Factors associated with early obstetric ultrasound uptake at a tertiary hospital in Northern Uganda: a cross-sectional study

Background 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. Methods 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 (20–24 weeks) 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. Results 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% CI 1.19 to 3.25), history of congenital anomaly (aPR=1.27, 95% CI 1.09 to 1.48), not being in a union (ie, unmarried and not cohabiting with a partner) (aPR=1.29, 95% CI 1.07 to 1.56) and being satisfied with the results of an ultrasound scan in a previous pregnancy (aPR=1.38, 95% CI 1.06 to 1.57). Conclusions 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.