Scrafford, Carolyn

Public Health

PhD

Nepal

Improving Community-Based Diagnosis of Acute Lower Respiratory Illness

The primary aim of this project is to determine the specificity and sensitivity of a new digital chest auscultation device to diagnose pneumonia and quantify the improvement upon the current WHO algorithm. When used by trained community-based health workers this algorithm has high sensitivity but low specificity for the diagnosis of pneumonia (1). The issue of low specificity and the misclassification of children can have significant consequences in both the management of pneumonia as well as outcome and effect size measurements in pneumonia prevention and intervention research trials. The use of chest auscultation using a stethoscope to diagnose pneumonia was the first diagnostic instrument to be widely used by clinicians. However, subjectivity in the interpretation of chest sounds, limitations of the human ear, and dependence on the skill level of medical personnel has limited its use in favor of more advanced diagnostic tests such as chest x-rays, or other imaging techniques. In low-resource settings, these advanced tests are not an option and diagnosis is reliant on clinical signs alone using the WHO algorithm. Analysis of auscultation recordings from a digital stethoscope allows for objectivity, decreased reliance on the memory and skill of the clinician and limiting exposure to radiation from chest x-rays. Digital stethoscopes can record chest sounds, reduce background noise, and amplify sounds that are typically outside the frequency range of an acoustic stethoscope. The ability to incorporate objective auscultation using a digital stethoscope into the WHO algorithm would increase the validity of this diagnostic tool in a low-resource setting.

People

Noreen Hynes, MD MPH

Director, Geographic Medicine Center of the Division of Infectious Diseases

Robert Bollinger Jr., MD MPH

Director, Johns Hopkins Center for Clinical Global Health Education (CCGHE); Associate Director, Johns Hopkins Center for Global...

Stefan Baral, MD MPH,MBA,MSc

Director, Key Populations Program

Caitlin Kennedy, PhD MPH,BA

Co-Director, MPH concentration in Social and Behavioral Sciences in Public Health; Associate Director, Center for Qualitative...

Yukari C. Manabe, MD

Associate Director of Global Health Research and Innovation

Joanne Katz, ScD MS,BSc

Associate Chair, Director of Academic Programs
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August 2017

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