Testing pneumonia diagnostic aids in Ethiopia and Nepal

Testing pneumonia diagnostic aids in Ethiopia and Nepal

The challenges in pneumonia diagnosis in low-resource settings have been well documented. The current method routinely used involves community health workers manually counting a child’s breath for one minute (known as the ‘respiratory rate’). Due to the challenges in counting the respiratory rate effectively it is often not done, or done poorly, frequently leading to misdiagnosis and inappropriate treatment. To improve the management of pneumonia, frontline health workers need to be able to access improved, automated diagnostic tools as well as safe, effective treatments, including amoxicillin dispersible tablets and oxygen therapy.

The Acute Respiratory Infection Diagnostic Aid (ARIDA) project tested the performance, usability and acceptability of two new pneumonia diagnostic aids in Ethiopia and Nepal between 2016 and 2019. The project sought to introduce automated respiratory rate counting aids that can be used to classify fast breathing – a symptom of pneumonia – by frontline health workers in resource-limited community settings and health facilities.

The ARIDA field trial design included a number of research stages to assess the usability and acceptability of two devices: the Phillips ChARM device that uses an accelerometer to calculate a child’s respiratory rate (tested in Ethiopia and Nepal), and the Masimo Rad-G multi-modal device that calculates a child’s respiratory rate and oxygen saturation level (tested in Ethiopia).

The project was delivered through a unique technical and operational partnership between Malaria Consortium, who developed the study designs, UNICEF Supply Division and UNICEF Programme Division, who provided technical oversight to the studies, as well as Malaria Consortium Ethiopia and HERD International who conducted the research in the two countries. UNICEF country offices in Ethiopia and Nepal also played a part in supporting the in-country ethical review, setting up the research sites and engaging with Ministries of Health.

Results of the studies showed that community health workers in Ethiopia were able to adhere to the required case management guidelines when using both ChARM and Rad-G devices. However, in Nepal, community health workers had lower levels of adherence to the required guidelines when using ChARM after two months. This may be due to environmental factors and capacity constraints – such as lower level of literacy, numeracy, training and/or the remote location of the study. In each country, both devices were considered acceptable to frontline health workers and caregivers.

The encouraging results for these new automated diagnostic aids will hopefully lead to future studies investigating the performance and cost effectiveness further.

Authors: Malaria Consortium

December 2019