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

Abstract

Low-and middle-income countries (LMIC) are faced with healthcare challenges including lack of specialized healthcare workforce and limited diagnostic infrastructure. Task shifting for point-of-care ultrasound (POCUS) can overcome both shortcomings. This review aimed at identifying benefits and challenges of task shifting for POCUS in primary healthcare settings in LMIC. Medline and Embase were searched up to November 22nd, 2021. Publications reporting original data on POCUS performed by local ultrasound naïve healthcare providers in any medical field at primary healthcare were included. Data were analyzed descriptively. PROSPERO registration number CRD42021223302. Overall, 36 publications were included, most (n = 35) were prospective observational studies. Medical fields of POCUS application included obstetrics, gynecology, emergency medicine, infectious diseases, and cardiac, abdominal, and pulmonary conditions. POCUS was performed by midwives, nurses, clinical officers, physicians, technicians, and community health workers following varying periods of short-term training and using different ultrasound devices. Benefits of POCUS were yields of diagnostic images with adequate interpretation impacting patient management and outcome. High cost of face-to-face training, poor internet connectivity hindering telemedicine components, and unstable electrici'ty were among reported drawbacks for successful implementation of task shifting POCUS. At the primary care level in resource-limited settings task shifting for POCUS has the potential to expand diagnostic imaging capacity and impact patient management leading to meaningful health outcomes.

Keywords: Low- and middle-income country; Point of care; Task shifting; Ultrasound.

Figure 1

PRISMA Flow diagram of study selection.

Figure 2

Medical fields and conditions of task shifting for POCUS studies identified by this review across continents. The outer circle displays POCUS applications, the inner circle continents where POCUS applications were applied. The relative sizes of cells indicate the frequency of studies evaluating respective POCUS applications and the continent origin, respectively. (POCUS: point-of-care ultrasound, FAST: focused assessment with sonography for trauma, FASH: focused assessment with sonography for HIV-associated tuberculosis, FASE: focused assessment with sonography for echinococcosis).