NIHR Global Health Research Unit on Respiratory Health (RESPIRE)

Community use of digital auscultation in diagnosis of pneumonia

This project is based at Projahnmo Research Foundation in Bangladesh

Overview

  • Project title: Community use of digital auscultation to improve diagnosis of paediatric pneumonia in Sylhet, Bangladesh
  • Acute or chronic:  Acute
  • Based at:  Projahnmo Research Foundation
  • Start date:  May 2019
  • End date:  August 2021
  • Principal investigator:  Dr Dipak Kumar Mitra
  • Project team:  Dr Salahuddin Ahmed, Dr Eric D McCollum, Professor Harish Nair, Professor Steve Cunningham, Professor Harry Campbell, Professor Aziz Sheikh, Professor John Norrie, Dr Ahad Mahmud Khan, Dr M.A. Quaiyum, Nazma Begum, Professor Abdullah H Baqui

Background

Integrated Community Case Management (iCCM) is a World Health Organization (WHO) approach in which community health workers deliver basic healthcare services in the community setting, including childhood pneumonia treatment.

The WHO pneumonia guidelines are sensitive but non-specific, in order to ensure that children with possible pneumonia receive antibiotic treatment. As a result, while the guidelines miss few children with pneumonia (high sensitivity), many children who do not have pneumonia incorrectly receive antibiotics (low specificity), resulting in antibiotic overuse.

The WHO guidelines do not include lung auscultation (listening to lung sounds) in their pneumonia definition for frontline healthcare workers, likely due to its high inter-observer variability, regardless of healthcare providers’ training level. Digital auscultation by electronic stethoscopes may help to overcome these limitations. Inclusion of lung auscultation in the current algorithm could enhance the specificity of the guidelines.

Aim and impact

This study aims to improve the diagnostic accuracy of child pneumonia by using automated lung sound classification through digital auscultation.

If effective, healthcare providers at first level facilities will be able to more accurately diagnose pneumonia in low- and middle-income countries. Improved accuracy of pneumonia diagnosis holds the potential of markedly improving pneumonia treatment decision-making where most children first access respiratory care.

Key developments

  • A Memorandum of Understanding (MoU) has been signed between the Directorate General of Health Service and Projahnmo Research Foundation on 30 July 2019. This MoU will help to conduct stakeholders meetings and scale up of the study.
  • Held meetings with national level policymakers from the Ministry of Health as well as WHO representatives, Save the Children, professional bodies (e.g. Bangladesh Paediatric Association), and healthcare professionals on the potential of digital auscultation in the specificity of detecting childhood pneumonia in the community level health settings.
  • A stakeholder engagement workshop “Sensitization Workshop on Digital Auscultation Study” was conducted at national level, with policy makers, program managers, paediatricians, health officials of non-government and international organizations on 20 January 2021, to discuss and sensitize on different aspect of the study, its objectives and activities, and future scale up of digital stethoscope.
  • A district level stakeholder engagement meeting was organized on 17 February 2021 at the Civil Surgeon Office, Sylhet with the presence of health officials from all 12 sub-districts of Sylhet and the Program Managers of National Newborn Health Program and Integrated Management of Childhood Illness (NNHP & IMCI), Directorate of Health Services.
  • The enrolment of children as per the sample size was completed.
  • An online-based application was developed to capture the interpretation of lung sounds by a listening panel.

Project data

Download the project Data Management Plan

View the project metadata on the Health Data Research Innovations Gateway

Embedded PhD project

RESPIRE PhD student Salahuddin Ahmed is conducting an embedded project as part of this wider study.

Find out more about Salahuddin's PhD