Digital stethoscope use by non-physician primary care health workers on children under five years of age in rural Bangladesh: a feasibility study

Abstract

Lung auscultation is not included in the WHO Integrated Management of Childhood Illness algorithm, partly due to concerns regarding feasibility and reliability when performed by non-physician primary health workers in low-resource settings. In this feasibility study, we evaluated whether non-physician primary care health workers (community health care providers (CHCPs)) can record quality lung sounds from children aged 2–59 months. Feasibility was predefined as more than 50% of children having quality recordings at the overall sample level. After receiving three days of structured training, nine CHCPs recorded lung sounds from four chest positions using a digital stethoscope (Sonavi Labs, United States) in 990 children attending first-level rural clinics in Bangladesh between November 2019 and December 2020, with enrolment paused during the COVID-19 pandemic. A blinded paediatrician listening panel, trained to a standardised interpretation protocol, classified the recordings. A quality recording was defined a priori as the panel classifying three of four chest positions on a participant as interpretable. Lung sounds were recorded from 990 children, and the panel classified 867 children as having a quality recording (87.6%; 95% confidence interval: 85.4%, 89.6%). Among children with quality recordings and available timing data, 89.8% (766/853) were recorded within five minutes. This study demonstrates CHCPs at rural, first-level clinics in Bangladesh are capable of timely, quality recordings of lung sounds from most children using a digital stethoscope.