Automated Respiratory Rate Counter to Assess Children for Symptoms of Pneumonia: Protocol for Cross-Sectional Usability and Acceptability Studies in Ethiopia and Nepal

Abstract

Background Manually counting a child’s respiratory rate (RR) for 60 seconds using an acute respiratory infection timer is the World Health Organization (WHO) recommended method for detecting fast breathing as a sign of pneumonia. However, counting the RR is challenging and misclassification of an observed rate is common, often leading to inappropriate treatment. To address this gap, the acute respiratory infection diagnostic aid (ARIDA) project was initiated in response to a call for better pneumonia diagnostic aids and aimed to identify and assess automated RR counters for classifying fast breathing pneumonia when used by front-line health workers in resource-limited community settings and health facilities. The Children’s Automated Respiration Monitor (ChARM), an automated RR diagnostic aid using accelerometer technology developed by Koninklijke Philips NV, and the Rad-G, a multimodal RR diagnostic and pulse oximeter developed by Masimo, were the two devices tested in these studies conducted in the Southern Nations, Nationalities, and Peoples’ Region in Ethiopia and in the Karnali region in Nepal. Objective In these studies, we aimed to understand the usability of two new automated RR diagnostic aids for community health workers (CHWs; health extension workers [Ethiopia] and female community health volunteers [Nepal]) and their acceptability to CHWs in Ethiopia and Nepal, first-level health facility workers (FLHFWs) in Ethiopia only, and caregivers in both Ethiopia and Nepal. Methods This was a prospective, cross-sectional study with a mixed methods design. CHWs and FLHFWs were trained to use both devices and provided with refresher training on all WHO requirements to assess fast breathing. Immediately after training, CHWs were observed using ARIDA on two children. Routine pneumonia case management consultations for children aged 5 years and younger and the device used for these consultations between the first and second consultations were recorded by CHWs in their patient log books. CHWs were observed a second time after 2 months. Semistructured interviews were also conducted with CHWs, FLHFWs, and caregivers. The proportion of consultations with children aged 5 years and younger where CHWs using an ARIDA and adhered to all WHO requirements to assess fast breathing and device manufacturer instructions for use after 2 months will be calculated. Qualitative data from semistructured interviews will be analyzed using a thematic framework approach. Results The ARIDA project was funded in November 2015, and data collection was conducted between April and December 2018. Data analysis is currently under way and the first results are expected to be submitted for publication in 2020. Conclusions This is the first time the usability and acceptability of automated RR counters in low-resource settings have been evaluated. Outcomes will be relevant for policy makers and are important for future research of this new class of diagnostic aids for the management of children with suspected pneumonia. International Registered Report Identifier (IRRID) DERR1-10.2196/14405

Usability and acceptability of a multimodal respiratory rate and pulse oximeter device in case management of children with symptoms of pneumonia: A cross‐sectional study in Ethiopia

“…Full details of the methods have been described elsewhere 21 …”

“…Full details of the methods have been described elsewhere. 21 Masimo developed the Rad-G (Figure 1) which uses differential light absorbance technology to measure SpO 2 and derives respiration rate (RR), pulse rate (PR) and perfusion index (Pi) from the photo plethysmography waveform or Pleth (RRp™) in children 0 to 59 months and classifies the RR and SpO 2 of the child according to WHO IMCI/iCCM guideline cut-offs. 3,4 The device, designed for LMIC use, is comprised of a handheld unit with a liquid crystal display touchscreen user interface and a detachable universal sensor probe suitable for children above 3 kg and which is placed on the child's finger or toe.…”

“…The study was approved by the Liverpool School of Tropical Medicine Research Ethics Committee (ref [18][19][20][21][22][23][24][25][26]. and the SNNPR Regional Health Bureau Ethics Committee (ref.…”

Usability and acceptability of an automated respiratory rate counter to assess children for symptoms of pneumonia: A cross‐sectional study in Ethiopia

“…Only HEWs were observed, under the assumption that FLHFWs would be able to use ChARM as well or better than HEWs due to their higher education level and longer training. The methods are described in full elsewhere …”

Usability and acceptability of an automated respiratory rate counter to assess childhood pneumonia in Nepal

“…Prior to starting the first quantitative data collection, a training of trainers (ToT) and research teams and a cascade training for FCHVs were conducted. The methods are described in detail elsewhere …”