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MAKERERE UNIVERSITY COLLEGE OF HEALTH SCIENCES DEPARTMENT OF RADIOLOGY ACCURACY OF CHEST ULTRASOUND IN DIAGNOSING PNEUMONIA IN PEDIATRIC PATIENTS AT MULAGO NATIONAL REFERRAL HOSPITAL, KAMPALA, UGANDA. PRINCIPAL INVESTIGATOR: DR KYOMUHANGI AGNES, MBChB, MUK SUPERVISORS: 1. DR BUGEZA SAM MBChB(MUK), MMED (Rad). 2. DR EREM GEOFFREY MBChB(MUST), MMED(Rad) 3. DR MWOROZI EDISON ARWANIRE MBChB(MUK), MMED (SENIOR CONSULTANT, Pead). A DISSERTATION SUBMITTED TO SCHOOL OF GRADUATE STUDIES IN PARTIAL FULLFILLMENT OF THE REQUIREMENT FOR AWARD OF THE DEGREE OF MASTERSAggie OF MEDICINE IN RADIOLOGY AT MAKERERE UNIVERSITY. [Date] AUGUST 2019 i DECLARATION I Kyomuhangi Agnes, hereby declare that the work presented in this dissertation has not been presented for any other degree in this university. Signed…………………………………. …………………………………. DR. KYOMUHANGI AGNES Date This dissertation has been submitted for examination with approval of the following supervisors; Signed…………………………………. …………………………………. DR. BUGEZA SAMUEL Date MBChB, MMed Rad Specialist Radiologist / lecturer, College of Health Sciences, Makerere University. Signed……………………………….... ………………………………….. DR. EREM GEOFFREY Date MBChB, MMed Rad Specialist Radiologist / lecturer, College of Health Sciences, Makerere University. Signed…………………………………. ……………………………………. DR. MWOROZI EDISON ARWANIRE Date MBChB, MMed Pead Consultant Pediatrician Mulago National Referral Hospital / Senior lecturer, College of Health Sciences, Makerere University. ii DEDICATION To my family, for being a constant source of inspiration, I am eternally grateful for their love, unwavering encouragement and all round support during the course of my masters programme. iii ACKNOWLEDGEMENTS The development and completion of this course/work was first of all made possible, by the Almighty God who has been faithful providing me with grace, mercy and strength. The funding to do this study was made possible by Uganda Cancer Institute (UCI-AfDB) scholarship which sponsored me throughout my masters programme and this study. Special thanks go to my supervisors; Dr. Bugeza Samuel, Dr. Erem Geoffrey and Dr. Mworozi Edison Arwanire for their guidance and advise they gave me throughout the preparation of this dissertation. I would also like to thank my mother, Ms. Bekinga Monica Kyomuhangi, my guardian, Mr. John Diisi and my siblings for their sympathetic ear, wise counsel, support and for providing happy distraction to rest my mind outside this course and study. I further extend my special thanks to Dr. Muyinda Zeridah and Dr. Ameda Faith for their support and help during this study. My sincere thanks also go to my classmates for their encouragement and help during this study and dissertation preparation. Special thanks to the members of the department of radiology, Mulago hospital, mostly Mr. Bwangu and Mr. Senoga who assisted me during this study. I thank the pediatric team at Acute Care Unit at Mulago National Referral Hospital for their co- operation that enabled me carry out my research smoothly. Finally, huge and special thanks to the study participants and their parents / guardians for participating in this study and providing the information that made it a success. iv Table of Contents ABBREVIATIONS AND ACRONYMS. ..................................................................................... ix OPERATIONAL DEFINITIONS. .................................................................................................. x ABSTRACT .................................................................................................................................. 12 INTRODUCTION ........................................................................................................................ 14 1.1 PROBLEM STATEMENT ................................................................................................. 15 1.2. JUSTIFICATION. ............................................................................................................. 15 1.3. RESEARCH QUESTIONS. .............................................................................................. 16 1.4. OBJECTIVES OF THE STUDY. ...................................................................................... 16 1.4.1. GENERAL OBJECTIVE............................................................................................ 16 1.4.2. SPECIFIC OBJECTIVES. .......................................................................................... 16 2.0. LITERATURE REVIEW ...................................................................................................... 18 2.1. Burden of pneumonia. ........................................................................................................ 18 2.2. Aetiology of pneumonia. ................................................................................................... 18 2.3. Pathogenesis of pneumonia................................................................................................ 19 2.4. Risk factors of pneumonia. ................................................................................................ 19 2.5. Clinical diagnosis of pneumonia. ....................................................................................... 19 2.6. Role of plain chest radiography in diagnosis of pneumonia. ............................................. 20 2.7. Role of chest computed tomography in diagnosis of pneumonia. ..................................... 21 2.8. Role of chest ultrasound in diagnosing pneumonia. .......................................................... 21 3.0 METHODOLOGY ................................................................................................................. 25 3.1. STUDY DESIGN............................................................................................................... 25 3.2. STUDY SETTING............................................................................................................. 25 3.3. STUDY POPULATION. ................................................................................................... 25 3.3.1. Target population ........................................................................................................ 25 3.3.2. Accessible population ................................................................................................. 25 3.3.3. Eligible population ...................................................................................................... 26 3.3.4. Inclusion criteria ......................................................................................................... 26 3.3.5. Exclusion criteria ........................................................................................................ 26 3.4. Sample size determination. ................................................................................................ 26 3.4.1. Sampling strategy........................................................................................................ 26 v 3.5. DATA COLLECTION TECHNIQUE. ............................................................................. 27 3.5.1. Patient demographics. ................................................................................................. 27 3.5.2. The chest X rays.......................................................................................................... 27 3.5.3. Chest ultrasounds. ....................................................................................................... 27 3.6. DATA COLLECTION TOOLS. ....................................................................................... 31 3.6.1 Independent variables .................................................................................................. 31 3.6.2. Dependent variables .................................................................................................... 31 3.7. Quality control. .................................................................................................................. 32 3.8. Data management............................................................................................................... 33 3.8.1. Data analysis. .............................................................................................................. 33 3.9. Ethical considerations. ....................................................................................................... 33 3.10. Limitations of the study. .................................................................................................. 34 4.0 RESULTS. .............................................................................................................................. 35 4.1. Participants’ characteristics ............................................................................................... 36 4.1.1. Demographic characteristics ...................................................................................... 36 4.1.2 Clinical features ........................................................................................................... 37 4.1.3 Radiological diagnostic yield of pneumonia by both Chest ultrasound and Chest X-ray ............................................................................................................................................... 38 4.2 Diagnostic accuracy of chest ultrasonography in children with suspected pneumonia at Acute Care Unit .......................................................................................................................
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