{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T14:45:51Z","timestamp":1787323551562,"version":"build-2736575974"},"reference-count":40,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"unspecified","delay-in-days":20,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,8,11]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Early obstetric ultrasound improves gestational age estimation, detection of fetal anomalies and management of pregnancy complications. The WHO recommends at least one ultrasound examination before 24 weeks of gestation. However, uptake of early obstetric ultrasound in many low-resource settings remains poorly documented, including in post-conflict Northern Uganda. This study assessed the prevalence and factors associated with uptake of obstetric ultrasound before 24 weeks of gestation among pregnant women attending antenatal care at a tertiary hospital in Northern Uganda.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A facility-based cross-sectional study was conducted among 428 pregnant women attending antenatal care at Gulu Regional Referral Hospital between December 2024 and May 2025. Participants were selected using systematic sampling. Data were collected using a pretested interviewer-administered questionnaire. The facility does not routinely offer a dedicated second-trimester (20\u201324\u2009weeks) anatomy scan; ultrasound is largely opportunistic and clinician or patient initiated. Multivariable Poisson regression with robust SEs was used to estimate adjusted prevalence ratios (aPR) and 95% CIs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The prevalence of at least one obstetric ultrasound scan before 24 weeks of gestation was 64.0%. Independent predictors of early ultrasound uptake included access to transportation (aPR=1.96, 95%\u2009CI 1.19 to 3.25), history of congenital anomaly (aPR=1.27, 95%\u2009CI 1.09 to 1.48), not being in a union (ie, unmarried and not cohabiting with a partner) (aPR=1.29, 95%\u2009CI 1.07 to 1.56) and being satisfied with the results of an ultrasound scan in a previous pregnancy (aPR=1.38, 95%\u2009CI 1.06 to 1.57).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Uptake of early obstetric ultrasound in Northern Uganda remains suboptimal even in tertiary health facilities. Structural access barriers, obstetric history and previous service experience influence utilisation. Strategies aimed at improving transport access, strengthening provider counselling and improving service quality may enhance early ultrasound uptake.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-120018","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T14:08:42Z","timestamp":1787321322000},"page":"e120018","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Factors associated with early obstetric ultrasound uptake at a tertiary hospital in Northern Uganda: a cross-sectional study"],"prefix":"10.1136","volume":"16","author":[{"given":"Innocent","family":"Canogura","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Gulu University, Gulu, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5116-1458","authenticated-orcid":false,"given":"Morrish Obol","family":"Okello","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Gulu University, Gulu, Uganda"},{"name":"Department of Pediatrics and Child Health, Jinja Regional Referral Hospital, Jinja, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian Daniel","family":"Lutara","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Gulu University, Gulu, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denish","family":"Okot","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Gulu University, Gulu, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonan","family":"Nyesiga","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Gulu University, Gulu, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4510-6736","authenticated-orcid":false,"given":"Simple","family":"Ouma","sequence":"additional","affiliation":[{"name":"School of Health Sciences, Soroti University, Soroti, Eastern Region, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"2026082106552011000_16.8.e120018.1","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-025-08456-5","article-title":"Global, regional, and national levels of maternal mortality, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021","volume":"25","author":"Wei","year":"2025","journal-title":"BMC Pregnancy Childbirth"},{"key":"2026082106552011000_16.8.e120018.2","doi-asserted-by":"crossref","first-page":"e306","DOI":"10.1016\/S2214-109X(23)00468-0","article-title":"A global analysis of the determinants of maternal health and transitions in maternal mortality","volume":"12","author":"Souza","year":"2024","journal-title":"Lancet Glob Health"},{"key":"2026082106552011000_16.8.e120018.3","unstructured":"WHO . SDG target 3.7_sexual and reproductive health 2023. 