in developed countries undergo at least one ultrasound scan during pregnancy as part of routine care (World Health Organization, 2016).

In Africa, the use of ultrasound is lower compared to developed countries. A systematic review and meta-analysis reported that about 63.3% of pregnant women in Africa use ultrasound during pregnancy, although access is still not equal in all countries (Gashaw et al., 2025).

In Cameroon, although ultrasound is recommended during pregnancy, its use is still limited in some areas. Studies conducted in Cameroon show that access and utilization of ultrasound services remain inconsistent, especially in rural and low-resource settings (Bisahnyui et al., 2020).

Ultrasound screening during pregnancy is a non-invasive imaging technique that uses high-frequency sound waves to assess fetal development and maternal reproductive structures. It is widely used to confirm pregnancy, estimate gestational age, assess fetal viability, monitor growth patterns, detect multiple pregnancies, identify placental abnormalities and diagnose congenital anomalies (Whitworth et al., 2015). Early and appropriate use of obstetric ultrasound has been associated with improved pregnancy outcomes through early detection of complications such as ectopic pregnancy, intrauterine growth restriction and structural fetal abnormalities (Salomon et al., 2019).

Despite its clinical importance, the utilization of ultrasound screening is highly dependent on women’s knowledge and perception of the procedure.

Several studies have demonstrated that although many pregnant women are aware of ultrasound screening, their knowledge is often incomplete or inaccurate (Ugwu et al., 2008). In many settings, ultrasound is commonly perceived as a means of determining fetal sex rather than a critical diagnostic tool for monitoring fetal wellbeing and detecting abnormalities (Adebayo et al., 2014).

Some pregnant women believe that repeated ultrasound exposure may be harmful to the fetus, despite scientific evidence supporting its safety when used appropriately, which may negatively influence acceptance and utilization (Eze et al., 2019)

In addition to limited knowledge and negative perceptions, numerous barriers hinder access to and utilization of ultrasound screening among pregnant women. These barriers are particularly pronounced in resource-limited settings and include high cost of ultrasound services, lack of functional equipment, long waiting times at health facilities and poor geographical access, especially in rural areas (Kabakyenga et al., 2016).

Health system-related challenges also play a significant role. Poor communication between healthcare providers and pregnant women, limited counselling during antenatal visits, and inadequate emphasis on the importance of ultrasound screening may result in missed opportunities for early diagnosis and intervention (Gross et al., 2011).

Given these challenges, understanding pregnant women’s knowledge, perceptions and barriers to ultrasound screening is essential for improving maternal healthcare delivery. Assessing these factors provides valuable insight into gaps in health education, service delivery and policy implementation. Such evidence is crucial for designing targeted interventions aimed at improving awareness, correcting misconceptions, reducing barriers to access and ultimately increasing the effective utilization of ultrasound screening services.

1.2 Statement of the problem

Ultrasound screening is recommended as a routine component of antenatal care for monitoring fetal development and detecting pregnancy complications. Despite this, its utilization remains inadequate in many settings. Studies have shown that while a high proportion of pregnant women have heard about ultrasound, a substantial number have limited knowledge of its medical purpose and appropriate timing, with many perceiving it mainly as a means of determining fetal sex (Adebayo et al., 2019). Furthermore, misconceptions regarding the safety of ultrasound, including fears of possible harm to the fetus, have also been reported and may negatively influence its utilization (Kabakyenga et al., 2016).

In addition to knowledge and perception gaps, factors such as high cost of services, limited access to equipment, and shortage of trained personnel continue to affect the use of ultrasound services in many African settings (World Health Organization, 2022). These challenges can lead to delay or non-utilization of ultrasound, increasing the risk of undetected pregnancy complications and poor maternal and fetal outcomes.

However, in Douala, it has been observed that although many pregnant women attend antenatal clinics, some do not carry out ultrasound screening as recommended. Some women appear to have limited understanding of its importance, while others complain about cost and accessibility of the service. Despite these observations, there is limited documented information on the knowledge, perception, and barriers to ultrasound screening among pregnant women in this community. This gap justifies the need for this study.

1.3 Research Questions

1.3.1 Main Research Question

What is the level of knowledge, perception, and the barriers to ultrasound screening among pregnant women at The Regina Pacis Catholic  Hospital Mutengene

1.3.2 Specific Research Questions

1. What is the  level of knowledge on ultrasound screening among pregnant women at the the Regina Pacis Catholic  Hospital Mutengene
2. What are the perceptions towards ultrasound screening among  pregnant at the Regina Pacis Catholic  Hospital Mutengene
3. What are barriers that hinder pregnant women at the Regina Pacis Catholic Hospital Mutengene  from accessing and utilizing ultrasound screening services ?

1.4 Research Objectives

1.4.1 General Objective

To assess women’s knowledge, perception, and barriers to ultrasound screening among pregnant women.

1.4.2 Specific Objectives

This study seeks to:

1. Determine the level of knowledge on ultrasound screening among pregnant women at the Regina Pacis
2. Evaluate perceptions toward ultrasound screening among pregnant women at the  Regina Pacis Catholic Hospital Mutengene
3. Identify the barriers to ultrasound screening among pregnant women the Regina Pacis Catholic Hospital Mutengene