This project aims to improve pediatric emergency care at Kamuzu Central Hospital (KCH) in Malawi through the creation and implementation of a point-of-care ultrasound education program in collaboration with an established US-based pediatric emergency medicine consortium on the ground named PACHIMAKE. At KCH, one challenge to clinicians evaluating sick children is inconsistent access to radiographic imaging and interpretation, lab studies, and specialty consultation when formulating a diagnosis and treatment plan. A recent study done reviewing pediatric deaths at this institution found that 15% of those patients had an imaging study ordered but not completed within 24 hours. With limited access to imaging or labs, it is difficult to accurately manage severely ill children presenting with non-specific clinical symptoms which may represent various disease processes.
Point-of-care ultrasound (POCUS) allows a clinician to use a portable ultrasound to acquire, interpret, and incorporate ultrasound findings in real-time at a patient's bedside. We aim to create a novel and feasible ultrasound scanning protocol based on the most common and high yield diagnoses and to develop a locally-led, sustainable training program to improve the care of urgently and emergently ill children. Ultimately, we hope this project will be transferrable to other global health sites to further widen its impact.
KCH has identified training of its healthcare providers in POCUS as a priority this year and the training curriculum will begin in January. Our work will focus on performing a series of lectures focusing on skills, image acquisition, normal findings and pathology. We will then work side by side with the clinical officers and local providers at KCH and perform bedside ultrasounds while we provide care. Additionally we will provide ongoing mentoring over the next 1-2 years through rotating POCUS experts and online communication.
Malawi is a landlocked country located in southeastern Africa with a significant health burden with a high under 5 mortality rate and a large prevalence of HIV/AIDS, tuberculosis, and malaria. Kamuzu Central Hospital is the national referral hospital in the capital city of Lilongwe serving the central region of Malawi. The pediatric ward admits more than 27,000 patients per year and manages all medical emergencies. In the emergency zone, a small staff of nurses and clinicians will care for often over 100 acutely and critically ill children each day. This project will serve to benefit this especially vulnerable population of sick children and the dedicated local clinicians who care for them.
This project will provide local clinician partners with skills in point-of-care ultrasound to better care for their critically ill children. Through the ability to have improved bedside diagnostics, children will be able to receive more appropriate care, faster which has been shown to decrease mortality and improve long-term health outcomes.
This project will not only teach clinicians in the skills of point-of-care ultrasound, but will also aim to train trainers, thus allowing knowledge to be passed on to others and to eventually function independently.
Thanks to this grant, we were able to travel and train the first clinical officer in pediatric bedside ultrasound at KCH. We began an educational curriculum for local providers that has continued since it was implemented during this trip.
This trip has allowed for quicker decision making at the bedside for critically ill pediatric patients at KCH. It has also allowed for better procedure guidance and confirmation of successful interventions. As a response to this intervention, many other local providers have expressed interest in learning this skill and has opened the door to many more educational interventions.