2023. Available: https:\/\/www.who.int\/data\/gho\/data\/themes\/topics\/sdg-target-3_7-sexual-and-reproductive-health"},{"key":"2026082106552011000_16.8.e120018.4","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2017-017122","article-title":"Antenatal care services and its implications for vital and health outcomes of children: evidence from 193 surveys in 69 low-income and middle-income countries","volume":"7","author":"Kuhnt","year":"2017","journal-title":"BMJ Open"},{"key":"2026082106552011000_16.8.e120018.5","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13451"},{"key":"2026082106552011000_16.8.e120018.6","doi-asserted-by":"crossref","unstructured":"Arsenault C , Mfeka-Nkabinde NG , Chaudhry M , et al . Antenatal care quality and detection of risk among pregnant women: An observational study in Ethiopia, India, Kenya, and South Africa. PLoS Med 2024;21. doi:10.1371\/journal.pmed.1004446","DOI":"10.1371\/journal.pmed.1004446"},{"key":"2026082106552011000_16.8.e120018.7","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-025-07209-8","article-title":"A scoping review of digital technologies in antenatal care: recent progress and applications of digital technologies","volume":"25","author":"Mohamed","year":"2025","journal-title":"BMC Pregnancy Childbirth"},{"key":"2026082106552011000_16.8.e120018.8","doi-asserted-by":"crossref","DOI":"10.3390\/jcm13051244","article-title":"Clinical Ultrasound Applications in Obstetrics and Gynecology in the Year 2024","volume":"13","author":"Recker","year":"2024","journal-title":"J Clin Med"},{"key":"2026082106552011000_16.8.e120018.9","doi-asserted-by":"crossref","first-page":"e368","DOI":"10.1016\/S2589-7500(20)30131-X","article-title":"Achieving accurate estimates of fetal gestational age and personalised predictions of fetal growth based on data from an international prospective cohort study: a population-based machine learning study","volume":"2","author":"Fung","year":"2020","journal-title":"Lancet Digit Health"},{"key":"2026082106552011000_16.8.e120018.10","unstructured":"World Health Organization . WHO recommendations on antenatal care for a positive pregnancy experience. Geneva: WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience Geneva; 2016. Available: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK409110\/ [Accessed 3 Feb 2026]."},{"key":"2026082106552011000_16.8.e120018.11","doi-asserted-by":"crossref","DOI":"10.1186\/s13089-019-0139-2","article-title":"Impact of an ultrasound-driven diagnostic protocol at early intensive-care stay: a randomized-controlled trial","volume":"11","author":"Pontet","year":"2019","journal-title":"Ultrasound J"},{"key":"2026082106552011000_16.8.e120018.12","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-025-08261-0","article-title":"Facilitators and barriers to implementation of obstetric ultrasound scanning intervention by midwives within maternal and child health departments of the selected healthcare facilities in four districts of Zambia: experiences of healthcare workers","volume":"26","author":"Hangulu","year":"2026","journal-title":"BMC Pregnancy Childbirth"},{"key":"2026082106552011000_16.8.e120018.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.radi.2020.10.010"},{"key":"2026082106552011000_16.8.e120018.14","doi-asserted-by":"crossref","DOI":"10.1186\/s12978-018-0571-y","article-title":"Obstetric ultrasound use in low and middle income countries: a narrative review","volume":"15","author":"Kim","year":"2018","journal-title":"Reprod Health"},{"key":"2026082106552011000_16.8.e120018.15","doi-asserted-by":"crossref","DOI":"10.1186\/s13089-025-00420-w","article-title":"Knowledge and utilization of obstetric ultrasound and associated factors among pregnant mother in Africa: a systematic review and meta-analysis","volume":"17","author":"Gashaw","year":"2025","journal-title":"Ultrasound