Ultrasound Use in Resource-limited Settings: A Systematic Review

Purpose: Over the past decade, ultrasound (US) machines have become smaller, less expensive, more reliable, durable and user-friendly, making ultrasonography an ideal imaging modality in resource-poor settings. We conducted a literature review to examine the use of ultrasound in resource-limited settings, with emphasis on common applications, barriers to implementation, and impact on clinical decision-making and patient disposition.

Methods and Materials: Literature review. We conducted a PubMed and Cochrane Central search on the clinical use of ultrasound in the developing world. Search terms included ultrasonography, developing countries, resource limited, remote setting, poverty, and low income. Articles from 2000 to 2015 that included data on the clinical use of ultrasound in resource limited settings were eligible for inclusion. Data on country of origin, medical specialty, US modality, clinical impact, and potential barriers to implementation were recorded.

Results: Fifty-eight articles were eligible for inclusion. Most studies were observational, with Africa as the most common site, accounting for 35 articles. Radiology was the most represented specialty. Cardiac and obstetric were the most commonly utilized ultrasound modalities. Most data on cardiac ultrasound pertained to its role in the diagnosis of rheumatic heart disease. Obstetric ultrasound was primarily used for pregnancy dating and diagnosing fetal abnormalities. Twelve studies examined clinical impact of ultrasound in resource-limited settings and showed that its use dramatically altered differential diagnosis and patient disposition. Common barriers to implementation were the high cost of equipment and maintenance, and lack of skilled personnel and formal training programs. A commonly cited consequence of ultrasound use in resource-poor settings was sex-selective abortions.

Conclusion: Ultrasound has widespread clinical applications, particularly as a diagnostic tool in the developing world. Significant barriers exist with respect to access and training of US in resource-limited settings. Further research is needed to study its impact on medical decision-making, patient disposition and outcomes.