The use of bedside or emergency point-of-care ultrasound (ePOCUS) reduces the time it takes to diagnose diseases in severely ill patients who are being treated in emergency centres and also decreases the chances of missed, wrong, or delayed diagnoses. This could potentially save the lives of patients.
However, healthcare workers in Africa struggle to use ePOCUS because they don't have adequate access to training, mentorship, ultrasound machines and ultrasound-related consumables such as gels and sterile sleeves.
This is according to a new study published recently in the African Journal of Emergency Medicine. It was conducted by researchers from the Division of Emergency Medicine at Stellenbosch University, the Department of Emergency Medical Services in the Ministry of Health in Uganda and the Department of Emergency Medicine at Makerere University College of Health Sciences in Uganda.
The researchers used an online questionnaire to explore the use of ePOCUS by healthcare practitioners who are members of the African Federation of Emergency Medicine (AFEM). They wanted to determine the practitioners' demographics; their level of qualification and training; the barriers they encounter; as well as the ePOCUS modules they use and the frequency with which they do so.
According to the researchers, the AFEM recommends the use of ePOCUS as a core skill for healthcare practitioners in Africa. At the time of their study, the AFEM network represented more than 2 000 members from 25 different countries.
The researchers say participants – predominantly male – who completed the questionnaire indicated inadequate training, a lack of supervision or feedback, malfunctioning of ultrasound machines or lack of ultrasound-related consumables as some of the main reasons why they struggle to use ePOCUS.
“Two-thirds of respondents in Africa indicated that they use ePOCUS, which is much lower than in South Korean, Canadian, and Australian emergency centres.
“The low adoption rate in the survey is of concern since the availability of mobile ultrasound machines increased substantially over the last couple of years. Although the uptake of ePOCUS into lower resourced settings had been sluggish, cheaper portable hand-held ultrasound systems could alleviate some of the financial barriers."
The researchers do acknowledge that the usage of ePOCUS in Africa is likely much higher than reported in their study. They say there is still room for improvement considering that ePOCUS has the potential to increase access to quality healthcare in remote areas.
The researchers point out that only a third of those who use ePOCUS have validated their expertise by means of a formal examination to ensure that they have all the skills required to use it safely and effectively. “This is rather unfortunate, as the self-perceived level of ePOCUS skills was substantially higher in those that were credentialed.
“The most frequently used ePOCUS modules are ultrasound in trauma, focused cardiac assessment, and thoracic (chest or lung ultrasound) assessment. The low credentialing rate and the potential discordance between local burden of disease and ePOCUS training require further investigation."
The researchers say that despite these challenges the potential benefit of ePOCUS use in Africa is tremendous as it is a fast and relatively low-cost imaging modality that can be used for the diagnosis and management of diseases prevalent in African countries.
“The assessment of patients with trauma and obstetric-related complaints immediately comes to mind, but it is also valuable for highly prevalent infectious diseases. The use of ePOCUS in the diagnosis of HIV-associated tuberculosis has the potential to diagnose patients quicker, especially if it forms part of an extensive point-of-care orientated clinical algorithm."
The researchers emphasise the need for detailed planning by the AFEM, meticulous coordination and local buy-in to overcome the current challenges and improve the safe and competent use of ePOCUS in Africa.
“We recommend more in-depth and context-specific studies to improve the understanding of the difficulties healthcare workers face on the ground to firstly access ePOCUS training and secondly to use ePOCUS seamlessly in their daily practice."
- Source: Van Hoving, DJ; Alenyo, AN; Komagum, F; & Lamprecht, H 2022. Current use and perceived barriers of emergency point-of-care ultrasound by African healthcare practitioners. African Journal of Emergency Medicine 12 (2022): 333-338: doi.org/10.1016/j.afjem.2022.07.009