Establishing a pediatric pulmonology unit at a large tertiary facility: A milestone in child respiratory health

Dear Editor,

Respiratory illnesses are leading contributors to child morbidity and mortality in sub-Saharan Africa. This is contributed to by the preponderance of risk factors for acute and chronic lung disease, such as poverty, malnutrition, human immunodeficiency virus/acquired immune deficiency syndrome, and tuberculosis.^[1] There is also ample evidence that adult chronic lung disease has childhood roots.^[2] Ghana’s child health system has traditionally managed respiratory diseases within the general medical services with emphasis on community-based programs such as the community health and preventive services^[3] with few opportunities for focused care or advanced diagnostics. Over the past few years, there has been an increasing awareness of the need for specialty and subspecialty services.^[4] Partners like the African Pediatric Fellowship Program (APFP) have supported the training of Ghanaian medical subspecialists, leading to an increase in the number of subspecialty practices. Through this collaboration, Korle Bu Teaching Hospital (KBTH), the largest referral hospital in Ghana, recently received a pediatric pulmonologist. This has led to the establishment of a pulmonology unit within the Department of Child Health to improve care for children with complex respiratory conditions, provide training for pediatric residents and future pulmonologists, serve as a hub for research into respiratory health in Ghana and West Africa, and facilitate regional collaboration and knowledge exchange. In this letter, we describe the process, initial outcomes, and challenges of the implementation of a pediatric pulmonology clinic with a spirometry service in a tertiary hospital in West Africa, to improve access to evidence-based respiratory care.

A mixed methods approach was adopted. Initial stakeholder engagement involved meetings with the heads of the Department of Child Health, allied health departments, and key organizations like the National Tuberculosis Program. On departmental approval, spaces were then allocated and equipped for an outpatient clinic and a spirometry room. Two nurses were identified to assist with the running of the clinic. Some equipment was procured from international partners as well as the hospital itself. The pulmonology unit was then formally integrated into the Department of Child Health in March 2024. With the aid of external funding, a pediatric pulmonology cohort study was started in January 2025 to monitor patient socio-demographics, diagnostic trends, and spirometry utilization.

From unit establishment in March 2024 to July 2025, 70 children, aged 0–16, were enrolled in the pulmonology clinic. Out of these, 32 children (median age 7 years) have been enrolled in a prospective cohort. Among these 32, common diagnoses include asthma with a previous near-fatal attack or low lung function (41%), recurrent lower respiratory tract infection (13%), congenital thoracic malformation (9%), and post-infective lung disease (9%). The pulmonology unit also supports the pre-existing asthma clinic. Inpatient consultations are provided within KBTH and other hospitals within and outside the Greater Accra Region. For hospitals other than KBTH, this is mainly done through telephone conversations. Spirometry has been performed for more than 100 children from KBTH and nearby hospitals according to American Thoracic Society/European Respiratory Society criteria. The most common indication for spirometry is a clinical diagnosis of asthma, either for confirmation or monitoring. Bronchoscopy has so far been with adult pulmonology collaboration in private practice, although there are plans to establish this service in-house. Several in-person and virtual training sessions and continuous medical education seminars for pediatric residents and other doctors have been organized. Topics include spirometry interpretation; recurrent pneumonia; climate change, air pollution, and lung health; asthma diagnosis and management; and bronchiectasis. These sessions were in collaboration with the Department of Child Health, Pediatric Society of Ghana, Ghana Thoracic Society, and Society of Family Physicians of Ghana. Several residents have rotated through the pulmonology clinic as well. The unit is currently involved in two studies, a chronic pulmonary disease cohort study and a post-tuberculosis lung disease study, both of which are yet to be published. It actively participates in advocacy activities in partnership with the Pediatric Society of Ghana and the Ghana Thoracic Society. World Asthma Day and World Lung Day have been marked with social media education and spirometry outreaches.

Healthcare in Ghana has traditionally been curative, with emphasis on infections and infestations. This has historically led to a focus on community-based services with task-shifting. However, there is a changing epidemiology of disease which requires investment in specialist and sub-specialist medical services, although the emphasis on curative medicine is still not misplaced. The establishment of a pediatric pulmonology unit in KBTH represents a major change in the pediatric respiratory landscape in Ghana. It addresses a gap in the diagnosis and management of complex respiratory conditions among children. Through providing support to other healthcare practitioners within and beyond the hospital, there is knowledge-sharing, which improves health workforce skills and eventually benefits the Ghanaian child. The introduction of in-house spirometry is a step toward guideline-based management of asthma and other chronic respiratory diseases among children. However, challenges remain. There is still limited awareness among health workers regarding the need for spirometry and which patients to refer to the clinic. In addition, there is limited respiratory diagnostic equipment and workforce, as well as affordability barriers. Nonetheless, strong departmental commitment, international and local partnerships, and gradual capacity building have enabled the unit to grow steadily.

The pediatric pulmonology unit at KBTH is well-positioned to become a regional center of excellence. Future goals include expanding diagnostic capacity (lung function testing and flexible bronchoscopy), establishing a multidisciplinary clinic, introducing fellowship training in pediatric pulmonology, and leading collaborative research into rare lung diseases such as cystic fibrosis, common conditions such as asthma, and emerging threats such as air pollution and climate change. This is possible with continued national and international collaborations.

The APFP deserves special mention for its commitment to improving pediatric specialty and sub-specialty human resources and infrastructure on the continent, an association from which Ghana has benefited for many years. As Ghana seeks to build local subspecialty medical capacity, it is essential that regulatory frameworks support the reintegration of internationally trained professionals. Maintaining professional standards is crucial and cannot be overemphasized. However, overly burdensome, costly, and protracted accreditation processes may inadvertently discourage skilled professionals from returning to their home countries to contribute their expertise, further worsening brain-drain. A collaborative approach will help strengthen local health systems toward the achievement of the Sustainable Development Goals.

The successful establishment of a pediatric pulmonology unit in KBTH has improved access to pediatric respiratory care in Ghana. Sustainable implementation involves ongoing multidisciplinary collaboration and targeted strategies to optimize uptake. This model may guide similar initiatives in resource-limited settings.