Qualitative assessment of the feasibility and acceptability of a low-cost device for gestational age assessment in a low-resource setting

Document Type



Obstetrics and Gynaecology (East Africa); Centre of Excellence in Women and Child Health


Objectives: The transcerebellar (TraCer) tool is a low-cost wireless probe linked to a commercially available tablet computer, with an artificial intelligence based software interface created to assess the fetal head circumference and transcerebellar diameter and provide a gestational age (GA). In this study we evaluate the acceptability, feasibility and the role of the TraCer tool in a low-resource setting.

Methods: The study was set in two health facilities in rural and peri-urban coastal Kenya. Prior to data collection, study participants were shown a video role-play on the use of TraCer at a typical antenatal care visit. Qualitative data were collected from pregnant women and their families through six focus group discussions (n = 52) and from 18 interviews with health care workers and managers. We applied thematic analysis using an a priori framework.

Results: Women and their family members felt that the tool would fit easily into usual antenatal care and that it would be of value particularly in women uncertain of their last menstrual period (LMP). However, there was a tendency for women to perceive the tool as providing a reassurance of fetal well-being rather than GA assessment. Nurses / midwives felt the tool could be easily implemented and would boost their confidence and positive image in the community. Health care managers viewed it as implementable but did express concern regarding increased workload with limited staff. There were suggestions to reserve its use for women with uncertain or unknown LMP only. Unanimously, nurses were deemed the most appropriate cadre to use the tool. The need for appropriate training of providers was emphasised.

Conclusions: The use of TraCer was perceived to be acceptable and feasible in coastal Kenya. This work informs the development of a simple training program and key patient communication messages to guide implementation. These are prerequisites for wider scale clinical testing.

Publication (Name of Journal)

Ultrasound in Obstetrics & Gynecology