Acute respiratory infections (ARI) and in particular community-acquired Pneumonia (CAP) represent the leading cause of morbidity and mortality in sub-Saharan Africa. In Ghana, CAP in adults account for the first infectious cause of admission to district and tertiary hospitals. In theory, large part of CAP are expected to be viral and the majority would not require antimicrobial treatment. However, accessible and cost-effective diagnostics able to differentiate viral from bacterial CAP are lacking. Further, in sub Saharan Africa, availability of malaria Rapid Diagnostic Test (RDT) support malaria diagnosis in case of overlapping clinical signs. However, the diagnostic challenge remain for differentiating between viral and bacterial respiratory infections. Therefore, clinicians default to antibiotic treatment due to fear of leaving potential bacterial infections untreated. This, together with over-the-counter self-medication are important drivers of the concerning increase of Antimicrobial Resistance in Africa.
The CLAARITY project addresses this challenge and aim to:
- Generate accuracy data on host inflammatory biomarkers thresholds potentially able to differentiate bacterial from viral CAP in a malaria-endemic context.
- Assess the feasibility and accuracy of Chest Point-of-Care Ultrasound (POCUS) for diagnosing Pneumonia is evaluated against the routine of care (chest x-rays) in our study population.
- Determine the turn-around times for all diagnostics implemented in the study as well as cost-effectiveness outcomes of this testing strategy are explored using observational approaches.
CLAARITY is a feasibility, pilot, cross-sectional study of outpatient or admitted adults attending with CAP to two district hospitals in Ghana: The Saint Francis Xavier Hospital in Assin Foso, Central Region and The Agogo Presbyterian Hospital in Agogo, Ashanti Region. A short follow up to day 5 is conducted only in those admitted patients in order to explore the role of host inflammatory biomarkers for antimicrobial stewardship.
Outcomes of this study can inform the development of true POC rapid diagnostic tests adapted to a context of endemic malaria. Further, together with feasibility of the POCUS and cost-effectiveness outcomes, this study may inform needed interventional studies for guiding antimicrobial therapy.
Teams at partner institutions:
Antonia Zapf, Linda Krause, Amra Hot (UKE Hamburg, Germany)
John Amuasi (local Co-PI, KCCR Kumasi, Ghana)