Point-of-care ultrasound (POCUS) in a remote area of Sierra Leone: impact on patient management and training program for
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ORIGINAL PAPER
Point‑of‑care ultrasound (POCUS) in a remote area of Sierra Leone: impact on patient management and training program for community health officers Vittorio Sabatino1 · Maria Rosaria Caramia2 · Antonietta Curatola3 · Francesca Vassallo4 · Andrea Deidda5 · Bianca Cinicola4 · Francesco Iodice3 · Carlo Caffarelli2 · Nicola Sverzellati1 · Danilo Buonsenso3,6 Received: 2 October 2019 / Accepted: 19 December 2019 © Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB) 2020
Abstract Purpose Point-of-care ultrasound (POCUS) has been shown to have unique potential in low-income countries. Physicians and other healthcare providers can perform effective scans after a short period of training. This study aimed to evaluate indications and utility of ultrasonography as the main imaging service in a poor rural sub-Saharan region of Africa. Second, it evaluated the effect of a short training on POCUS for non-physician health providers and their agreement with a group of Italian physicians. Methods This study was undertaken in Lokomasama—a chiefdom of Sierra Leone—between January and February 2019. Based on clinical indications, ultrasound findings were evaluated with respect to the initial diagnostic hypothesis. Volunteer doctors conducted a theoretical–practical training of two community health officers (CHO) on chest and abdominal POCUS and E-FAST protocol. The evaluation of the achieved technical skills was obtained with a numeric score. Inter-observer agreement concerning ultrasound diagnosis based on clinical indications was assessed. Results A total of 196 consecutive patients underwent ultrasound examination. POCUS findings were in keeping with the clinical diagnosis in the 49.5%. POCUS changed the initial diagnosis in 17% of cases. After training, E-FAST and POCUS knowledge score was 90% and 83%, respectively. An excellent inter-observer agreement (0.88) was found between CHOs and physicians. Conclusion POCUS represents a powerful diagnostic tool in a low-income country that may improve the patient management. Training of non-physician health providers is doable and may improve healthcare management in resource-limited settings. Keywords POCUS · Training · Ultrasound · Sub-Saharan Africa
Introduction Only 220 million people in developing countries (for a population of over five billion people) have access to basic radiology services. The World Health Organization (WHO) estimates that 60% of the world’s population does not have access to basic x-ray, computed tomography scanners, or other imaging tools in their local health centers [1]. Ultrasonography may be an important tool for developing health services in low- and middle-income countries [2]. Indeed, ultrasound is relatively cheap, portable, noninvasive, * Danilo Buonsenso [email protected] Extended author information available on the last page of the article
and easy to use for basic clinical queries. Nowadays, smartphone-size machine retails for less than 10,000 $ have dual probes with low and high sound wave frequencies, a
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