Community Health Worker Use of Novel Point-of-Care Diagnostics for Pneumonia in Resource-Constrained Settings

Pneumonia is the largest global infectious killer of children under 5 years, and mostly affects poor rural children in low and middle-income countries (LMICs) with no access to care except visits by community health workers (CHWs). A CHW detects pneumonia with an inaccurate set of physical findings that misses many cases while adding to global antibiotic resistance. We have developed a novel pneumonia diagnosis and treatment algorithm with innovative point-of-care tests to be used by CHWs. Point-of-care ultrasound (POCUS) is handheld imaging recently validated for detecting pediatric pneumonia. Combined with point-of-care oximetry (POCOX), it could accurately stratify which children need antibiotics and referral to health facilities. Our business partner’s low-cost device pairs with smartphones and has potential to scale in resource-limited settings. Previous studies in LMICs show lung POCUS can be rapidly taught to local physicians. We seek to establish whether a brief training intervention leads to accurate use of handheld lung POCUS by CHWs in Karachi, Pakistan. CHW training will occur over 2 days and focus on the technical performance and interpretation of lung POCUS. CHWs accuracy will then be assessed by comparing their results to an expert user for children in a Karachi hospital. While this study is facility based, it is specifically designed to lead to diffusion of this innovative technology to rural areas in LMICs.