One of our further research objectives is to contribute to the general improvement of clinical care for patients, especially in resource-poor settings. Our focus here is particularly on the work with POCUS (Point-Of-Care Ultrasound). POCUS can greatly improve patient diagnosis in resource-poor settings.

Why POCUS and what is its advantage?

Medical image-generating procedures are part of evidence-based modern medical care, facilitate the diagnosis of a wide range of diseases for treating physicians and are also used to guide and increase the safety of procedures. Therefore, medical imaging can improve the overall clinical care of patients. However, the use of large-scale radiological equipment such as MRI and CT as well as conventional X-ray is technically complex and requires, among other things, a continuous power supply, suitable premises, and radiation protection measures. In addition, special medical or technical training of the personnel is required. In low-resource settings, these prerequisites are only available in large central hospitals, and even there they are associated with considerable costs.

In comparison to other imaging techniques, ultrasound has relatively low technical requirements. Therefore, it can be utilised for clinical evaluation wherever the patient is being treated. This eliminates high costs and logistical constraints and professional diagnostics can be offered to the broad, financially disadvantaged rural population. Point-Of-Care-Ultrasound (POCUS) is used by clinicians to answer a specific clinical question to direct patient care and management. POCUS is relatively easy to learn and can be performed using standardised protocols, with findings being highly recognisable. In addition to the confirmation of an acutely treatable diagnosis, there is thus also a low-threshold and cost-effective initial assessment of the patient.

POCUS can be used for infectious diseases such as pneumonia, tuberculosis or schistosomiasis, as well as for non-communicable diseases such as cancer and liver cirrhosis or emergencies such as heart failure or trauma. Using POCUS can rapidly narrow differential diagnosis, shorten time to definitive treatment, reduce failure and complication rates during procedures and improve patient satisfaction. POCUS is therefore a relevant innovation and serves to optimise medical care for the financially disadvantaged population.

1. Taking Point Of Care Ultrasound (POCUS) to the District in Malawi (TaPoDiMa)

Cooperation partner

• Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi

Objectives

• Integration of POCUS training at KUHeS into clinical care at the Queen Elizabeth Central Hospital and Mangochi Campus.
• Creation of local capacity for POCUS and long-term sustainable training capacity
• Integration of POCUS into routine teaching
• Building scientific capacity for POCUS

This project and partnership build on several years of collaboration and joint work in the field of POCUS. The first training activities in POCUS at KUHeS were initiated in 2017. In the initial partnership phase from 2017-2019, a training curriculum for internal medicine was developed. By 2019 almost the entire staff of the department was trained in POCUS. In addition, several members of the department were trained as trainers for future courses and the impact of POCUS on clinical care was assessed scientifically. In the subsequent phase from 2019-2021, the training curriculum was adapted to include other departments apart from internal medicine and training activities were extended. In addition, a mobile phone-based, open-source teaching application was developed.

Now, through the further development of electronic training resources and a strong base of local trainers, the next steps in this partnership are first to consolidate teaching and research activities in POCUS in the eight clinical departments of KUHeS, and second to extend these activities to the main training centre for family medicine of the Mangochi Campus at Mangochi District Hospital.

You can find more information on the project on the website of the Else Kröner-Fresenius-Stiftung.

2. Improvement of Child Health in Low-Resource-Settings through Implementation of Ultrasonography

Cooperation partners

• Society for Tropical Paediatrics & International Child Health (GTP) e.V., Dinslaken, Germany
• Paediatric Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
• Paediatric Department, The University of Dodoma, School of Medicine and Dentistry, Dodoma, Tanzania
• Paediatric Department, Kamuzu University of Health Sciences, Blantyre, Malawi
• Paediatrics and Child Health Department, Zomba Central Hospital, Zomba, Malawi
• Paediatric Department, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu, Nepal
• Department of Paediatrics, Charité-Universitätsmedizin Berlin, Berlin, Germany
• PedMedDev Hub: The Hub for Paediatric Medical Devices, University Lübeck, Lübeck, Germany
• University of Bonn, Institute of Hygiene and Microbiology, Section Global Health, Bonn, Germany

We support the project with ultrasound training, implementation and evaluation and cooperate in the general scientific guidance and the further development of the POCUS-Smartphone-App (ePOCUS). 

Objectives

• Creation of an international network for the increased and qualitative use of ultrasound in paediatrics in low-resource settings
• Establishing integrated access to ultrasound in paediatrics and adolescent medicine through a continuous offer of context-adapted ultrasound training and creation of an ultrasound infrastructure
• Strengthening the independence and sustainability of partners in improving diagnostic and interventional ultrasound capacities