Background Ultrasound utilization studies in the developing world are important to support appropriate use.

Methods A prospective, cross-sectional study in the medical wards at Queen Elizabeth Central Hospital, Blantyre, Malawi, was performed which aimed to assess referrals, reports and usefulness of scans to develop local recommendations. The primary outcome of a ‘useful scan' was based on scan results and utilization of the report. Indication, quality of requests and reports, and operator were documented. Recommendations for request and report writing were developed.

Results During 28 April–1 June 2011, 96 scans were analysed of which 66 (69%) were useful. Scans were not useful when the report was non-diagnostic, not documented or not acted upon. Seventy-eight scans (82%) were requested without prior laboratory investigations. A working diagnosis of a pericardial effusion was significantly associated with a useful scan (p = 0.01) as was a medical history of HIV (p = 0.001). The quality of requests and reports in terms of clinical information was moderate or poor in 73% and 33% of cases respectively. Scans by clinicians were at greater odds (OR = 4.0, p = 0.01) of being useful compared with those by radiology technicians.

Conclusion Despite the majority of ultrasound scans being useful, underutilization and non-useful scans were common, indicating the need to identify appropriate indications and develop relevant guidance and training.