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Sachdeva M, Datchoua AM, Yakam VF, Kenfack B, Jonnalagedda-Cattin M, Thiran JP, Petignat P, Schmidt NC. Acceptability of artificial intelligence for cervical cancer screening in Dschang, Cameroon: a qualitative study on patient perspectives. Reprod Health 2024; 21:92. [PMID: 38937771 PMCID: PMC11212410 DOI: 10.1186/s12978-024-01828-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 06/12/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Cervical cancer is the fourth most frequent cancer among women, with 90% of cervical cancer-related deaths occurring in low- and middle-income countries like Cameroon. Visual inspection with acetic acid is often used in low-resource settings to screen for cervical cancer; however, its accuracy can be limited. To address this issue, the Swiss Federal Institute of Technology Lausanne and the University Hospitals of Geneva are collaborating to develop an automated smartphone-based image classifier that serves as a computer aided diagnosis tool for cancerous lesions. The primary objective of this study is to explore the acceptability and perspectives of women in Dschang regarding the usage of a screening tool for cervical cancer relying on artificial intelligence. A secondary objective is to understand the preferred form and type of information women would like to receive regarding this artificial intelligence-based screening tool. METHODS A qualitative methodology was employed to gain better insight into the women's perspectives. Participants, aged between 30 and 49 were invited from both rural and urban regions and semi-structured interviews using a pre-tested interview guide were conducted. The focus groups were divided on the basis of level of education, as well as HPV status. The interviews were audio-recorded, transcribed, and coded using the ATLAS.ti software. RESULTS A total of 32 participants took part in the six focus groups, and 38% of participants had a primary level of education. The perspectives identified were classified using an adapted version of the Technology Acceptance Model. Key factors influencing the acceptability of artificial intelligence include privacy concerns, perceived usefulness, and trust in the competence of providers, accuracy of the tool as well as the potential negative impact of smartphones. CONCLUSION The results suggest that an artificial intelligence-based screening tool for cervical cancer is mostly acceptable to the women in Dschang. By ensuring patient confidentiality and by providing clear explanations, acceptance can be fostered in the community and uptake of cervical cancer screening can be improved. TRIAL REGISTRATION Ethical Cantonal Board of Geneva, Switzerland (CCER, N°2017-0110 and CER-amendment n°4) and Cameroonian National Ethics Committee for Human Health Research (N°2022/12/1518/CE/CNERSH/SP). NCT: 03757299.
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Affiliation(s)
- Malika Sachdeva
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Alida Moukam Datchoua
- Department of Gynaecology and Obstetrics, Dschang Regional Annex Hospital, Dschang, Cameroon
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Virginie Flore Yakam
- Department of Gynaecology and Obstetrics, Dschang Regional Annex Hospital, Dschang, Cameroon
| | - Bruno Kenfack
- Department of Gynaecology and Obstetrics, Dschang Regional Annex Hospital, Dschang, Cameroon
| | - Magali Jonnalagedda-Cattin
- Signal Processing Laboratory LTS5, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
- EssentialTech Centre, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Jean-Philippe Thiran
- Signal Processing Laboratory LTS5, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Patrick Petignat
- Gynaecology Division, Department of Paediatrics, Gynaecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Nicole Christine Schmidt
- Gynaecology Division, Department of Paediatrics, Gynaecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland
- Faculty of Social Science, Catholic University of Applied Science, Munich, Germany
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Jiménez-Díaz G, Aune A, Elizarrarás-Rivas J, Gierman LM, Keitsch M, Marcuzzi A, Infanti JJ. Neonatal jaundice detection in low-resource Mexican settings: possibilities and barriers for innovation with mobile health. BMC Health Serv Res 2024; 24:671. [PMID: 38807158 PMCID: PMC11134921 DOI: 10.1186/s12913-024-11141-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 05/22/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Neonatal jaundice is a common condition that can lead to brain damage and disabilities when severe cases go undetected. Low- and middle-income countries often lack accurate methods for detecting neonatal jaundice and rely on visual assessment, resulting in a higher incidence of adverse consequences. Picterus Jaundice Pro (Picterus JP), an easy-to-use and affordable smartphone-based screening device for the condition, has demonstrated higher accuracy than visual assessment in Norwegian, Philippine and Mexican newborns. This study aimed to identify the barriers and facilitators to implementing Picterus JP in public health services in low-income settings in Mexico by exploring the current process of neonatal jaundice detection and stakeholders' perspectives in that context. METHODS Qualitative data collection techniques, including one focus group, 15 semi-structured interviews and four observations, were employed in urban and rural health facilities in Oaxaca, Mexico. The participants included medical doctors, nurses and health administrators. The data were analysed by thematic analysis guided by the Consolidated Framework for Implementation Research. RESULTS The analysis yielded four main themes: (I) the current state of neonatal care and NNJ detection, (II) the needs and desires for enhancing NNJ detection, (III) the barriers and facilitators to implementing Picterus JP in the health system and (IV) HCWs' expectations of Picterus JP. The findings identify deficiencies in the current neonatal jaundice detection process and the participants' desire for a more accurate method. Picterus JP was perceived as easy to use, useful and compatible with the work routine, but barriers to adoption were identified, including internet deficiencies and costs. CONCLUSIONS The introduction of Picterus JP as a supporting tool to screen for neonatal jaundice is promising but contextual barriers in the setting must be addressed for successful implementation. There is also an opportunity to optimise visual assessment to improve detection of neonatal jaundice.
