Assessing the Quality of Care for Pneumonia in Integrated Community Case Management: A Cross-Sectional Mixed Methods Study

Sinyangwe, Chomba; Graham, Kirstie; Nicholas, Sarala; King, Rebecca; Mukupa, Samuel; Källander, Karin; Counihan, Helen; Montague, Mark; Tibenderana, James; Hamade, Prudence

doi:10.1371/journal.pone.0152204

Cited by 19 publications

(27 citation statements)

References 18 publications

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“…This study shows that while community health workers (CHWs) using four different RR counting devices are able to obtain respiratory rates (RR) from children in the majority of cases, the agreement of their measurements with the reference standard was low for all devices tested. As in previous studies in Zambia and Uganda, where expert clinicians were used as the reference standard to assess agreement with CHW measurements [8], [34], our study also shows a lot of variability between the CHWs and our automated reference standard RR count. Our data shows that it was especially difficult for CHWs to obtain an accurate count (± 2 breaths) in young infants, in which only 8% to 20% of the assessments were in agreement with the reference standard, regardless of the RR device used.…”

Section: Discussionsupporting

confidence: 75%

Performance of Four Respiratory Rate Counters to Support Community Health Workers to Detect the Symptoms of Pneumonia in Children in Low Resource Settings: A Prospective, Multicentre, Hospital-Based, Single-Blinded, Comparative Trial

et al. 2019

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Summary Background Pneumonia is one of the leading causes of death in children under-five globally. The current diagnostic criteria for pneumonia are based on increased respiratory rate (RR) or chest in-drawing in children with cough and/or difficulty breathing. Accurately counting RR is difficult for community health workers (CHWs). Current RR counting devices are frequently inadequate or unavailable. This study analysed the performance of improved RR timers for detection of pneumonia symptoms in low-resource settings. Methods Four RR timers were evaluated on 454 children, aged from 0 to 59 months with cough and/or difficulty breathing, over three months, by CHWs in hospital settings in Cambodia, Ethiopia, South Sudan and Uganda. The devices were the Mark Two ARI timer (MK2 ARI), counting beads with ARI timer, Rrate Android phone and the Respirometer feature phone applications. Performance was evaluated for agreement with an automated RR reference standard (Masimo Root patient monitoring and connectivity platform with ISA CO 2 capnography). This study is registered with ANZCTR [ACTRN12615000348550]. Findings While most CHWs managed to achieve a RR count with the four devices, the agreement was low for all; the mean difference of RR measurements from the reference standard for the four devices ranged from 0.5 (95% C.I. − 2.2 to 1.2) for the respirometer to 5.5 (95% C.I. 3.2 to 7.8) for Rrate. Performance was consistently lower for young infants (0 to < 2 months) than for older children (2 to ≤ 59 months). Agreement of RR classification into fast and normal breathing was moderate across all four devices, with Cohen's Kappa statistics ranging from 0.41 (SE 0.04) to 0.49 (SE 0.05). Interpretation None of the four devices evaluated performed well based on agreement with the reference standard. The ARI timer currently recommended for use by CHWs should only be replaced by more expensive, equally performing, automated RR devices when aspects such as usability and duration of the device significantly improve the patient-provider experience. Funding [OPP1054367].

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Section: Discussionsupporting

confidence: 75%

Performance of Four Respiratory Rate Counters to Support Community Health Workers to Detect the Symptoms of Pneumonia in Children in Low Resource Settings: A Prospective, Multicentre, Hospital-Based, Single-Blinded, Comparative Trial

et al. 2019

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“…In the absence of doctors, front line health workers screen and diagnose diseases. In a study in Zambia, despite moderately high level of agreement between CHW classification of children with fast and normal breathing with that of experts, the limits of agreement were wide enough to lead the authors to conclude that further use of diagnostic tools such as POx would greatly help in assessing pneumonia in remote settings in LMIC [15]. On the other hand, there have been studies where inter observer agreement was found to be poor in RR measurements [16,17].…”

Section: Discussionmentioning

confidence: 99%

Measuring accuracy of plethysmography based respiratory rate measurement using pulse oximeter at a tertiary hospital in India

