{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T18:07:31Z","timestamp":1789150051986,"version":"build-2803163510"},"reference-count":27,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007028","name":"Leona M. and Harry B. Helmsley Charitable Trust","doi-asserted-by":"publisher","award":["2301-06555"],"award-info":[{"award-number":["2301-06555"]}],"id":[{"id":"10.13039\/100007028","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Ultrasound is essential for accurate pregnancy dating, but its implementation in low- and middle-income countries is hindered by cost, infrastructure, and training barriers. The implementation of point-of-care ultrasound (POCUS) with artificial intelligence (AI) technology to accurately estimate gestational age can potentially address these barriers. We describe a protocol to evaluate the acceptability, feasibility, and fidelity of integrating AI-enabled POCUS for gestational age dating into routine antenatal care (ANC) in Zambia\u2019s Lusaka Province.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PIKABU (Piloting Integration, Knowledge and Acceptability of Baby Ultrasounds) is a multi-year pilot program to introduce and maintain AI-enabled POCUS in six ANC facilities across three districts. To evaluate these activities, we designed a prospective, mixed methods evaluation to assess acceptability, feasibility, and fidelity. Informed by the Consolidated Framework for Implementation Research, the evaluation comprises six separate components: focus-group discussions, in-depth interviews, patient register reviews, time motion studies, implementation strategy assessments, and patient exit surveys. Participants include patients, community members, and healthcare providers. By collecting baseline and follow-up data every four months, we are able to measure these outcomes in longitudinal fashion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Integrating portable, AI-enabled POCUS into routine ANC can improve gestational age dating and improve maternal health services in resource limited settings. Through its assessment of the acceptability, feasibility, and fidelity, this study provides novel insights about service implementation. Our findings are expected to inform policy and programs considering AI-enabled POCUS and support broader adoption across a range of healthcare settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0357962","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T17:23:24Z","timestamp":1789147404000},"page":"e0357962","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["A pilot study to implement artificial intelligence-enabled, point-of-care obstetric ultrasound for gestational age estimation in Zambia: An evaluation protocol"],"prefix":"10.1371","volume":"21","author":[{"given":"Erika","family":"Gazzetta","sequence":"first","affiliation":[{"name":"University of North Carolina School of Medicine","place":["Chapel Hill, North Carolina, United States of America"],"department":["Department of Obstetrics and Gynecology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tulani Francis L.","family":"Matenga","sequence":"additional","affiliation":[{"name":"University of Zambia","place":["Lusaka, Zambia"],"department":["Department of Health Promotion and Education, School of Public Health"]},{"name":"UNC Global Projects Zambia, LLC","place":["Lusaka, Zambia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0378-802X","authenticated-orcid":true,"given":"Stephanie","family":"Martin","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill","place":["Chapel Hill, North Carolina, United States of America"],"department":["Department of Nutrition, Gillings School of Global Public Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelly","family":"Mandona","sequence":"additional","affiliation":[{"name":"UNC Global Projects Zambia, LLC","place":["Lusaka, Zambia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3135-4886","authenticated-orcid":true,"given":"Rassil","family":"Barada","sequence":"additional","affiliation":[{"name":"University of North Carolina School of Medicine","place":["Chapel Hill, North Carolina, United States of America"],"department":["Department of Obstetrics and Gynecology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Modesta","family":"Chileshe","sequence":"additional","affiliation":[{"name":"UNC Global Projects Zambia, LLC","place":["Lusaka, Zambia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Stringer","sequence":"additional","affiliation":[{"name":"University of North Carolina School of Medicine","place":["Chapel Hill, North Carolina, United States of America"],"department":["Department of Obstetrics and Gynecology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manze","family":"Chinyama","sequence":"additional","affiliation":[{"name":"UNC Global Projects Zambia, LLC","place":["Lusaka, Zambia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beene","family":"Chembo","sequence":"additional","affiliation":[{"name":"UNC Global Projects Zambia, LLC","place":["Lusaka, Zambia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harmony","family":"Chi","sequence":"additional","affiliation":[{"name":"University of North Carolina School of Medicine","place":["Chapel Hill, North Carolina, United States of America"],"department":["Department of Obstetrics and