The clinical trial will enroll and follow-up 3500 children with non-severe pneumonia in Senegal, South Africa and Tanzania who will be randomized to either receive lung ultrasound evaluation or not. The aim is to assess whether lung ultrasound, integrated into the current IMCI guidelines for the management of childhood pneumonia, has an impact on antibiotic prescription and clinical outcomes. The trial will also generate evidence on pneumonia aetiology and risk stratification, the role of lung ultrasound in diagnosing paediatric tuberculosis, and the cost-effectiveness of integrating lung ultrasound into current IMCI algorithms. The clinical research teams at each site will work closely with the health care workers within the routine care facilities, the local communities and the stakeholders within the government health departments.

Through implementation research, we aim to understand and address facilitators and barriers to the implementation of point-of-care lung ultrasound in routine services for integrated management of childhood illnesses. The implementation strategy will be co-designed in close consultation with policymakers, healthcare providers and caregivers to ensure relevance and appropriateness. Following the clinical trial, implementation will be led by clinical teams in each country, working closely with relevant Ministry of Health and facility stakeholders. Accompanying evaluation will assess acceptability, uptake and impact in routine services to inform approaches to scale-up.