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Affiliation(s)
- Gabriela Jiménez-Díaz
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.
- Picterus AS, Trondheim, Norway.
| | - Anders Aune
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- Picterus AS, Trondheim, Norway
- Department of Pediatrics, St Olav's University Hospital, Trondheim, Norway
| | - Jesús Elizarrarás-Rivas
- Health Research Coordination, Mexican Institute of Social Security, IMSS, Oaxaca, Mexico
- Faculty of Medicine and Surgery, Universidad Autónoma Benito Juárez de Oaxaca, Oaxaca City, México
| | | | - Martina Keitsch
- Department of Design, Faculty of Architecture and Design, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anna Marcuzzi
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- Department of Physical Medicine and Rehabilitation, St. Olav's University Hospital, Trondheim, Norway
| | - Jennifer J Infanti
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
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Wohlgemut JM, Pisirir E, Kyrimi E, Stoner RS, Marsh W, Perkins ZB, Tai NRM. Methods used to evaluate usability of mobile clinical decision support systems for healthcare emergencies: a systematic review and qualitative synthesis. JAMIA Open 2023; 6:ooad051. [PMID: 37449057 PMCID: PMC10336299 DOI: 10.1093/jamiaopen/ooad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 06/15/2023] [Accepted: 06/30/2023] [Indexed: 07/18/2023] Open
Abstract
Objective The aim of this study was to determine the methods and metrics used to evaluate the usability of mobile application Clinical Decision Support Systems (CDSSs) used in healthcare emergencies. Secondary aims were to describe the characteristics and usability of evaluated CDSSs. Materials and Methods A systematic literature review was conducted using Pubmed/Medline, Embase, Scopus, and IEEE Xplore databases. Quantitative data were descriptively analyzed, and qualitative data were described and synthesized using inductive thematic analysis. Results Twenty-three studies were included in the analysis. The usability metrics most frequently evaluated were efficiency and usefulness, followed by user errors, satisfaction, learnability, effectiveness, and memorability. Methods used to assess usability included questionnaires in 20 (87%) studies, user trials in 17 (74%), interviews in 6 (26%), and heuristic evaluations in 3 (13%). Most CDSS inputs consisted of manual input (18, 78%) rather than automatic input (2, 9%). Most CDSS outputs comprised a recommendation (18, 78%), with a minority advising a specific treatment (6, 26%), or a score, risk level or likelihood of diagnosis (6, 26%). Interviews and heuristic evaluations identified more usability-related barriers and facilitators to adoption than did questionnaires and user testing studies. Discussion A wide range of metrics and methods are used to evaluate the usability of mobile CDSS in medical emergencies. Input of information into CDSS was predominantly manual, impeding usability. Studies employing both qualitative and quantitative methods to evaluate usability yielded more thorough results. Conclusion When planning CDSS projects, developers should consider multiple methods to comprehensively evaluate usability.
