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

Abstract

Aim Pneumonia is the leading infectious cause of death among children under five globally. Many pneumonia deaths result from inappropriate treatment due to misdiagnosis of signs and symptoms. This study aims to identify whether health extension workers (HEWs) in Ethiopia, using an automated multimodal device (Masimo Rad‐G), adhere to required guidelines while assessing and classifying under five children with cough or difficulty breathing and to understand device acceptability. Methods A cross‐sectional study was conducted in three districts of Southern Nations, Nationalities, and Peoples' Region, Ethiopia. Between September and December 2018, 133 HEWs were directly observed using Rad‐G while conducting 599 sick child consultations. Usability was measured as adherence to the World Health Organization requirements to assess fast breathing and device manufacturer instructions for use. Acceptability was assessed using semi‐structured interviews with HEWs, first‐level health facility workers and caregivers. Results Adherence using the Rad‐G routinely for 2 months was 85.3% (95% CI 80.2, 89.3). Health workers and caregivers stated a preference for Rad‐G. Users highlighted a number of device design issues. Conclusion While demonstrating high levels of acceptability and usability, the device modifications to consider include better probe fit, improved user interface with exclusive age categories and simplified classification outcomes.

Performance of Automated Point-of-Care Respiratory Rate Counting versus Manual Counting in Children under Five Admitted with Severe Febrile Illness to Kisantu Hospital, DR Congo

“…A previous hospital-based study in Ethiopia from the ARIDA group assessed the usability of the Masimo Rad G pulse oximeter and reported that children were feeding or drinking, or not calm before or during RR counting, in up to 15% RR measurements, which corresponds with our observations [14]. They also reported slow performance with a median time of almost 6 min necessary for automated RR counting [14]. Finally, they reported failure to count the RR with the automated method after three attempts in 8% of children [14].…”

“…Previous studies in children under five years old in low-resource settings also reported difficulties to perform RR counting according to the WHO guidelines and a suboptimal performance of Masimo Rad G pulse oximeter for automated RR counting. A previous hospital-based study in Ethiopia from the ARIDA group assessed the usability of the Masimo Rad G pulse oximeter and reported that children were feeding or drinking, or not calm before or during RR counting, in up to 15% RR measurements, which corresponds with our observations [14]. They also reported slow performance with a median time of almost 6 min necessary for automated RR counting [14].…”

“…They also reported slow performance with a median time of almost 6 min necessary for automated RR counting [14]. Finally, they reported failure to count the RR with the automated method after three attempts in 8% of children [14]. When compared to our study, an Indian study in children under five that presented at the outpatient or emergency department reported better performance of Masimo Rad G, with a lower and less variable underestimation (mean difference −0.4, 95% CI limits of agreement −7-6; comparative method: manual RR counting) [15].…”

“…Therefore, UNICEF launched the acute respiratory infection diagnostic aid (ARIDA) project and determined the target product profile of an automated RR counter [13]. Recently, two automated RR counters, i.e., a photoplethysmography-based (Masimo Rad G) [14][15][16] and accelerometer-based (Philips ChARM) [17][18][19][20] device have been evaluated in a low-resource setting. These studies revealed variable accuracy and some usability issues, such as slow performance and measurement failure [14][15][16][17][18][19][20].…”

“…Recently, two automated RR counters, i.e., a photoplethysmography-based (Masimo Rad G) [14][15][16] and accelerometer-based (Philips ChARM) [17][18][19][20] device have been evaluated in a low-resource setting. These studies revealed variable accuracy and some usability issues, such as slow performance and measurement failure [14][15][16][17][18][19][20]. However, for a full evaluation of the value of these two methods to detect fast breathing as a clinical danger sign, field studies should specifically address children with severe febrile illness in a low resource setting.…”