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Objective Trials of environmental risk factors and acute lower respiratory infections (ALRI) face a double challenge: implementing sufficiently sensitive and specific outcome assessments, and blinding. We evaluate methods used in the first randomized exposure study of pollution indoors and respiratory effects (RESPIRE): a controlled trial testing the impact of reduced indoor air pollution on ALRI, conducted among children < 18 months in rural Guatemala. Methods Case-finding used weekly home visits by fieldworkers trained in integrated management of childhood illness methods to detect ALRI signs such as fast breathing. Blindness was maintained by referring cases to study physicians working from community centres. Investigations included oxygen saturation (SaO 2 ), respiratory syncytial virus (RSV) antigen test and chest X-ray (CXR). Findings Fieldworkers referred > 90% of children meeting ALRI criteria, of whom about 70% attended a physician. Referrals for cough without respiratory signs and self-referrals contributed 19.0% and 17.9% of physician-diagnosed ALRI cases respectively. Intervention group attendance following ALRI referral was 7% higher than controls, a trend also seen in compliance with RSV tests and CXR. There was no evidence of bias by intervention status in fieldworker classification or physician diagnosis. Incidence of fieldworker ALRI (1.12 episodes/child/year) is consistent with high sensitivity and low specificity; incidence of physician-diagnosed ALRI (0.44 episodes/child/year) is consistent with comparable studies. Conclusion The combination of case-finding methods achieved good sensitivity and specificity, but intervention cases had greater likelihood of reaching the physician and being investigated. There was no evidence of bias in fieldworkers' classifications despite lack of concealment at home visits. Pulse oximetry offers practical, objective severity assessment for field studies of ALRI.

PRONTO brings simulation training to low-resource settings and can empower interprofessional teams to respond more effectively within their institutional limitations to emergencies involving women and newborns. Further study is warranted to evaluate the potential impact of the program on obstetric and neonatal outcome.

Objectives Health technology assessment (HTA) for a wide range of healthcare technologies is an essential component of well‐functioning health systems. Knowledge of the use of HTA in low‐ and middle‐income countries (LMICs) is limited. Methods We performed a survey of HTA in selected LMICs. We interviewed key stakeholders on the use, conduct and challenges of performing HTA in their countries. We performed mixed‐methods analyses to identify, characterize and describe HTA and how it relates to gross domestic product and government effectiveness. Key findings Of the 19 countries selected for participation, stakeholders in 12 (63%) countries responded to the survey – Afghanistan, Bangladesh, Democratic Republic of Congo (DR Congo), Dominican Republic, Ethiopia, Jordan, Kenya, Namibia, Rwanda, South Africa, Swaziland and Vietnam. Eight countries surveyed have some form of informal HTA activity conducted by stakeholders including academia, industry, government and the World Health Organization. There is evidence of knowledge sharing with five countries using HTAs from their neighbouring countries or from more developed countries. We found no evidence of formal HTA performed through dedicated, independent bodies in the LMICs surveyed. There was some evidence that HTA was moderately related to GDP per capita and strongly related to degree of centralization (government effectiveness). Respondents identified resources, both financial and human, as challenges to conducting HTA. Conclusions Formal HTA appears to be non‐existent or limited in the LMICs surveyed but some evidence of informal HTA exists. Efforts to formalize HTA and to use existing HTA evidence will improve the quality of regulatory, coverage, formulary and reimbursement decisions, and individual and public health.