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Affiliation(s)
- Jared M Wohlgemut
- Corresponding Author: Jared M. Wohlgemut, MSc, Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, 4 Newark St, London E1 2AT, UK;
| | - Erhan Pisirir
- Department of Electrical Engineering and Computer Science, Queen Mary University of London, London, UK
| | - Evangelia Kyrimi
- Department of Electrical Engineering and Computer Science, Queen Mary University of London, London, UK
| | - Rebecca S Stoner
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
- Trauma Service, Royal London Hospital, Barts NHS Health Trust, London, UK
| | - William Marsh
- Department of Electrical Engineering and Computer Science, Queen Mary University of London, London, UK
| | - Zane B Perkins
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
- Trauma Service, Royal London Hospital, Barts NHS Health Trust, London, UK
| | - Nigel R M Tai
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
- Trauma Service, Royal London Hospital, Barts NHS Health Trust, London, UK
- Academic Department of Military Surgery and Trauma, Royal Centre of Defence Medicine, Birmingham, UK
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Labarta JI, Dimitri P, Keiser M, Koledova E, Rivera-Romero O. Evaluating the Usefulness and Ease of Use of a Next-Generation-Connected Drug Delivery Device for Growth Hormone Therapy: Qualitative Study of Health Care Professionals' Perceptions. JMIR Hum Factors 2023; 10:e46893. [PMID: 37531173 PMCID: PMC10433030 DOI: 10.2196/46893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/09/2023] [Accepted: 06/17/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Digital solutions targeting children's health have become an increasingly important element in the provision of integrated health care. For the treatment of growth hormone deficiency (GHD), a unique connected device is available to facilitate the delivery of recombinant human growth hormone (r-hGH) by automating the daily injection process and collecting injection data such that accurate adherence information is available to health care professionals (HCPs), caregivers, and patients. The adoption of such digital solutions requires a good understanding of the perspectives of HCPs as key stakeholders because they leverage data collection and prescribe these solutions to their patients. OBJECTIVE This study aimed to evaluate the third generation of the easypod device (EP3) for the delivery of r-hGH treatment from the HCP perspective, with a focus on perceived usefulness and ease of use. METHODS A qualitative study was conducted, based on a participatory workshop conducted in Zaragoza, Spain, with 10 HCPs experienced in the management of pediatric GHD from 7 reference hospitals in Spain. Several activities were designed to promote discussion among participants about predefined topics based on the Technology Acceptance Model and the Unified Theory of Acceptance and Use of Technology to provide their perceptions about the new device. RESULTS Participants reported 2 key advantages of EP3 over previous easypod generations: the touch screen interface and the real-time data transmission functionality. All participants (10/10, 100%) agreed that the new device should be part of a digital health ecosystem that provides complementary functionalities including data analysis. CONCLUSIONS This study explored the perceived value of the EP3 autoinjector device for the treatment of GHD by HCPs. HCPs rated the new capabilities of the device as having substantial improvements and concluded that it was highly recommendable for clinical practice. EP3 will enhance decision-making and allow for more personalized care of patients receiving r-hGH.
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Affiliation(s)
- José I Labarta
- Unit of Endocrinology, Department of Pediatrics, Hospital Universitario Miguel Servet, Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Paul Dimitri
- Department of Paediatric Endocrinology, Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom
| | - Matthew Keiser
- Ares Trading SA (an affiliate of Merck KGaA), Eysins, Switzerland
| | - Ekaterina Koledova
- Global Medical Affairs Cardiometabolic & Endocrinology, Merck Healthcare KGaA, Darmstadt, Germany
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Dougherty K, Hobensack M, Bakken S. Scoping review of health information technology usability methods leveraged in Africa. J Am Med Inform Assoc 2023; 30:726-737. [PMID: 36458941 PMCID: PMC10018268 DOI: 10.1093/jamia/ocac236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/14/2022] [Accepted: 11/18/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE The aim of this study was to explore the state of health information technology (HIT) usability evaluation in Africa. MATERIALS AND METHODS We searched three electronic databases: PubMed, Embase, and Association for Computing Machinery. We categorized the stage of evaluations, the type of interactions assessed, and methods applied using Stead's System Development Life Cycle (SDLC) and Bennett and Shackel's usability models. RESULTS Analysis of 73 of 1002 articles that met inclusion criteria reveals that HIT usability evaluations in Africa have increased in recent years and mainly focused on later SDLC stage (stages 4 and 5) evaluations in sub-Saharan Africa. Forty percent of the articles examined system-user-task-environment (type 4) interactions. Most articles used mixed methods to measure usability. Interviews and surveys were often used at each development stage, while other methods, such as quality-adjusted life year analysis, were only found at stage 5. Sixty percent of articles did not include a theoretical model or framework. DISCUSSION The use of multistage evaluation and mixed methods approaches to obtain a comprehensive understanding HIT usability is critical to ensure that HIT meets user needs. CONCLUSIONS Developing and enhancing usable HIT is critical to promoting equitable health service delivery and high-quality care in Africa. Early-stage evaluations (stages 1 and 2) and interactions (types 0 and 1) should receive special attention to ensure HIT usability prior to implementing HIT in the field.
