Novel handheld ultrasound technology to enhance non‐expert screening for rheumatic heart disease in the Republic of Palau: A descriptive study

Abstract

Aim Non‐expert training in rheumatic heart disease (RHD) detection is a valuable strategy in resource‐limited settings. Here we present an innovative handheld ultrasound application featuring views of correct probe position, imaging protocol and echocardiographic loops of RHD pathology versus normal, accessible during real‐time scanning. Methods This prospective study was implemented into a pre‐existing school health screening programme at an elementary school in Koror, Palau. Six learners with no prior ultrasound experience were taught a simplified screening protocol in which a mitral regurgitation jet ≥1.5 cm and/or presence of aortic insufficiency were considered a positive screen. All consented children underwent echocardiographic screening by experts with standard portable echocardiography. All positive cases and 25% of negative cases were referred for handheld scans by learners. Results A total of 26 (4.1%) children were diagnosed with borderline or definite RHD. Mean sensitivity and specificity compared to expert RHD diagnosis over all learners was 71% (standard deviation (SD) 11.3) and 92% (SD 4.9), respectively. For the three highest scanning learners, mean sensitivity was 88% (SD 4.9) and mean specificity was 90% (SD 5.7). For all definite RHD cases, sensitivity was 100% for all but one learner, who achieved sensitivity of 60%. The novel application was used in 229 of 624 (36%) of all handheld scans and 50 of 112 (45%) of expert‐diagnosed positive scans, with protocol and reference features most frequently used. Utilisation of the novel application overall decreased per day of scanning per learner. Conclusion Adjunctive handheld ultrasound technology may help ease non‐experts into RHD screening.

Task shifting for point of care ultrasound in primary healthcare in low- and middle-income countries-a systematic review

“… 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 Thirty-five studies were prospective observational studies and one randomized controlled trial. 30 The majority of the included publications ( n = 20) were conducted on the African continent, 21 , 22 , 31 , 32 , 33 , 34 , 35 , 37 , 39 , 40 , 42 , 43 , 44 , 46 , 47 , 49 , 50 , 51 , 52 , 53 nine studies originated from the Americas, 24 , 27 , 29 , 38 , 41 , 45 , 54 , 55 , 56 two from Asia, 26 , 36 and three from Oceania 23 , 28 , 57 as shown in Figure 2…”

“…Ten publications reported on task shifting for POCUS in obstetric care, examining pregnancy and pregnancy related complications. 24 , 25 , 26 , 30 , 31 , 34 , 35 , 43 , 46 , 47 Nine and three publications reported on task shifting for chest POCUS for cardiac and pulmonary conditions respectively, including rheumatic heart disease screening, diagnosing cardiac structural anomalies, aneurysms and deep vein thrombosis, 23 , 28 , 30 , 36 , 38 , 39 , 45 , 55 , 57 , 58 and lung examinations to diagnose conditions such as pneumonia, tuberculosis, pleural effusion and atelectasia. 29 , 53 , 59 Further reported task shifting for POCUS applications included abdominopelvic examination for liver, gallbladder diseases, and kidney diseases, prostate hypertrophy and urinary tract infection, 21 , 32 , 41 , 42 , 44 , 54 breast and axillary examination for breast cancer screening, 40 , 56 examination in trauma patients for pneumothorax and internal haemorrhage, 48 examination for HIV associated tuberculosis, 33 and screening for abdominal cystic echinococcosis.…”

“…Cardiac POCUS was used to screen for rheumatic heart disease (RHD) in pediatric populations by obtaining qualitative images of pathologies such as mitral and aortic regurgitation with satisfactory interobserver agreement when compared with experienced reviewers. 23 , 28 , 38 , 39 , 55 , 57 Task shifting for cardiac POCUS was also used to diagnose heart failure and hypertensive heart disease in the adult population. 36 , 45 …”

“…Challenges of task shifting for POCUS including drawbacks to successful implementation and sustainability were described in 13 (37%) of the publications. 21 , 23 , 24 , 27 , 32 , 35 , 39 , 41 , 43 , 44 , 50 , 54 , 57 The common constraints of working in resource limited settings including poor quality of the healthcare system paired with lack of local healthcare providers to lead and sustain ultrasound programs, 44 a high turn-over of local supportive supervision, 27 and unstable electricity 43 , 54 were identified as barriers. These factors led to reduced frequency of POCUS examination, incomplete data log, loss of data, loss of ultrasound images and interpretations.…”

“…21−48 Thirty-five studies were prospective observational studies and one randomized controlled trial. 30 The majority of the included publications (n = 20) were conducted on the African continent, 21,22,31 −35,37,39,40,42−44,46,47,49−53 nine studies originated from the Americas, 24,27,29,38,41,45,54−56 two from Asia, 26,36 and three from Oceania 23,28,57 as shown in Figure 2. Two studies were multi-national studies.…”