J"},{"key":"2026082106552011000_16.8.e120018.16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4236\/ojcd.2021.111001","article-title":"Barriers and enablers that influence utilisation of ultrasound screening services among antenatal women in Kajiado and Kisii Counties Kenya","volume":"11","author":"Matiang\u2019i","year":"2021","journal-title":"OJCD"},{"key":"2026082106552011000_16.8.e120018.17","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-022-04609-y","article-title":"Enablers and barriers to introduction of obstetrics ultrasound service at primary care facilities in a resource-limited setting: a qualitative study in four regions of Ethiopia","volume":"22","author":"Roro","year":"2022","journal-title":"BMC Pregnancy Childbirth"},{"key":"2026082106552011000_16.8.e120018.18","unstructured":"UBOS . Uganda demographic and health. USA; 2022.1."},{"key":"2026082106552011000_16.8.e120018.19","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0005249","article-title":"Community health knowledge and access to care in post-conflict Northern Uganda: Perspectives of community health workers in Pader District","volume":"6","author":"Albee","year":"2026","journal-title":"PLOS Glob Public Health"},{"key":"2026082106552011000_16.8.e120018.20","doi-asserted-by":"crossref","unstructured":"Susu B , Temesgen K , Ayalew S , et al . Prenatal ultrasound utilization and associated factors among pregnant women attending antenatal care in south Wollo zone public hospitals, north east, Ethiopia, 2023. Front Digit Health 2023;7. doi:10.3389\/fdgth.2025.1547547","DOI":"10.3389\/fdgth.2025.1547547"},{"key":"2026082106552011000_16.8.e120018.21","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1002\/bimj.19680100122","article-title":"Kish, L.: Survey Sampling. John Wiley & Sons, Inc., New York, London 1965, IX + 643 S., 31 Abb., 56 Tab., Preis 83 s","volume":"10","author":"Wiegand","year":"1968","journal-title":"Biom J"},{"key":"2026082106552011000_16.8.e120018.22","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0321521","article-title":"Determinants of maternity services utilisation among women of reproductive age across sub-Saharan Africa","volume":"21","author":"Hajjar","year":"2026","journal-title":"PLoS One"},{"key":"2026082106552011000_16.8.e120018.23","doi-asserted-by":"crossref","unstructured":"Nakimera A . n.d. Factors influencing utilisation of ultrasound scan services among pregnant mothers at Ndejje Health Center IV, Wakiso District. SJHR-Africa 1:22. doi:10.51168\/sjhrafrica.v1i12.10","DOI":"10.51168\/sjhrafrica.v1i12.10"},{"key":"2026082106552011000_16.8.e120018.24","first-page":"18","article-title":"Knowledge, attitude and use of obstetric ultrasound among pregnant women in a community in North-Western, Nigeria","volume":"22","author":"Nmadu","year":"2023","journal-title":"Abuth Int J Physio & Health Sc"},{"key":"2026082106552011000_16.8.e120018.25","doi-asserted-by":"crossref","DOI":"10.1186\/s12978-018-0647-8","article-title":"Factors influencing referrals for ultrasound-diagnosed complications during prenatal care in five low and middle income countries","volume":"15","author":"Franklin","year":"2018","journal-title":"Reprod Health"},{"key":"2026082106552011000_16.8.e120018.26","doi-asserted-by":"crossref","DOI":"10.1186\/1472-698X-11-S1-S10","article-title":"Exploring new health markets: experiences from informal providers of transport for maternal health services in Eastern Uganda","volume":"11 Suppl 1","author":"Pariyo","year":"2011","journal-title":"BMC Int Health Hum Rights"},{"key":"2026082106552011000_16.8.e120018.27","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-025-07225-8","article-title":"Barriers and facilitators to maternal healthcare in East Africa: a systematic review and qualitative synthesis of perspectives from women, their families, healthcare providers, and key stakeholders","volume":"25","author":"Yihune Teshale","year":"2025","journal-title":"BMC Pregnancy Childbirth"},{"key":"2026082106552011000_16.8.e120018.28","doi-asserted-by":"crossref","first-page":"e222","DOI":"10.1055\/s-0041-1733872","article-title":"Association of sociodemographic, obstetric, and attitudinal factors with prenatal ultrasound in Mashhad, Iran","volume":"11","author":"Jarahi","year":"2021","journal-title":"Journal of Child Science"},{"key":"2026082106552011000_16.8.e120018.29","article-title":"Prenatal ultrasound utilisation and its associated factors among pregnant women