Helping Reduce Child Pneumonia Deaths in Cambodian Rural Communities
28 September 2015
Rochom Wart is one of 65 village malaria workers (VMWs) in Cambodia, who has been trained to also detect the signs and symptoms of pneumonia in children under five years using special new diagnostic tools.
The new devices - pulse oximeters, which measure the levels of oxygen in the blood, as low levels are a symptom of severe pneumonia; and respiratory rate timers which help determine a child’s breath rate, as high breath rate is an indicator of pneumonia - are being tested for use by health workers at community and first level health facility levels across four low-income countries as part of Malaria Consortium’s Pneumonia Diagnostics Project.
“I think this study is important,” said Rochom Wart, a community health worker in Ratanakiri province, Cambodia. “With these devices, now we can see the results on the screen so we can quickly know if the child is sick or not. I am happy to participate in this study because before I did not know how to use the devices in order to know if it is severe pneumonia or not.”
Pneumonia is the number one infectious killer of children under five years old in Southeast Asia and sub-Saharan Africa. The mortality rate for children under five in Cambodia is amongst the highest in the region, with pneumonia accounting for between 16-30 percent of child deaths. Pneumonia deaths can be attributed to late care-seeking and inappropriate treatment due to misdiagnosis of symptoms.
The Pneumonia Diagnostics Project, funded by the Bill & Melinda Gates Foundation, will identify the most accurate, acceptable and user-friendly devices for use by frontline health workers. The four countries forming part of the study are Cambodia, South Sudan, Uganda and Ethiopia.
The first phase of the project involved a device selection stage where devices for diagnosing pneumonia in low-resource settings were systematically reviewed. After the most promising and appropriate respiratory rate timers and pulse oximeters for field testing had been identified, the next stage entailed exploring the accuracy of each device used by community and first level health facility workers against three reference standards.
Like Rochom Wart, a large number of health workers at community and first level health facilities in Ratanakiri travel daily from remote parts of the province to take part in the project.
“The training is very good and useful because I get more experience and gain more knowledge on pneumonia as a disease,” said Sol Leang, a VMW in Oyadav District, “Taking part in this study, I have learned about signs and symptoms of pneumonia and how to use modern devices to diagnose severe pneumonia.”
An especially motivating factor for many of those participating in the research study is the hope that they could eventually use the improved and easy-to-use technologies on children in their communities to help diagnose pneumonia as part of their day-to-day work.
“We can help the community with these devices. In case of severe pneumonia, we can refer quickly to hospital,”said Kay Raseu, a VMW from Ochum District. ”With these devices it is easy to assess the child, since I can see the results quickly.”
The next and final stage of the Pneumonia Diagnostics Project is the field evaluation, which will be conducted from September to November 2015. The field evaluation will assess the feasibility of introducing the devices into routine health worker practice at community and first level health facility level and explore the acceptability of the devices by both the health workers and the children’s parents or caregivers.
Monica Posada is the Behaviour Change Communication Technical Specialist at Malaria Consortium, Cambodia. She is in charge of providing technical support for projects that combat targeted diseases and promote child and maternal health trough sustainable and innovative public health communications.
The first step of the project involved device selection, where the most promising existing devices for pneumonia diagnosis were identified for field testing. Here, a LIFEBOX Handheld Pulse Oximeter is on display – a device that measures oxygen levels in the blood to diagnose pneumonia.
Copyright Malaria Consortium/Peter Caton
The selected devices were then tested for accuracy against three reference standards. Training took place at Banlung city, in Ratanakiri province, where community health workers and first level health facility workers were taught to use the selected devices, which included pulse oximeters and respiratory rate timers. “I think Masimo smartphone is easier, I can see the results quickly. The other devices take a bit longer,” said Kay Raseu, a village malaria worker participating in the evaluations.
Copyright Malaria Consortium/Peter Caton
“I think this study is important,” said Rochom Wart, a 24-year-old village malaria worker who participated in the accuracy evaluation stage. “With these devices, now we can see the results on the screen so we can quickly know if the child is sick or not. I am happy to participate in this study because before I did not know how to use the devices in order to know if it is severe pneumonia or not.”
Copyright Malaria Consortium/Peter Caton
The health workers practiced using the devices by testing each other, and by conducting role plays with a life-size doll.
Copyright Malaria Consortium/Peter Caton
At Borkeo Referral Hospital, a Malaria Consortium employee explained the pneumonia diagnostics study to a community member and asked if she would be willing to have her child tested as part of the evaluation stage.
Copyright Malaria Consortium/Peter Caton
Keo Chetna, Expert Counter, placed a probe on a baby’s toe to measure his blood oxygen saturation level in order to detect pneumonia.
Copyright Malaria Consortium/Peter Caton
Ke Kosal, Malaria Consortium’s Field Research Assistant, observed how a village malaria worker conducted an assessment using a pulse oximeter device.
Copyright Malaria Consortium/Peter Caton
A family visitor cooked on an open fire at Banlung Hospital. It is the only referral hospital in Banlung district. From January to March 2015, around 100 pneumonia cases in children under five years old were diagnosed and treated.
Copyright Malaria Consortium/Peter Caton
Community members leaving Borkeo Referral Hospital, Ratanakiri, after having participated in the device testing. A total number of 402 children were assessed during this stage.
Copyright Malaria Consortium/Peter Caton
Residents of Kakthom village cooked at their house with a typical charcoal and wood stove. In-house smoke is a risk factor for pneumonia for children under five years old.
Copyright Malaria Consortium/Peter Caton
Romas Dean is a village malaria worker in Ratanakiri Province who took part in the training. After returning to her village, she continues to diagnose and treat malaria, diarrhoea and pneumonia in her rural community. Here, she used a respiratory rate timer to assess symptoms of a young child who had come to seek treatment at her house.
Copyright Malaria Consortium/Peter Caton
Romas Dean divides her time working as a village malaria worker and as a cassava farmer. “Sometimes people call us when we are working in the farm, then we come back to the village and treat them.”
Copyright Malaria Consortium/Peter Caton
The next and final stage of the Pneumonia Diagnostics Project is the field evaluation, which will be conducted from September to November 2015. The field evaluation will assess the feasibility of introducing the devices into the routine practice of community health workers and first line health facility workers, taking into account their feedback as well as that of patients and caregivers.
Copyright Malaria Consortium/Peter Caton
One of the most exciting aspects of the training for many health workers is that they will be able to use the improved technology to save lives in their communities. “We can help the community with these devices. In case of severe pneumonia, we can refer quickly to hospital and people will save money like this”, said Kay Raseu, a village malaria worker from Ochum District. ”With these devices it is easy to assess the child, since I can see the results quickly.”
Copyright Malaria Consortium/Peter Caton
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Country: Cambodia
Keywords: Diagnosis