Title: The Role of Point-of-Care Ultrasound Education in Improving Health Outcomes in Sub-Saharan Africa

Emmanuel Owusu¹, MD.

¹Western University School of Medicine, Department of Internal Medicine

Correspondence should be addressed to Emmanuel Owusu, MD, Western University School of Medicine, Mailing address: Victoria Hospital, 800 Commissioners Rd E, London, ON N6A 5W9. Tel: +1-929-466-5270, Email: eowusu3@uwo.ca

Brief Title: Utility of POCUS in SSA

Abstract

Sub-Saharan Africa (SSA) bears a disproportionate share of the world’s illnesses, taking on approximately a quarter of the entire global disease burden. Despite this, the region has only about 3% of the world’s health workforce and 1% of global health expenditure. Currently, communicable diseases account for two-thirds of the region’s disease burden. HIV, Tuberculosis, and their sequelae are the major related cause of morbidity and mortality. However, the World Health Organization (WHO) estimates that by 2030 this region will see a 27% increase in mortality from non-communicable diseases (NCD), primarily in cardiovascular and respiratory disease, and cancer related illness. At this point, NCD will exceed the total deaths in SSA that are due to communicable, maternal, infant, and nutritional disease. Though initially considered non-endemic in SSA, NCD are therefore gaining in significance as a public health issue in the region.

Point-of-Care Ultrasound (POCUS) is a relatively inexpensive, safe, and non-invasive imaging modality that can be used to augment the diagnosis and management of these emergent conditions. With a wide range of applications in acute medical and obstetric settings, POCUS can be very useful in treatment and has been shown to improve diagnostic time as well as accuracy and management of many common health issues present in SSA. Its utility includes, but is not limited to diagnosis of the pulmonary and extra-pulmonary complications of tuberculosis, as well as the examining of cardiac causes of heart failure, such as HIV-associated cardiomyopathy, rheumatic heart disease, and tamponade. In many cases, it may be the only tool available for prompt management of trauma and for the identification and management of high-risk pregnancies. Despite the fact that POCUS has the potential to improve health outcomes, its availability in SSA remains relatively low in both training programs and in the clinical setting.

At this time, there are many pressing reasons why POCUS education programs should be developed in the region. Effective POCUS education programs in SSA will be tasked to use several media, including online, didactic, and clinical site training and at various levels. They can be managed through collaboration with local stakeholders and tailored to fit existing challenges.  Making POCUS training part of the medical school and residency curriculum and in-service for providers would be imperative in advancing this cause. Global partnerships also play a major role in coordinating initial training as well as in the procurement and servicing of ultrasound equipment. These partnerships are equally vital when assessing competence and the on-going impact on health services in the region. For example, the Global Health Service Partnership has successfully introduced POCUS training in certain regions of Malawi, Tanzania, and Uganda, creating an increase in acceptance and usage while causing increasingly positive health outcomes.

POCUS education not only improves the medical skills of trainees, it also enhances retention of providers. Proper utilization of POCUS has led to increased provision of services in remote, resource limited settings, and therefore, the training can provide an incentive for young professionals to accept placement in rural areas. In a region with limited resources and a highly centralized health care system, coordinated POCUS training has the potential to increase general accessibility to health services and can act as a way to help bridge some overarching health inequities. With this in mind, the widespread adoption and use of this rapidly evolving, yet affordable, technology seems a very viable way for SSA to help alleviate some of its health care needs particularly as a useful tool in the early detection of NCD.  

Keywords: point of care ultrasound, education, Sub-Sahara Africa, health outcomes, health inequity, trends and challenges, public health