in Jimma Town public health institutions, Ethiopia","volume":"9","author":"Yetwale","year":"2022","journal-title":"Health Serv Res Manag Epidemiol"},{"key":"2026082106552011000_16.8.e120018.30","doi-asserted-by":"crossref","unstructured":"Haile ZW , Goshu EM , Kumsa MJ , et al . Attitude, practice, and associated factors of pregnant women towards prenatal ultrasound in addis ababa, ethiopia. a cross- sectional study. In Review [Preprint] 2022. doi:10.21203\/rs.3.rs-2205940\/v1 Available: https:\/\/doi.org\/10.21203\/rs.3.rs-2205940\/v1","DOI":"10.21203\/rs.3.rs-2205940\/v1"},{"key":"2026082106552011000_16.8.e120018.31","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-024-20400-4","article-title":"Determinants of health-seeking behaviour in rural district of Jasikan, Ghana: a cross-sectional study","volume":"24","author":"Ketor","year":"2024","journal-title":"BMC Public Health"},{"key":"2026082106552011000_16.8.e120018.32","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-024-06320-6","article-title":"Risk factors of adverse birth outcomes among a cohort of pregnant women in Coastal Kenya, 2017-2019","volume":"24","author":"Mirieri","year":"2024","journal-title":"BMC Pregnancy Childbirth"},{"key":"2026082106552011000_16.8.e120018.33","doi-asserted-by":"crossref","first-page":"100124","DOI":"10.1016\/j.glmedi.2024.100124","article-title":"Adverse perinatal outcomes and their associated determinants in Sub-Saharan Africa","volume":"3","author":"Yahaya","year":"2024","journal-title":"Journal of Medicine, Surgery, and Public Health"},{"key":"2026082106552011000_16.8.e120018.34","doi-asserted-by":"crossref","first-page":"100736","DOI":"10.1016\/j.ssmqr.2026.100736","article-title":"Women\u2019s experiences negotiating barriers and asserting agency on family planning in urban east-central Uganda: A photovoice study","volume":"9","author":"Ssanyu","year":"2026","journal-title":"SSM - Qualitative Research in Health"},{"key":"2026082106552011000_16.8.e120018.35","doi-asserted-by":"crossref","first-page":"306","DOI":"10.3138\/jcfs.54.4.02","article-title":"Women\u2019s autonomy in maternal healthcare decision-making in urban Ghana","volume":"54","author":"Khalid","year":"2024","journal-title":"J Comp Fam Stud"},{"key":"2026082106552011000_16.8.e120018.36","doi-asserted-by":"crossref","first-page":"105292","DOI":"10.1016\/j.worlddev.2020.105292","article-title":"Taking power: Women\u2019s empowerment and household Well-being in Sub-Saharan Africa","volume":"140","author":"Annan","year":"2021","journal-title":"World Dev"},{"key":"2026082106552011000_16.8.e120018.37","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-023-06078-3","article-title":"Gender inequities in women\u2019s access to maternal health care utilisation in Zambia: a qualitative analysis","volume":"23","author":"Kalindi","year":"2023","journal-title":"BMC Pregnancy Childbirth"},{"key":"2026082106552011000_16.8.e120018.38","unstructured":"Jamila H , Borokini S , Samson BS . Knowledge and Utilization of ultrasound scan among pregnant women attending antenatal clinic at Orile-Agege General Hospital. Lagos State 2025;167\u2013201."},{"key":"2026082106552011000_16.8.e120018.39","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-025-08071-4","article-title":"Supply and demand barriers to PHC maternal care services uptake: qualitative and behavioural insights from Gombe State, Nigeria","volume":"25","author":"Alhaji","year":"2025","journal-title":"BMC Pregnancy Childbirth"},{"key":"2026082106552011000_16.8.e120018.40","doi-asserted-by":"crossref","DOI":"10.1017\/S1463423622000706","article-title":"Health system-related barriers to prenatal care management in low- and middle-income countries: a systematic review of the qualitative literature","volume":"24","author":"Mohseni","year":"2023","journal-title":"Prim Health Care Res Dev"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2026-120018","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T14:08:51Z","timestamp":1787321331000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2026-120018"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":40,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,21]]},"published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1136\/bmjopen-2026-120018"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2026-120018","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]}}}