Implementation of lung ultrasound in low- to middle-income countries: a new challenge global health?

Abstract

Pneumonia remains the leading cause of death globally in children under the age of five. The poorest children are the ones most at risk of dying. In the recent years, lung ultrasound has been widely documented as a safe and easy tool for the diagnosis and monitoring of pneumonia and several other respiratory infections and diseases. During the pandemic, it played a primary role to achieve early suspicion and prediction of severe COVID-19, reducing the risk of exposure of healthcare workers to positive patients. However, innovations that can improve diagnosis and treatment allocation, saving hundreds of thousands of lives each year, are not reaching those who need them most. In this paper, we discuss advantages and limits of different tools for the diagnosis of pneumonia in low- to middle-income countries, highlighting potential benefits of a wider access to lung ultrasound in these settings and barriers to its implementation, calling international organizations to ensure the indiscriminate access, quality, and sustainability of the provision of ultrasound services in every setting. What is Known: • Pneumonia remains the leading cause of death globally in children under the age of five. The poorest children are the ones most at risk of dying. In the recent years, lung ultrasound has been widely documented as a safe and easy tool for the diagnosis and monitoring of pneumonia and several other respiratory infections and diseases. During the pandemic, it played a primary role to achieve early suspicion and prediction of severe COVID-19, reducing the risk of exposure of healthcare workers to positive patients. However, innovations that can improve diagnosis and treatment allocation, saving hundreds of thousands of lives each year, are not reaching those who need them most. What is New: • We discuss advantages and limits of different tools for the diagnosis of pneumonia in low- to middle-income countries, highlighting potential benefits of a wider access to lung ultrasound in these settings and barriers to its implementation, calling international organizations to ensure the indiscriminate access, quality, and sustainability of the provision of ultrasound services in every setting.

Keywords: ALRTI; Children; Global health; LMCIs; Low- to middle-income countries; Lung ultrasound; Personalized medicine; Pneumonia.

Fig. 1

A Viral pneumonia (H1N1): subcentimeter subpleural consolidation (arrows) associated with vertical long perilesional vertical artifacts and areas of white lung (asterisk). B Bacterial pneumonia: compact/hepatized large subpleural consolidation with static air bronchograms and deep fluid bronchograms (arrows). Complicated pleural effusion (asterisk) with multiple and concamerated fibrin

Fig. 2

Key characteristics of clinical examination, lung ultrasound, and chest X-ray with traffic light system signaling potential for achieving a comprehensive management of pneumonia in low- to middle-income countries. We used a traffic light system to identify factors or barriers to widespread global implementation of lung ultrasound in LMICs compared with clinical examination and traditional radiology, with red indicating high difficulty/barriers, amber medium, and green little or no difficulty/barriers to implementation. Colors were decided by the two authors according with available literature. Disagreements were resolved through discussion