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Digital auscultation to record and analyze the breath sounds of a patient, as seen in The Gambia. Photo by Eric D. McCollum.

Accurately diagnosing pneumonia can be very difficult in the resource-challenged settings of developing nations.  IVAC’s PERCH study allows the opportunity to explore a new technology that can help improve the accuracy and speed of pneumonia diagnoses. This type of innovation enables us to reach more children and save more lives, while also furthering our understanding of the epidemiology of this disease. In advance of World Pneumonia Day, marked each year on November 12, we’re excited to offer a look at the digital future of using state-of-the-art technology in diagnosing and treating respiratory illness in the world’s poorest settings.

By Eric D. McCollum, MD

The scene is familiar, an African healthcare worker with only several months of training but working as the community doctor, is setting up his temporary pediatric clinic in a remote village beneath the shade of a baobab tree. The queue is long, as mothers and their children from this small community and beyond have waited since the early morning for their child to be seen. Some children are sick and need medicine, and some are not and instead need only a weight check and their immunizations. The penetrating tropical sun begins to rise signaling the beginning of the clinic. Fortunately, the girth of the baobab tree provides the necessary relief. “Okay, let’s begin,” the healthcare worker states in the local dialect as his eyes meet with the mother of the first child, a toddling 17 month old girl with only a dirty brown shirt covering her body. “How can I help you?”

“She is sick with fever and cough for four days,” the mother answers, brow tense with concern.

The healthcare worker continues with his routine follow-up questions until this trite scenario takes an unexpected, most interesting turn. He reaches into his pocket and pulls out his mobile phone and attaches to it what looks to be almost a miniature suction cup with fine beads covering its face. Several mothers waiting in the line take notice and turn to each other talking quickly. The worker pushes several buttons on his phone and then presses the device onto the bare chest of the girl, who remains clinging to her mother’s breast. He then sits back, rests against the heavy trunk of the baobab tree, punches a button on his mobile phone, and waits. After several short moments the phone then beeps, and his eyebrows raise up in response. “Your child has pneumonia… and needs antibiotics.”

The continent that skipped over clunky technology like landline phones and large desktop computers in favor of slick mobile phones and the internet may also be leapfrogging what many consider to be the first medical device, the stethoscope.  Learning to interpret the sounds captured by the stethoscope can take years of practice.  Even then, opinions processed by the ears of vastly experienced physicians can still differ.  The stethoscope is quite simply “the art of medicine.” Given these inherent drawbacks of traditional stethoscopes, the World Health Organization’s (WHO) diagnostic criteria for childhood pneumonia intentionally ignores respiratory sounds altogether. This allows healthcare providers with minimal training who work in remote areas, often where childhood pneumonia mortality is greatest, to still diagnose and treat pneumonia. The drawback of the WHO not including respiratory sounds in its diagnostic criteria is that many children with pneumonia are incorrectly diagnosed and thus incorrectly treated, a potential danger to the health of the child and waste of scarce financial resources.

Digital auscultation at work. Photo by Eric D. McCollum.

Art may soon be giving way to cutting edge clinical science and computer technology. Electronic devices exist that act similarly to traditional stethoscopes, except that they generate digital sound waves that can be fed into computer software programs. In fact, they are under active study and continued refinement, such that a small mobile device that contains sophisticated software may soon be able to accurately interpret chest sounds for use in clinical care of children. The Pneumonia Etiology Research for Child Health study, or PERCH, is a large collaborative project funded by The Bill and Melinda Gates Foundation currently ongoing in seven developing countries throughout Africa and Asia.  PERCH is utilizing digital stethoscopes to record chest sounds from children hospitalized with life-threatening pneumonia. These sounds are then uploaded onto local internet servers that can be accessed by co-investigators at The Johns Hopkins School of Public Health International Vaccine Access Center and the Johns Hopkins University Engineering Department. These investigators are in turn creating novel computer software algorithms that can interpret these sounds and therefore accurately diagnose childhood respiratory illness. This could mean more efficient use of childhood pneumonia resources and even better outcomes for children sick with pneumonia, the number one cause of childhood mortality globally.

While digital auscultation devices and computer software able to interpret chest sounds from children may still be in experimental phases, it is not unrealistic to envision a time where healthcare professionals located anyplace and anywhere, even beneath a Baobab tree in a remote African village, can utilize this technology to accurately diagnose and provide life-saving treatments to children with pneumonia. So listen up carefully on this World Pneumonia Day, a revolution is coming.

Dr. Eric D. McCollum is a Post-doctoral Fellow in the Division of Pediatric Pulmonology at the Johns Hopkins School of Medicine, and a member of the PERCH study team.

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