Interdisciplinary Research Award
Applicants: Ramon Sanchez-Jacob, MD; Adi Nadimpalli, MD; Ignacio Prieto-Egido, PhD
The World Health Organization estimates that acute lower respiratory infections kill two million children every year, making them the leading cause of death for children under five and accounting for 20% of all under-5 deaths each year. According to the United Nations, in 2019 pneumonia accounted for 15% of all deaths of children under five. The vast majority of these deaths, 99%, occur in low and middle income countries. While chest x-rays are most commonly used for the diagnosis of pneumonia and other cardio-pulmonary diseases, they subject children to unnecessary radiation and present several logistical challenges to operation in low resource settings. Lung Ultrasound (LUS) is a tool which provides a similar if not better diagnostic accuracy but without the potentially harmful radiation and operational challenges. The training needed to perform and interpret LUS is also significantly less than that required for chest x-rays and LUS is cheaper and requires less maintenance. LUS has the potential to lead to earlier and more frequent diagnosis, detection, and treatment for pneumonia, leading to lower rates of morbidity and mortality for children at greater risk of contracting pneumonia.
Research performed by Medecins Sans Frontieres has proved the utility of LUS for diagnosing acute respiratory infections (ARI) in an environment with limited access to adequately trained healthcare providers and imaging capabilities in South Sudan. LUS has not been tested in Guatemala, however. This project aims to explore the use of LUS in order to optimize the potential of this diagnostic tool in the context of a public health system in a rural area characterized by high vulnerability and low resources.
Large economic disparities exist between urban and rural populations in Guatemala where large indigenous groups live without access to resources such as healthcare. This project will focus on Alta Verapaz, a department in the North of Guatemala which is home to 1.2 million people, 78% of whom live in rural areas and 89% of whom belong to an indigenous group. 48% of this indigenous population lives in extreme poverty.
In 2015, the leading cause of death in Alta Verapaz was respiratory disease. Building on the existing training efforts of the EHAS Foundation to improve prenatal care through ultrasound in isolated communities, this project will apply and expand existing strategies for application to a different health challenge. With the goal of improving respiratory diagnosis for children under five years of age in the outpatient setting, the project will train six clinicians at the health center in Alta Verapaz in the LUS technique. Following an orientation and needs assessment, the local providers will go through a robust educational program including academic instruction, hands on learning, and telemedicine training. The capacity of the trained local providers to make accurate diagnoses will be evaluated long-term using a system of expert reviewers who will assess the quality of scans, accuracy of diagnoses, and success of treatments via telemedicine.
The project ultimately aims to assess the feasibility of providing training for local providers on LUS in Alta Verapaz, Guatemala, with the goal of reducing child mortality and morbidity as a result of acute respiratory infections. If successful, LUS represents an innovating way to address the number one killer of children under-five worldwide.
Objectives:
- To analyze the feasibility of using Point-of-Care Ultrasound to allow mid-level healthcare providers to differentiate cardio-pulmonary diseases in public health establishments in rural Guatemala.
- To determine if ultrasound naive mid-level providers of the public health system of Guatemala can learn an already published algorithm to diagnose and evaluate the evolution of pneumonia, bronchiolitis, and interstitial lung disease in children using ultrasound equipment
- To determine if COs can subsequently also be trained to triage other cardio-pulmonary diseases in children (such as TB and RHD) using ultrasound equipment
- To analyze the benefits that this new strategy would provide in terms of improving diagnosis, reducing references and costs, and avoiding saturation of specialist consultation.