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Affiliation(s)
- Kylie Dougherty
- School of Nursing, Columbia University, New York, New York, USA
| | | | - Suzanne Bakken
- School of Nursing, Columbia University, New York, New York, USA
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Spurr R, Ng E, Onchiri FM, Rapha B, Nakatumba-Nabende J, Rosenfeld M, Najjingo I, Stout JW, Nantanda R, Ellington LE. Performance and usability of a new mobile application for measuring respiratory rate in young children with acute lower respiratory infections. Pediatr Pulmonol 2022; 57:3009-3016. [PMID: 35996862 PMCID: PMC10583740 DOI: 10.1002/ppul.26125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 07/18/2022] [Accepted: 08/17/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Respiratory rate (RR) measurement is critical to diagnosing pneumonia in resource-constrained settings, but accurate RR measurement is challenging. The acute lower respiratory illness treatment and evaluation (ALRITE) mobile phone application (app), designed to help healthcare workers (HCWs) manage pediatric respiratory illnesses, includes a semiautomated RR counter. This study aimed to evaluate the accuracy and usability of the ALRITE RR counter and a commercially available RR counter app, RRate, with a reference standard. METHODS This was a cross-sectional observational study of HCWs. Participants used both apps to measure the RR of pediatric patients from standardized videos. The reference standard was determined by consensus of a manual 1-min count by two providers. We assessed agreement using Spearman's rank correlation coefficient and constructed Bland-Altman plots to determine bias and limits of agreement. Participants completed a usability survey. RESULTS Thirty-nine HCWs participated. The agreement between the apps and reference standard (Spearman's coefficient) was 0.83 (95% confidence interval [CI]: 0.78-0.87) for ALRITE and 0.62 (95% CI: 0.52-0.70) for RRate. ALRITE had a bias of -2 breaths/min (lower limit of agreement [LoA] -16 to +12) and RRate had a bias of -0.4 breaths/min (LoA -24 to +23) compared to the reference standard. Both apps had a poorer agreement at higher RRs. Based on usability survey responses, 95% found ALRITE easy to use. CONCLUSIONS The ALRITE RR counter has acceptable accuracy for counting RR in infants with respiratory distress, appears to be more accurate than a commercially available option, and was user-friendly. The ALRITE RR counter is a promising tool for meriting evaluation in real-world settings.
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Affiliation(s)
- Rebecca Spurr
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Erin Ng
- Center for Clinical and Translational Research, Seattle Children’s Hospital, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Frankline M. Onchiri
- Center for Clinical and Translational Research, Seattle Children’s Hospital, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Ben Rapha
- Department of Computer Science, Makerere University School of Computing and Information Technology, Kampala, Uganda
| | - Joyce Nakatumba-Nabende
- Department of Computer Science, Makerere University School of Computing and Information Technology, Kampala, Uganda
| | - Margaret Rosenfeld
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
- Center for Clinical and Translational Research, Seattle Children’s Hospital, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Irene Najjingo
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - James W. Stout
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Rebecca Nantanda
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Laura E. Ellington
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
- Center for Clinical and Translational Research, Seattle Children’s Hospital, Seattle Children’s Research Institute, Seattle, Washington, USA
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Owoyemi A, Osuchukwu JI, Azubuike C, Ikpe RK, Nwachukwu BC, Akinde CB, Biokoro GW, Ajose AB, Nwokoma EI, Mfon NE, Benson TO, Ehimare A, Irowa-Omoregie D, Olaniran S. Digital Solutions for Community and Primary Health Workers: Lessons From Implementations in Africa. Front Digit Health 2022; 4:876957. [PMID: 35754461 PMCID: PMC9215204 DOI: 10.3389/fdgth.2022.876957] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
The agenda for Universal Health Coverage has driven the exploration of various innovative approaches to expanding health services to the general population. As more African countries have adopted digital health tools as part of the strategic approach to expanding health services, there is a need for defining a standard framework for implementation across board. Therefore, there is a need to review and employ an evidence-based approach to inform managing challenges, adopting best approaches, and implement informed recommendations. We reviewed a variety of digital health tools applied to different health conditions in primary care settings and highlighted the challenges faced, approaches that worked and relevant recommendations. These include limited coverage and network connectivity, lack of technological competence, lack of power supply, limited mobile phone usage and application design challenges. Despite these challenges, this review suggests that mHealth solutions could attain effective usage when healthcare workers receive adequate onsite training, deploying applications designed in an intuitive and easy to understand approach in a manner that fits into the users existing workflows, and involvement of the stakeholders at all levels in the design, planning, and implementation stages of the interventions.