Gynecology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angel","family":"Mwiche","sequence":"additional","affiliation":[{"name":"Ministry of Health","place":["Lusaka, Zambia"],"department":["Department of Public Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selia","family":"Ng\u2019anjo","sequence":"additional","affiliation":[{"name":"Women and Newborn Hospital, University Teaching Hospital","place":["Lusaka, Zambia"],"department":["Department of Obstetrics and Gynaecology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey S.A.","family":"Stringer","sequence":"additional","affiliation":[{"name":"University of North Carolina School of Medicine","place":["Chapel Hill, North Carolina, United States of America"],"department":["Department of Obstetrics and Gynecology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1435-8455","authenticated-orcid":true,"given":"Benjamin H.","family":"Chi","sequence":"additional","affiliation":[{"name":"University of North Carolina School of Medicine","place":["Chapel Hill, North Carolina, United States of America"],"department":["Department of Obstetrics and Gynecology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Kasaro","sequence":"additional","affiliation":[{"name":"University of North Carolina School of Medicine","place":["Chapel Hill, North Carolina, United States of America"],"department":["Department of Obstetrics and Gynecology"]},{"name":"UNC Global Projects Zambia, LLC","place":["Lusaka, Zambia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,11]]},"reference":[{"key":"pone.0357962.ref001","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1186\/s12978-018-0524-5","article-title":"Improving pregnancy outcomes in low- and middle-income countries","volume":"15","author":"RL Goldenberg","year":"2018","journal-title":"Reprod Health"},{"key":"pone.0357962.ref002","doi-asserted-by":"crossref","first-page":"1533","DOI":"10.12688\/gatesopenres.13046.2","article-title":"Adverse birth outcomes and their clinical phenotypes in an urban Zambian cohort","volume":"3","author":"JT Price","year":"2020","journal-title":"Gates Open Res"},{"issue":"2","key":"pone.0357962.ref003","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.wfumbo.2024.100057","article-title":"Quality of ultrasound images by midwives implementing ultrasound scanning services during antenatal clinics within selected healthcare facilities of Zambia","volume":"2","author":"S Haluzani","year":"2024","journal-title":"WFUMB Ultrasound Open"},{"key":"pone.0357962.ref004","doi-asserted-by":"crossref","first-page":"18","DOI":"10.4236\/health.2024.166036","article-title":"Ultrasound scanning competencies in midwifery education in Zambia: findings from a desk review and needs assessment","volume":"16","author":"M Zulu","year":"2024","journal-title":"Health"},{"issue":"1","key":"pone.0357962.ref005","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1186\/s12978-018-0571-y","article-title":"Obstetric ultrasound use in low and middle income countries: a narrative review","volume":"15","author":"ET Kim","year":"2018","journal-title":"Reprod Health"},{"key":"pone.0357962.ref006","first-page":"23333928221085881","article-title":"Prenatal ultrasound utilization and its associated factors among pregnant women in jimma town public health institutions, Ethiopia","volume":"9","author":"A Yetwale","year":"2022","journal-title":"Health Serv Res Manag Epidemiol"},{"key":"pone.0357962.ref007","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1186\/1471-2393-14-73","article-title":"First look: a cluster-randomized trial of ultrasound to improve pregnancy outcomes in low income country settings","volume":"14","author":"EM McClure","year":"2014","journal-title":"BMC Pregnancy Childbirth"},{"issue":"15","key":"pone.0357962.ref008","doi-asserted-by":"crossref","first-page":"1669","DOI":"10.3390\/diagnostics14151669","article-title":"Artificial intelligence (AI) Applications for Point of Care Ultrasound (POCUS) in low-resource settings: a scoping review","volume":"14","author":"S Kim","year":"2024","journal-title":"Diagnostics (Basel)"},{"key":"pone.0357962.ref009","doi-asserted-by":"crossref","first-page":"101333","DOI":"10.1016\/j.eclinm.2022.101333","article-title":"Task shifting for point of care ultrasound in primary healthcare in low- and middle-income countries-a systematic review","volume":"45","author":"SK Abrokwa","year":"2022","journal-title":"EClinicalMedicine"},{"issue":"2","key":"pone.0357962.ref010","doi-asserted-by":"crossref","first-page":"315","DOI":"10.9745\/GHSP-D-16-00191","article-title":"Challenges of implementing antenatal ultrasound screening in a rural study site: a case study from the Democratic Republic of the Congo","volume":"5","author":"D Swanson","year":"2017","journal-title":"Glob Health Sci Pract"},{"issue":"3","key":"pone.0357962.ref011","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1002\/ajum.12138","article-title":"Exploring the availability and impact of antenatal point-of-care ultrasound services in rural and remote communities: a scoping review","volume":"22","author":"M Doig","year":"2019","journal-title":"Australas J Ultrasound Med"},{"issue":"5","key":"pone.0357962.ref012","doi-asserted-by":"crossref","DOI":"10.1056\/EVIDoa2100058","article-title":"AI estimation of gestational age from blind ultrasound sweeps in low-resource settings","volume":"1","author":"T Pokaprakarn","year":"2022","journal-title":"NEJM Evid"},{"issue":"8","key":"pone.0357962.ref013","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1001\/jama.2024.10770","article-title":"Diagnostic accuracy of an integrated AI Tool to estimate gestational age from blind ultrasound sweeps","volume":"332","author":"JSA Stringer","year":"2024","journal-title":"JAMA"},{"key":"pone.0357962.ref014","unstructured":"Anonymous. Butterfly Network Secures First FDA Clearance for Blind Sweep Ultrasound AI Tool, Marking a Major Stride for Women\u2019s Health. https:\/\/www.butterflynetwork.com\/press-releases\/fda-cleared-gestational-age-tool?srsltid=AfmBOopKX9HtKDkjuxbbTVQOoMmeFpT_q-c9J_oJjeZRojPF1WhJ6thI. Accessed July 7, 2026."