Point-of-care ultrasound for tuberculosis management in Sub-Saharan Africa—a balanced SWOT analysis

Suttels, Véronique; Toit, Jacques du; Fiogbé, A A; Wachinou, A P; Guendehou, B; Alovokpinhou, F; Toukoui, P; Hada, A R; Sefou, F; Vinasse, P; Makpemikpa, G; Capo-Chichi, D; Garcia, E; Brahier, Thomas; Keitel, Kristina; Ouattara, K.; Cissoko, Yacouba; Beye, SA; Mans, P.; Agodokpessi, G; Boillat‐Blanco, Noémie; Hartley, Mary-Anne

doi:10.1016/j.ijid.2022.07.009

Cited by 12 publications

(9 citation statements)

References 42 publications

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“…This streamlining of the workflow is consistent with previous qualitative findings in a paediatric setting 9. Its lack of radiation also makes it an interesting technique for pregnant women and children 18…”

Section: Discussionsupporting

confidence: 88%

Barriers and facilitators to implementation of point-of-care lung ultrasonography in a tertiary centre in Benin: a qualitative study among general physicians and pneumologists

et al. 2023

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ObjectivesOwing to its ease-of-use and excellent diagnostic performance for the assessment of respiratory symptoms, point-of-care lung ultrasound (POC-LUS) has emerged as an attractive skill in resource-low settings, where limited access to specialist care and inconsistent radiology services erode health equity.To narrow down the research to practice gap, this study aims to gain in-depth insights in the perceptions on POC-LUS and computer-assisted POC-LUS for the diagnosis of lower respiratory tract infections (LRTIs) in a low-income and middle-income country (LMIC) of sub-Saharan Africa.Design and settingQualitative study using face-to-face semi-structured interviews with three pneumologists and five general physicians in a tertiary centre for pneumology and tuberculosis in Benin, West Africa. The center hosts a prospective cohort study on the diagnostic performance of POC-LUS for LRTI. In this context, all participants started a POC-LUS training programme 6 months before the current study. Transcripts were coded by the interviewer, checked for intercoder reliability by an independent psychologist, compared and thematically summarised according to grounded theory methods.ResultsVarious barriers− and facilitators+ to POC-LUS implementation were identified related to four principal categories: (1) hospital setting (eg, lack of resources for device renewal or maintenance−, need for POC tests+), (2) physician’s perceptions (eg, lack of opportunity to practice−, willingness to appropriate the technique+), (3) tool characteristics (eg, unclear lifespan−, expedited diagnosis+) and (4) patient’s experience (no analogous image to keep−, reduction in costs+). Furthermore, all interviewees had positive attitudes towards computer-assisted POC-LUS.ConclusionsThere is a clear need for POC affordable lung imaging techniques in LMIC and physicians are willing to implement POC-LUS to optimise the diagnostic approach of LRTI with an affordable tool. Successful integration of POC-LUS into clinical routine will require adequate responses to local challenges related to the lack of available maintenance resources and limited opportunity to supervised practice for physicians.

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Section: Discussionsupporting

confidence: 88%

Barriers and facilitators to implementation of point-of-care lung ultrasonography in a tertiary centre in Benin: a qualitative study among general physicians and pneumologists

et al. 2023

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“…14 Considering the versatility and the increasing affordability of handheld ultrasound devices, together with the World Health Organization (WHO) estimation that 60% of the world's population does not have access to basic X-ray, computed tomography (CT) scanners, or other imaging tools, it seems worthwhile to promote this low-cost high-yield technology in LRS. 15,16 Nowadays, handheld, smartphone-size machines capable imaging superficial (vascular, pleura) and deep (cardiac, abdomen) anatomical structures are sold for less than CAD $4000. 17 Additionally, since PoCUS answers focused diagnostic questions, using easily employed techniques, it is relatively simple to acquire PoCUS skills, with studies demonstrating that effective and accurate scans can be performed even after as little as 3 hours of teaching and 5 hours of hands-on training.…”

Section: Discussionmentioning

confidence: 99%

Point-of-Care Ultrasound (PoCUS) and Its Potential to Advance Patient Care in Low-Resource Settings and Conflict Zones

Dana,

Nour,

Kpa’Hanba

et al. 2023

Disaster med. public health prep.

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Point-of-care ultrasound (PoCUS) is used by health care professionals of various specialties worldwide, with excellent results demonstrating significant potential to advance patient care. However, in low resource areas of the world, where other imaging modalities are scarce and the potential of handheld pocket-sized PoCUS devices with great versatility and increasing affordability seems most significant, its use is far from being widespread. In this report, our group of Chadian, Israeli, and Canadian physicians with experience in rural, military, and conflict zone medical aid, discusses the barriers to the implementation of PoCUS in low resource areas and offers potential solutions.

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“…Meanwhile, based on currently available data, on the case series shown by us and on studies performed in extremely resource-limited setting [ 12 , 27 , 28 ], we believe LUS can be useful—in high-resources countries for the follow-up of TB lung consolidations which touch the pleura and—as instrumental diagnostic support in particular conditions such as in low-resource countries with high childhood mortality PTB due to missed or delayed diagnosis [ 1 , 6 , 12 , 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

“…Data on the use of LUS for the diagnosis and follow-up of childhood PTB are limited and in some respects contradictory [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. Precisely because in some contexts such as in poor countries—which are also the countries in which childhood pulmonary tuberculosis is most widespread—LUS is the only tool that can be used, it is important to study its role in supporting the clinical diagnosis of childhood PTB.…”

Section: Introductionmentioning

confidence: 99%

Utility and Limits of Lung Ultrasound in Childhood Pulmonary Tuberculosis: Lessons from a Case Series and Literature Review

Morello¹,

Ferrari²,

Valentini³

et al. 2022

JCM

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Childhood pulmonary tuberculosis (PTB) diagnosis is often a challenge that requires a combination of history, clinical, radiological, immunological and microbiological findings. Radiological diagnosis is based today on the use of chest X-ray and chest CT that, in addition to being radio-invasive tools for children, are often not available in countries with low-resources. A non-invasive, easily usable and reproducible, low-cost diagnostic tool as LUS would therefore be useful to use to support the diagnosis of childhood PTB. Data on the use of LUS for the diagnosis and follow-up of childhood PTB are limited and in some respects contradictory. To help better define the potential role of LUS we have described the pros and cons of lung ultrasound method through a brief review of the studies in the literature and reporting some case series in which we describe clinical, laboratory, radiological results as well as detailed lung ultrasound findings of four children/adolescents with PTB.

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Point-of-care ultrasound for tuberculosis management in Sub-Saharan Africa—a balanced SWOT analysis

Cited by 12 publications

References 42 publications

Barriers and facilitators to implementation of point-of-care lung ultrasonography in a tertiary centre in Benin: a qualitative study among general physicians and pneumologists

Barriers and facilitators to implementation of point-of-care lung ultrasonography in a tertiary centre in Benin: a qualitative study among general physicians and pneumologists

Point-of-Care Ultrasound (PoCUS) and Its Potential to Advance Patient Care in Low-Resource Settings and Conflict Zones

Utility and Limits of Lung Ultrasound in Childhood Pulmonary Tuberculosis: Lessons from a Case Series and Literature Review

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