Utility of hand-held ultrasound for image acquisition and interpretation by trained Kenyan providers.

BACKGROUND: Point-of-care ultrasound (POCUS) plays a prominent role in the timely recognition and management of multiple medical, surgical, and obstetric conditions. A POCUS training program for primary healthcare providers in rural Kenya was developed in 2013. A significant challenge to this program is the acquisition of reasonably priced ultrasound machines with adequate image quality and the ability to transmit images for remote review. The goal of this study is to compare the utility of a smartphone-connected, hand-held ultrasound with a traditional ultrasound device for image acquisition and interpretation by trained healthcare providers in Kenya. METHODS: This study took place during a routine re-training and testing session for healthcare providers who had already received POCUS training. The testing session involved a locally validated Observed Structured Clinical Exam (OSCE) that assessed trainees' skills in performing the Extended Focused Assessment with Sonography for Trauma (E-FAST) and focused obstetric exams. Each trainee performed the OSCE twice, once using a smartphone-connected hand-held ultrasound and once using their notebook ultrasound model. RESULTS: Five trainees obtained a total of 120 images and were scored on image quality and interpretation. Overall E-FAST imaging quality scores were significantly higher for the notebook ultrasound compared to the hand-held ultrasound but there was no significant difference in image interpretation. Overall focused obstetric image quality and image interpretation scores were the same for both ultrasound systems. When separated into individual E-FAST and focused obstetric views, there were no statistically significant differences in the image quality or image interpretation scores between the two ultrasound systems. Images obtained using the hand-held ultrasound were uploaded to the associated cloud storage using a local 3G-cell phone network. Upload times were 2-3 min. CONCLUSION: Among POCUS trainees in rural Kenya, the hand-held ultrasound was found to be non-inferior to the traditional notebook ultrasound for focused obstetric image quality, focused obstetric image interpretation, and E-FAST image interpretation. However, hand-held ultrasound use was found to be inferior for E-FAST image quality. These differences were not observed when evaluating each E-FAST and focused obstetric views separately. The hand-held ultrasound allowed for rapid image transmission for remote review.

Feasibility of project ECHO telementoring to build capacity among non-specialist emergency care providers.

The COVID-19 pandemic has led to global disruptions in emergency medicine (EM) teaching and training and highlighted the need to strengthen virtual learning platforms. This disruption coincides with essential efforts to scale up training of the emergency healthcare workforce, particularly in low-resource settings where the specialty is not well developed. Thus, there is growing interest in strengthening virtual platforms that can be used to support emergency medicine educational initiatives globally. These platforms must be robust, context specific and sustainable in low-resource environments. This report describes the implementation of Project ECHO (Extension for Community Healthcare Outcomes), a telementoring platform originally designed to extend specialist support to health care workers in rural and underserved areas in New Mexico. This platform has now been implemented successfully across the globe. We describe the challenges and benefits of the Project ECHO model to support a Point-of-Care Ultrasound (POCUS) training program for health care providers in Kenya who do not have specialty training in emergency medicine. Our experience using this platform suggests it is amenable to capacity building for non-specialist emergency care providers in low-resource settings, but key challenges to implementation exist. These include unreliable and costly internet access and lack of institutional buy-in.

Tele-ECHO for Point-of-Care Ultrasound in Rural Kenya: A Feasibility Study.

BACKGROUND: Geographical isolation limits continuous point-of-care ultrasound (PoCUS) education for healthcare providers in rural Kenya. This study evaluates the use of the Project ECHO (Extension for Community Healthcare Outcomes) videoconference platform to connect health care providers in rural Kenya with PoCUS trainers at Brown University. METHODS: Twelve PoCUS trainees from 11 clinics were included in the study. Every week, trainees participated in a 2-hour Tele-ECHO session via Zoom. Attendance was logged onto iECHO. A Qualtrics survey was used to collect participant feedback. RESULTS: Trainees faced difficulty with computer-based Wi-Fi connection and mostly used smartphone-based Internet. Whatsapp messaging was preferable to email for Tele-ECHO notifications. Work obligations kept some trainees from participating. The majority of participating trainees felt that the didactic material was relevant to their practice. CONCLUSION: Telementoring through Project ECHO was found to be an acceptable adjunct to PoCUS training for rural trainees. Internet access was primarily smartphone-based.

Measuring User Compliance and Cost Effectiveness of Safe Drinking Water Programs: A Cluster-Randomized Study of Household Ultraviolet Disinfection in Rural Mexico.

Low adoption and compliance levels for household water treatment and safe storage (HWTS) technologies have made it challenging for these systems to achieve measurable health benefits in the developing world. User compliance remains an inconsistently defined and poorly understood feature of HWTS programs. In this article, we develop a comprehensive approach to understanding HWTS compliance. First, our Safe Drinking Water Compliance Framework disaggregates and measures the components of compliance from initial adoption of the HWTS to exclusive consumption of treated water. We apply this framework to an ultraviolet (UV)-based safe water system in a cluster-randomized controlled trial in rural Mexico. Second, we evaluate a no-frills (or "Basic") variant of the program as well as an improved (or "Enhanced") variant, to test if subtle changes in the user interface of HWTS programs could improve compliance. Finally, we perform a full-cost analysis of both variants to assess their cost effectiveness (CE) in achieving compliance. We define "compliance" strictly as the habit of consuming safe water. We find that compliance was significantly higher in the groups where the UV program variants were rolled out than in the control groups. The Enhanced variant performed better immediately postintervention than the Basic, but compliance (and thus CE) degraded with time such that no effective difference remained between the two versions of the program.