Kumar

Sarin²,

Kumar

et al. 2020

Pneumonia

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Background: Childhood pneumonia continues to be a major infectious killer in India. WHO recommended respiratory rate and oxygen saturation (SpO 2) measurements are not well implemented in Indian public health outpatient facilities with the result that treatment decision-making rely on subjective assessments from variably trained and supervised healthcare providers. The introduction of a multi-modal pulse oximeter (POx) that gives reliable measurements would mitigate incorrect diagnosis. In light of future potential use of pulse oximeter in peripheral health centres, it becomes important to measure accuracy of respiratory rate and oxygen saturation of such an instrument. The current study measures accuracy of plethysmography based respiratory rate (RR) using a pulse oximeter (Masimo Rad-G) by comparing it with a gold standard (pediatrician) measurement. Study design: A cross sectional study was conducted in the OPD and emergency ward of Kalawati Saran Children's Hospital over a 2 week period wherein a convenience sample of 97 children (2 to 59 months) were assessed by a pediatrician as part of routine assessment alongside independent measure by a consultant using pulse oximeter. The level of agreement between plethymography based RR and pediatrician measure was analyzed along with sensitivity and specificity of fast breathing of plethymography based RR measure. Results: Both methods of measurement show strong association (97%, p < 0.001) and observed values, falling on line of unity, obtained either from pulse oximeter or by pediatrician are very close to each other. Fast breathing measured by POx has a sensitivity of 95% and specificity of nearly 94%. Conclusion: The current study provides evidence of the accuracy of a plethysmography based RR using a pulse oximeter which can potentially be of use in planning of pneumonia management in public health facilities.

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“…This study did not aim at separating fever due to malaria from fever due to other reasons. The low validity of the HEWs’ classification of febrile conditions might be a result of errors both in performing clinical assessments and in interpreting the findings and classifying the illness . A previous Ethiopian study, however, showed that, given that the diagnosis was correct, the HEWs provided high‐quality care to sick children .…”

Section: Discussionmentioning

confidence: 99%

Health Extension Workers’ diagnostic accuracy for common childhood illnesses in four regions of Ethiopia: a cross‐sectional study

et al. 2019

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Aim: The Ethiopian primary care of sick children is provided within the integrated Community Case Management of childhood illnesses by Health Extension Workers (HEW). There is limited knowledge whether this cadre correctly assess and classify common diseases. The aim was to study their ability to correctly classify common childhood illnesses.Methods: A survey was conducted from December 2016 to February 2017 in four regions of Ethiopia. Observations of the HEWs' assessment and classification of sick children were followed by child re-examination by a trained health officer. Results:The classification by the HEWs of 620 sick children as compared to the reexaminer had a sensitivity of 89% and specificity of 94% for diarrhoea, sensitivity 52% and specificity 91% for febrile disorders, and a sensitivity of 59% and specificity of 94% for acute respiratory tract infection. Malnutrition and ear infection had a sensitivity of 39 and 61%, and a specificity of 99 and 99%, respectively.Conclusion: Most cases of diarrhoea were correctly classified, while other illnesses were not frequently identified. The identification of malnutrition was especially at fault. These findings suggest that a significant number of sick children were undiagnosed that could lead to absent or incorrect management and treatment. 2100

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Assessing the Quality of Care for Pneumonia in Integrated Community Case Management: A Cross-Sectional Mixed Methods Study

Cited by 19 publications

References 18 publications

Performance of Four Respiratory Rate Counters to Support Community Health Workers to Detect the Symptoms of Pneumonia in Children in Low Resource Settings: A Prospective, Multicentre, Hospital-Based, Single-Blinded, Comparative Trial

Performance of Four Respiratory Rate Counters to Support Community Health Workers to Detect the Symptoms of Pneumonia in Children in Low Resource Settings: A Prospective, Multicentre, Hospital-Based, Single-Blinded, Comparative Trial

Measuring accuracy of plethysmography based respiratory rate measurement using pulse oximeter at a tertiary hospital in India

Health Extension Workers’ diagnostic accuracy for common childhood illnesses in four regions of Ethiopia: a cross‐sectional study

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