},{"key":"pone.0357962.ref015","unstructured":"Gazzetta E, Mandona N, Chinyama M, Chembo B, Matenga T, Barada R. The implementation of a novel AI-enabled obstetric ultrasound program across three Zambia districts. In: Cape Town, South Africa, 2025."},{"key":"pone.0357962.ref016","unstructured":"Mandona N, Chileshe M, Kasaro M, Chinyama M, Gazzetta E, Matenga T. AI-assisted ultrasound training package for healthcare providers (HCPs) in Zambia: a case of piloting integration, knowledge and acceptability of baby ultrasound (PIKABU). In: Cape Town, South Africa, 2025."},{"issue":"1","key":"pone.0357962.ref017","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s13012-020-0977-0","article-title":"Evaluating and optimizing the consolidated framework for implementation research (CFIR) for use in low- and middle-income countries: a systematic review","volume":"15","author":"AR Means","year":"2020","journal-title":"Implement Sci"},{"issue":"1","key":"pone.0357962.ref018","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1186\/s13012-025-01450-7","article-title":"The Consolidated Framework for Implementation Research (CFIR) User Guide: a five-step guide for conducting implementation research using the framework","volume":"20","author":"CM Reardon","year":"2025","journal-title":"Implement Sci"},{"issue":"2","key":"pone.0357962.ref019","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1007\/s10488-010-0319-7","article-title":"Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda","volume":"38","author":"E Proctor","year":"2011","journal-title":"Administration and Policy in Mental Health"},{"key":"pone.0357962.ref020","volume-title":"Dimmeniation and Implementation Research in Health: Translating Science to Practice","author":"RC Brownson","year":"2018","edition":"2"},{"issue":"1","key":"pone.0357962.ref021","first-page":"13","article-title":"Demonstrating rigor using thematic analysis: a hybrid approach of inductive and deductive coding and theme development","volume":"5","author":"J Fereday","year":"2006","journal-title":"Int Inst Qual Methodol"},{"key":"pone.0357962.ref022","doi-asserted-by":"crossref","first-page":"114523","DOI":"10.1016\/j.socscimed.2021.114523","article-title":"Sample sizes for saturation in qualitative research: a systematic review of empirical tests","volume":"292","author":"M Hennink","year":"2022","journal-title":"Soc Sci Med"},{"key":"pone.0357962.ref023","doi-asserted-by":"crossref","first-page":"112516","DOI":"10.1016\/j.psychres.2019.112516","article-title":"Qualitative methods in implementation research: an introduction","volume":"280","author":"AB Hamilton","year":"2019","journal-title":"Psychiatry Res"},{"issue":"1","key":"pone.0357962.ref024","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1186\/s12884-025-07796-6","article-title":"AI-enabled obstetric point-of-care ultrasound as an emerging technology in low- and middle-income countries: provider and health system perspectives","volume":"25","author":"S Della Ripa","year":"2025","journal-title":"BMC Pregnancy Childbirth"},{"issue":"1","key":"pone.0357962.ref025","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1186\/s12913-025-13212-8","article-title":"Evaluation of large-scale implementation of obstetric point of care ultrasound in eight counties in Kenya using RE-AIM framework","volume":"25","author":"G Githemo","year":"2025","journal-title":"BMC Health Serv Res"},{"key":"pone.0357962.ref026","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1186\/s13012-016-0437-z","article-title":"A systematic review of the use of the consolidated framework for implementation research","volume":"11","author":"MA Kirk","year":"2016","journal-title":"Implement Sci"},{"issue":"1","key":"pone.0357962.ref027","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1111\/2041-210X.12860","article-title":"The use of focus group discussion methodology: insights from two decades of application in conservation","volume":"9","author":"T O.Nyumba","year":"2018","journal-title":"Methods Ecol Evol"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0357962","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T17:23:29Z","timestamp":1789147409000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0357962"}},"subtitle":[],"editor":[{"given":"Maurine Rofhiwa","family":"Musie","sequence":"first","affiliation":[{"name":"University of Pretoria","place":["SOUTH AFRICA"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,9,11]]},"references-count":27,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,11]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0357962","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,11]]}}}