Lung Ultrasound for Acute Respiratory Infections by Community Health Workers
Condition: Child; Pneumonia
MeSH terms: Pneumonia; Respiratory Tract Infections
Study type: Observational [Patient Registry]

Summary: 
      The specific objectives focus on using a train-the-trainer model to educate CHWs in Pakistan
      on performing and interpreting pediatric lung POCUS. In the first phase, the POCUS experts
      from Toronto will rigorously train the first generation of local lung POCUS users who are
      Pakistani health care providers to become local lung POCUS trainers. These first generation
      trainers will subsequently collaborate with the POCUS experts from Toronto to develop a
      two-day training program for lung POCUS image interpretation and acquisition that is tailored
      to novice users (CHWs) in low-resource settings. In the second phase, the first generation
      local lung POCUS trainers will deliver and evaluate the new training program to the second
      generation of users - a group of CHWs in Karachi. In the third phase, we will establish the
      reliability of CHWs to perform lung POCUS on pediatric patients with respiratory symptoms,
      upon completion of the training program developed by local trainers.
    

Detailed description: 
      POCUS is an example of technologies that are moving out of hospitals and to the
      point-of-care. The true potential of these novel diagnostics to improve global pediatric
      pneumonia outcomes will only be realized if they can be employed by CHWs in community
      settings in LMICs. No work has yet focused on the performance of POCUS by
      non-medically-trained CHWs in LMICs. Demonstrating that accurate POCUS performance and
      interpretation can be achieved by non-medically-trained CHWs after focused and succinct
      training is the first step towards developing a novel pediatric pneumonia diagnosis and
      management algorithm for LMICs. Feedback from these ultrasound-naïve users about their lung
      POCUS learning experience is also needed to clarify which POCUS findings would be best suited
      to this algorithm.

      The research team in AKUH will recruit and consent interested CHWs from AKU field sites in
      Karachi. The target is to recruit a convenience sample of 3 CHWs, who will be as
      representative as possible of the experience and skill sets as the average CHW in a
      government program. Study participants will be identified and approached by clinical team
      members in the AKUH emergency department, outpatient clinic and pediatric ward.

      Triaging children with ARI into accurate treatment categories will lead to increased
      paediatric pneumonia survival, improved antibiotic stewardship, and more appropriate resource
      use, all of which are clinically and programmatically significant in highest disease burden
      settings. This project also lays the foundation for future projects that harness the
      trans-formative potential of POCUS for global child health.
    

Intervention name(s): ULTRASOUND
Intervention type(s): Device
Intervention description(s): Lung ultrasound done through POCUS to diagnose pneumonia
Observational model: Case-Only
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Children between age of 2 months to 5 years and presenting with signs and symptoms of
        pneumonia, will be identified and approached by clinical team members in the AKUH emergency
        department, outpatient clinic and pediatric ward. The research member will review the study
        with the family and obtain informed consent from parents.
      
Keywords: Lung; POCUS; Pneumonia; ARI; CHWs