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


  • 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:  01 April 2019
  • End date:  30 June 2020
  • 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


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

  • Ethical approvals were obtained from Bangladesh Medical Research Council (Registration number 09630012018) on 12 June 2018 and ACCORD Medical Research Ethics Committee (Reference number 18-HV-051) on 22 November 2018.
  • Project protocol published on on 17 May 2019 (Registration number NCT03959956).
  • Questionnaires/data collection forms have been pre-tested and finalised, and the electronic data entry system has been developed in android platform.
  • Training of field staff on study procedure and recording lung sounds using the Smartscope are completed and the pilot is underway.
  • 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.

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