Diagnostic accuracy of lung ultrasound performed by midwives in under five children for detection of pneumonia in rural Sindh, Pakistan

Abstract Background Pneumonia is a preventable cause of child mortality if identified and treated early. In settings where access to chest X-ray (CXR) is difficult, the Lung ultrasound (LUS) conducted by the community midwives (CMWs) could be beneficial for early detection of pneumonia. Aim This study aimed to determine diagnostic accuracy of LUS performed by CMWs for identification of pneumonia in children under the age of five. Methods A cross-sectional study was conducted at a District Headquarters Hospital situated in Thatta. Children under five presenting with signs of pneumonia visiting the outpatient department were included. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+ve), negative likelihood ratio (LR-ve), pre and post-test probability, receiver operating characteristic (ROC) curve, and area under the curve (AUC), were calculated using STATA 17. Results A total of 156 children participated with mean age of 29 ±15 months. Fever was present in 139 (88.5%) children, and the mean respiratory rate was 57 breaths per minute (SD 8), cough was present is 152 (97%) and chest in drawing in 149 (95%). Overall, the test demonstrated a sensitivity of 89.42% and specificity of 38.4%, with PPV of 74.4% and NPV of 64.5%. The area under the ROC curve was 0.63 (95% CI: 0.56-0.71). Conclusion LUS can be performed by CMWs, which is a sensitive screening tool for screening pneumonia in children under five in rural settings. Keywords: Lung ultrasound, Community Midwives, Low resource settings, Community Acquired Pneumonia, Children under five.