From the field: female community health volunteers in Nepal

Nepal is one of only five countries that have reduced under-five mortality by 50% since 1990[1], however pneumonia remains one of the primary causes of death for Nepali children (15% of under five deaths in 2015[2]). In rural areas, the government relies on the country’s 50,000 Female Health Community Volunteers (FCHVs) to provide maternal and child health care. Although 42% of these women have never been to school[3] they have been trained to diagnose a number of illnesses, including pneumonia, and provide essential care to young children on a daily basis in the most remote areas where Health Posts are hard to reach.

Guta

As part of its Acute Respiratory Infection Diagnosis Aid (ARIDA) project/study, Malaria Consortium (MC) went on a scoping mission to Nepal end of January and visited an FCHV in a valley outside Kathmandu. Guta Kunwor is 38 years old and she has been an FCHV for 12 year. Her aunt was an FCHV before her and she used to accompany her to trainings at the local Health Centre. On average, she sees three children with cough or difficulty breathing every week. When children present with those symptoms she counts their respiratory rate (RR) for 60 seconds according to the Integrated Management of Neonatal and Childhood Illnesses (IMNCI) guidelines and refers them to the nearest Health Post if she diagnoses fast breathing.

A child wearing the ChARM device

So far, Guta has been using the ARI Timer, a device which works like a stopwatch whilst she is counting the child’s breaths by watching their stomach moving with each inhalation and exhalation. The ARIDA study is focused on testing an automated device which is strapped to the child’s belly and automatically counts the child’s breaths. It also reduces the assessment time from five minutes to merely a couple of minutes. When we told Guta about this new device, she spontaneously thought of an analogy which rang very true: she said that using the ARI Timer was a little like touching a child’s forehead and yours at the same time to check for fever, whilst using the ChARM device was more like using a thermometer to get a reliable diagnosis.

This stage of the ARIDA study is looking at the acceptability of this new automated device under a number of specific themes: affective attitude, burden, intervention coherence, perceived effectiveness and self-efficacy. The results should show whether FCHVs and health facility workers (HFWs) using an Acute Respiratory Infection Diagnostic Aid (ARIDA) can adhere to the IMNCI algorithm, and should help us better understand FCHVs’ and HFWs’ perceptions on the benefits of and barriers to using this new device.

Alice Maurel is Senior Programme Officer at Malaria Consortium. Alice visited Nepal in January 2018.

Find out more about the ARIDA study in our project brief here.

The ARIDA study is funded by the La Caixa Foundation and UNICEF in collaboration with the Federal Ministry of Health Ethiopia, Federal Ministry of Health Nepal and Ministry of Health Mozambique.

[1] P Dawson YP, R Houston, S Karki, D Poudel, S Hodgins. From research to national expansion: 20 years’ experience of community-based management of childhood pneumonia in Nepal. Bulletin of the World Health Organization, 2008

[2] Government of Nepal MoH. Annual Report, Department of Health Services, 2015–2016. 2016.

[3] Ibid.

Exciting times for new pneumonia diagnostic tools

kevin-photo2This year’s ASTMH saw a number of key sessions and presentations that highlighted the exciting work being done to evaluate the performance of new pneumonia diagnostic aids at the community level.

Day one included a presentation by Dr. Michael Hawkes from the University of Alberta titled: ‘Solar powered oxygen delivery: a randomized controlled non-inferiority trial’. The presentation provided evidence for to show solar powered oxygen delivery can be an effective intervention in resource poor settings. The study was conducted in Jinja, Uganda and based on the results the project team is now planning to expand the work to another 85 health facilities in Uganda.

This was followed by Save the Children’s evaluation of the Philips ChARM device (Children’s Automated Respiratory Monitor) – an innovative and easy to use pneumonia-screening tool for low resource settings. The evaluation showed that the ChARM device is an acceptable alternate diagnostic tool for identifying fast breathing among children under five. 

On day two, Malaria Consortium’s US Representative, Madeleine Marasciulo, moderated a symposium titled ‘Key elements for improving management of pneumonia in children in resource poor settings’. The symposium was attended by over 200 people.

The event featured a presentation from Malaria Consortium’s African Technical Advisor, Dr Ebenezer Baba, ‘Progress towards universal access to pneumonia treatment’, as well as results from the pneumonia diagnostics study, presented by Pneumonia Diagnostics Programme Coordinator, Kevin Baker. The results highlighted the difficulty health workers face when counting respiratory rates and the need for better tools to support them to better detect the symptoms of pneumonia.

Following this, Kristoffer Gandrup-Marino, Chief ofInnovation at UNICEF Supply Division presented plans for the ARIDA project and the important factors to consider when developing pneumonia diagnostic trials at the community level in resource poor settings.
If the pneumonia diagnostics project showed us anything, it is the urgent need for user-friendly devices and for technological innovators to continue developing diagnostic tools for the millions of health workers who use them to count respiratory rates every day. The ARIDA trial is taking this forward, Kevin Baker said.

Finally, Dr Grant Aaron, Global Health Director at Masimo, presented ‘Scaling up Medical Oxygen and Pulse Oximetry – the case of Ethiopia’. Dr. Aaron highlighted the work being done to scale up oxygen management in Ethiopia as well as a new respiratory rate device being developed by Masimo.

On Tuesday evening an important session was held on the Pneumonia Etiology Research for Child Health Study (PERCH). PERCH is a multi-country, comprehensive evaluation of the etiologic agents causing severe and very severe pneumonia among children 28 days to 59 months with data collected between August 2011 and January 2014, with over 9,500 cases enrolled.

It was great to see such high quality sessions on pneumonia at ASTMH this year with several of the sessions presenting important findings for the first time. Community health delivery in remote or low resource settings will surely benefit from the new diagnostic tools and study results.

By Kevin Baker

pPanel photo from the pneumonia symposiump
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