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Affiliation(s)
- Ayomide Owoyemi
- Department of Biomedical and Health Information Sciences, Chicago, IL, United States
- *Correspondence: Ayomide Owoyemi
| | | | - Clark Azubuike
- Social and Behavioral Sciences Department, T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
| | | | - Blessing C. Nwachukwu
- Department of Biomedical and Health Information Sciences, Chicago, IL, United States
| | | | - Grace W. Biokoro
- Department of Human and Health Sciences, Northern Illinois University, DeKalb, IL, United States
| | - Abisoye B. Ajose
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | - Nehemiah E. Mfon
- Department of Obstetrics and Gynecology, National Hospital, Abuja, Nigeria
| | - Temitope O. Benson
- Institute for Computational and Data Sciences, University at Buffalo, State University of New York, Albany, NY, United States
| | - Anthony Ehimare
- Department of Health Informatics, Swansea University, Wales, United Kingdom
| | | | - Seun Olaniran
- Department of Integrated Information Technology, College of Engineering and Computing, University of South Carolina, Columbia, SC, United States
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Ahmed S, Mitra DK, Nair H, Cunningham S, Khan AM, Islam AA, McLane IM, Chowdhury NH, Begum N, Shahidullah M, Islam MS, Norrie J, Campbell H, Sheikh A, Baqui AH, McCollum ED. Digital auscultation as a novel childhood pneumonia diagnostic tool for community clinics in Sylhet, Bangladesh: protocol for a cross-sectional study. BMJ Open 2022; 12:e059630. [PMID: 35140164 PMCID: PMC8830242 DOI: 10.1136/bmjopen-2021-059630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION The WHO's Integrated Management of Childhood Illnesses (IMCI) algorithm for diagnosis of child pneumonia relies on counting respiratory rate and observing respiratory distress to diagnose childhood pneumonia. IMCI case defination for pneumonia performs with high sensitivity but low specificity, leading to overdiagnosis of child pneumonia and unnecessary antibiotic use. Including lung auscultation in IMCI could improve specificity of pneumonia diagnosis. Our objectives are: (1) assess lung sound recording quality by primary healthcare workers (HCWs) from under-5 children with the Feelix Smart Stethoscope and (2) determine the reliability and performance of recorded lung sound interpretations by an automated algorithm compared with reference paediatrician interpretations. METHODS AND ANALYSIS In a cross-sectional design, community HCWs will record lung sounds of ~1000 under-5-year-old children with suspected pneumonia at first-level facilities in Zakiganj subdistrict, Sylhet, Bangladesh. Enrolled children will be evaluated for pneumonia, including oxygen saturation, and have their lung sounds recorded by the Feelix Smart stethoscope at four sequential chest locations: two back and two front positions. A novel sound-filtering algorithm will be applied to recordings to address ambient noise and optimise recording quality. Recorded sounds will be assessed against a predefined quality threshold. A trained paediatric listening panel will classify recordings into one of the following categories: normal, crackles, wheeze, crackles and wheeze or uninterpretable. All sound files will be classified into the same categories by the automated algorithm and compared with panel classifications. Sensitivity, specificity and predictive values, of the automated algorithm will be assessed considering the panel's final interpretation as gold standard. ETHICS AND DISSEMINATION The study protocol was approved by the National Research Ethics Committee of Bangladesh Medical Research Council, Bangladesh (registration number: 09630012018) and Academic and Clinical Central Office for Research and Development Medical Research Ethics Committee, Edinburgh, UK (REC Reference: 18-HV-051). Dissemination will be through conference presentations, peer-reviewed journals and stakeholder engagement meetings in Bangladesh. TRIAL REGISTRATION NUMBER NCT03959956.
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Affiliation(s)
- Salahuddin Ahmed
- Projahnmo Research Foundation, Dhaka, Bangladesh
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Dipak Kumar Mitra
- Projahnmo Research Foundation, Dhaka, Bangladesh
- Public Health, North South University, Dhaka, Bangladesh
| | - Harish Nair
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Steven Cunningham
- Department of Child Life and Health, Royal Hospital for Sick Children, Edinburgh, UK
| | - Ahad Mahmud Khan
- Projahnmo Research Foundation, Dhaka, Bangladesh
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | | | | | - Nazma Begum
- Projahnmo Research Foundation, Dhaka, Bangladesh
| | - Mohammod Shahidullah
- Department of Neonatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Muhammad Shariful Islam
- Directorate General of Health Services, Ministry of Health and Family Welfare, Government of Bangladesh, Dhaka, Bangladesh
| | - John Norrie
- Usher Institute, Edinburgh Clinical Trials Unit, University of Edinburgh No. 9, Bioquarter, Edinburgh, UK
| | - Harry Campbell
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Abdullah H Baqui
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Eric D McCollum
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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