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.

中文翻译：

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撒哈拉以南非洲的儿童肺炎诊断：系统评价

背景 由于疾病管理资源有限，儿童肺炎的迅速和准确的病因诊断仍然是一个挑战，尤其是在撒哈拉以南非洲 (SSA)。目的 回顾现有的儿童肺炎诊断方法以及可用于区分 SSA 中细菌和病毒病因的潜在方法。方法 搜索在线数据库，查找 2010 年 1 月至 2020 年 12 月期间发表的有关儿童肺炎诊断的相关文章，这些文章是在 18 岁以下儿童的 SSA 中进行的。2020 PRISMA 清单用于评估选定的研究，并使用 QUADAS-2 工具评估每项选定研究的偏倚风险。结果 共筛选了 1542 篇研究标题和摘要，随后选择了 45 篇研究（39 篇关于儿童肺炎诊断，6 篇关于区分细菌性和病毒性儿童肺炎）进行审查。微生物调查（79.7%）是最常用的指标测试，血液相关样本（32.8%）是最常用的样本。执行最多的指标诊断方式是聚合酶链反应 (PCR) (53.1%)。最常见的参考金标准技术是基于疾病的临床诊断（46.2%）。在 SSA 中只有 6 项研究尝试单独或联合使用血清生物标志物来区分使用组合生物标志物的病因。结论 微生物学检查是 SSA 儿童肺炎最常用的诊断方法。需要更多的研究来评估血清生物标志物的潜在用途；单独或与区分细菌性和病毒性儿童肺炎的目标结合使用。