Childhood Pneumonia Diagnostics in Sub-Saharan Africa: A Systematic Review

Abstract Background The prompt and accurate aetiological diagnosis of childhood pneumonia remains a challenge, especially in sub-Saharan Africa (SSA) because of limited resources for disease management. Objective To review existing diagnostics for childhood pneumonia and potential modalities available to differentiate between bacterial and viral aetiologies in SSA. Methods Online databases were searched for relevant articles published between January 2010 and December 2020 regarding childhood pneumonia diagnosis, conducted in SSA in children less than 18 years of age. The 2020 PRISMA checklist was utilized in appraising the selected studies and the QUADAS-2 tool was employed to assess the risk of bias in each of the studies selected. Results A total of 1542 study titles and abstracts were screened following which 45 studies (39 on childhood pneumonia diagnostics and 6 on discriminating between bacterial and viral childhood pneumonia) were selected for review. Microbiological investigations (79.7%) constituted the most utilized index tests with blood-related specimen (32.8%) being the most utilized specimen. The most performed index diagnostic modality was polymerase chain reaction (PCR) (53.1%). The commonest reference gold standard technique was based on clinical diagnosis of the disease (46.2%). Only six studies in SSA attempted at using serum biomarkers, either singly or in combination to distinguish between aetiologies with use of combined biomarkers showing promise. Conclusion Microbiological investigations are the most employed diagnostic methods for childhood pneumonia in SSA. More studies are required to evaluate the potential use of serum biomarkers; either singly or in combination with the goal of discriminating bacterial and viral childhood pneumonia. Lay Summary Childhood pneumonia remains a disease of global health significance, contributing greatly to childhood morbidity and mortality especially in SSA. The effective management of the disease anchors on prompt diagnosis and identification of the likely aetiologic agent in order to guide appropriate therapeutic interventions. Though a global challenge, the diagnosis of the disease remains a major concern particularly in low- and middle-income settings given the limited resources. This study aimed at systematically reviewing childhood pneumonia diagnostics in SSA which is a high burden area with limited resources. The review also aimed at identifying potential modalities available to differenti