Background: The burden of neurological disorders in low- and middle-income countries (LMICs) may be underestimated due to the limited number of diagnostic imaging devices and trained specialists to operate and interpret scans. Recent advancements in low-field (< 100 milliteslas) magnetic resonance imaging (LFMRI) hold significant promise for improving access to pediatric neuroimaging due to the technology’s lower costs, portability, and reduced infrastructure and training requirements. Purpose: Explore user needs and experiences on the training and use of a portable LFMRI for pediatric neuroimaging in LMICs. Methods: We conducted qualitative interviews with end users of the LFMRI systems across 11 sites in Bangladesh, Ethiopia, Ghana, Malawi, Pakistan, South Africa, Uganda, and Zambia. A semi-structured questionnaire with open-ended questions on usability and feasibility was used to encourage participants to share their experiences and opinions on ease of use, user satisfaction, and integration into local health systems. Results: Among 46 participants, key challenges were reported in infant positioning, power stability, and internet connectivity. Suggestions included developing reference materials with content and format tailored to local needs and contexts, conducting refresher trainings, and providing education that includes technical and maintenance support crucial for appropriate utilization and implementation sustainability. Conclusion: This study underscores the importance of incorporating human-centered design principles and user feedback into identifying and resolving usability issues, sharing insights for successful integration of LFMRI within existing health care infrastructures in LMICs, and optimizing LFMRI use for pediatric populations.

Background: Pneumonia and possible serious bacterial infection (PSBI) are leading causes of death among under-five children. The World Health Organization (WHO) issued global recommendations for the case management of childhood pneumonia and PSBI when referral is not feasible with oral amoxicillin. However, few governments to date have incorporated child-friendly amoxicillin dispersible tablets (DT) into their national treatment guidelines and policies. We aimed to understand the key drivers to the implementation of WHO recommendations for childhood pneumonia and PSBI using amoxicillin DT in Bangladesh. Methods: A qualitative study was conducted from October 2017 to March 2018 in two districts of Bangladesh. Interviews were completed with 67 participants consisting of government officials and key stakeholders, international development agencies, health service providers (HSPs), and caregivers of young children diagnosed and treated with amoxicillin for pneumonia or PSBI. Data were analyzed thematically. Results: Policies and operational planning emerged as paramount to ensuring access to essential medicines for childhood pneumonia and PSBI. Though amoxicillin DT is included for National Newborn Health Programme and Integrated Management of Childhood Illnesses in the Operational Plan of the Directorate General of Health Services, inclusion in Community-Based Healthcare Project and Directorate General of Family Planning policies is imperative to securing national supply, access, and uptake. At the sub-national level, training on the use of amoxicillin DT as a first line intervention is lacking, resulting in inadequate management of childhood pneumonia by HSPs. Advocacy activities are needed to create community-wide demand among key stakeholders, HSPs, and caregivers not yet convinced that amoxicillin DT is the preferred formulation for the management of childhood pneumonia and PSBI. Conclusion: Challenges in policy and supply at the national level and HSP preparedness at the sub-national levels contribute to the slow adoption of WHO recommendations for amoxicillin DT in Bangladesh. A consultation meeting to disseminate study findings was instrumental in driving the development of recommendations by key stakeholders to address these challenges. A comprehensive and inclusive evidence-based strategy involving all divisions of the Ministry of Health and Family Welfare will be required to achieve national adoption of WHO recommendations and country-wide introduction of amoxicillin DT in Bangladesh.