Training in lung ultrasound for the diagnosis of lower respiratory tract infections in children under five years of age in rural healthcare facilities in Guatemala

Background: Lower respiratory tract infections (LRTI) in children under five years of age remain a leading cause of mortality, especially in low- and middle-income countries (LMIC). Although many of these deaths are preventable, accurate diagnosis of bacterial pneumonia is essential to ensure appropriate treatment and to reduce unnecessary antibiotic use. Imaging technologies are essential for improving the specificity of diagnoses; however, chest x-rays are often unavailable in rural LMIC settings. In this context, point-of-care lung ultrasound (POCLUS) offers a promising alternative, but the limited training remains a significant barrier to its widespread adoption and long-term sustainability. This study proposes and evaluates a training methodology to address this challenge. Methods: We conducted a pre-post observational study without a control group across 10 rural health districts in Alta Verapaz, Guatemala. We divided the training programme into four progressive phases: training in technical skills and basic image acquisition (phase 0); assessment of image acquisition skills (phase 1); evaluation of the ability to identify pathological findings (phase 2); and training in a diagnostic algorithm and evaluation in the clinical context (phase 3). In each phase, two specialists independently evaluated images, and a third resolved disagreements. We combined in-person and remote training activities and implemented them between April 2021 and December 2024. Results: A total of 23 healthcare professionals (six physicians, 15 nurses, and two nursing assistants) participated in the training. Of these, 19 successfully completed phase 1, 18 completed phase 2, and 13 completed phase 3. Eight participants discontinued the programme, primarily due to changes in professional roles or location. Conclusions: The blended learning model proposed in this study enabled physician and non-physician healthcare providers to use POCLUS to diagnose LRTI in children under five years of age in a rural primary care setting in a low-income country.