Challenges in implementing ultrasound-guided hydrostatic reduction of intussusception: Perspectives from radiologists trained and practicing in resource-limited settings.

BACKGROUND: While non-operative management has long been the standard of care for intussusception in many settings, surgical intervention remains predominant in sub-Saharan Africa. Ultrasound-guided hydrostatic reduction has emerged as a viable alternative for uncomplicated cases in the region. However, the practical challenges hindering its broader adoption remain underexplored. OBJECTIVE: We aimed to assess the practice of ultrasound-guided hydrostatic reduction among recently trained Ethiopian radiologists and the barriers to its implementation. MATERIALS AND METHODS: This study used a cross-sectional survey composed of a custom-designed, pilot-tested questionnaire on demographics, training exposure, confidence, current practice, perceived barriers, and proposed solutions. It was distributed through Radiological Society of Ethiopia's online group to reach all radiology residency graduates in Ethiopia from 2015 to 2024 (N ≈ 365). Descriptive statistics, logistic regression, and chi-square tests were used for analysis, with significance set at p < 0.05. Ethical approval was obtained, and informed consent was secured from all participants. RESULTS: We received 178 responses (48.8% response rate). While 70.7% (n = 106/150) of trained respondents had performed ultrasound-guided hydrostatic reduction post-graduation, only 58.6% (n = 88/150) of total respondents reported currently practicing the procedure. Most respondents (86.5%, n = 154/178) supported ultrasound-guided hydrostatic reduction as the first-line treatment for pediatric intussusception. Confidence was significantly associated with current practice (p < 0.001) but not with graduation year(p = 0.95). Key barriers included lack of protocols (69.1%, 123/178), delayed presentation (46.6%, 83/178), and limited surgical support (38.7%, 69/178). CONCLUSION: This study underscores the complex and multifactorial challenges in implementing ultrasound-guided hydrostatic reduction in resource-limited settings. Effectively addressing these challenges requires targeted training programs, better resource allocation, and stronger interdisciplinary collaboration.