Digital auscultation as a novel childhood pneumonia diagnostic tool for community clinics in Sylhet, Bangladesh: protocol for a cross-sectional study

Abstract

IntroductionThe WHO’s Integrated Management of Childhood Illnesses (IMCI) algorithm for diagnosis of child pneumonia relies on counting respiratory rate and observing respiratory distress to diagnose childhood pneumonia. IMCI case defination for pneumonia performs with high sensitivity but low specificity, leading to overdiagnosis of child pneumonia and unnecessary antibiotic use. Including lung auscultation in IMCI could improve specificity of pneumonia diagnosis. Our objectives are: (1) assess lung sound recording quality by primary healthcare workers (HCWs) from under-5 children with the Feelix Smart Stethoscope and (2) determine the reliability and performance of recorded lung sound interpretations by an automated algorithm compared with reference paediatrician interpretations.Methods and analysisIn a cross-sectional design, community HCWs will record lung sounds of ~1000 under-5-year-old children with suspected pneumonia at first-level facilities in Zakiganj subdistrict, Sylhet, Bangladesh. Enrolled children will be evaluated for pneumonia, including oxygen saturation, and have their lung sounds recorded by the Feelix Smart stethoscope at four sequential chest locations: two back and two front positions. A novel sound-filtering algorithm will be applied to recordings to address ambient noise and optimise recording quality. Recorded sounds will be assessed against a predefined quality threshold. A trained paediatric listening panel will classify recordings into one of the following categories: normal, crackles, wheeze, crackles and wheeze or uninterpretable. All sound files will be classified into the same categories by the automated algorithm and compared with panel classifications. Sensitivity, specificity and predictive values, of the automated algorithm will be assessed considering the panel’s final interpretation as gold standard.Ethics and disseminationThe study protocol was approved by the National Research Ethics Committee of Bangladesh Medical Research Council, Bangladesh (registration number: 09630012018) and Academic and Clinical Central Office for Research and Development Medical Research Ethics Committee, Edinburgh, UK (REC Reference: 18-HV-051). Dissemination will be through conference presentations, peer-reviewed journals and stakeholder engagement meetings in Bangladesh.Trial registration numberNCT03959956.

End-user acceptability of a prototype digital stethoscope to diagnose childhood pneumonia- A qualitative exploration from Sylhet, Bangladesh

“…This is a qualitative study to explore the acceptability of the 2018 prototype digital stethoscope system among potential end-users. This study is a part of a larger study (7) aiming to compare automated lung sound classi cations by digital auscultation based on trained pediatricians' reading, as part of a broader effort to improve the accuracy of childhood pneumonia diagnosis.…”

“…The prototype digital stethoscope was designed for non-traditional clinical settings, such as rural or walkin clinics, homes, or low-resource areas, to be used by both trained and untrained personnel. It is equipped with advanced onboard and real-time algorithms that can detect adventitial lung sounds in recordings and improve the quality of the body sounds detected by the device through adaptive noise cancellation and the use of an externally facing microphone, mitigating any ambient noise typically present in nontraditional settings (7).…”

“…This application can be applied to support clinical care and research projects involving the stethoscope. The application guides participants through the data collection process at four preset locations on the body -two from back and two from front chest ( (7). and subsequently asks participants questions regarding symptoms at the time of recording.…”

“…Second, its application demands a quiet environment, which may be di cult to nd in crowded rural health centers such as Community Clinics (CCs) in Bangladesh. A technology that overcomes the limitations of standard conventional stethoscopes and, at the same time, is inexpensive and acceptable to end-users could be a transformative solution (7).…”

Mapping national information and communication technology (ICT) infrastructure to the requirements of potential digital health interventions in low- and middle-income countries

“…Digital health solutions can overcome the problems of distance, poor transport infrastructure, limited medical provision in rural areas and the need to provide rural practitioners with specialist support [ 1 ]. Recent telehealth examples from the National Institute for Health and Care Research (NIHR) Global Health Research Unit on Respiratory Health (RESPIRE) include digital auscultation to improve diagnosis of paediatric pneumonia [ 2 ], computational frameworks to interpret chest x-rays [ 3 ], home-based pulmonary rehabilitation [ 4 ], mHealth support for Community Health Workers [ 5 , 6 ], remote teleconsultation facilities (Micro-Health Centres) [ 7 ] mobile-based interventions for adults with asthma with limited health literacy [ 8 ] , and blended learning for professional [ 9 , 10 ]. However, poor mobile signal coverage [ 11 ] and limited availability of mobile/smart devices [ 12 ] hinder the application of digital health in rural and/or deprived communities.…”