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Pneumonia Diagnostics

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Context Overview

Currently, community health workers use a number of devices to diagnose the symptoms of pneumonia in children under five years of age. These range from mobile phone applications, manual respiratory rate timers to coloured counting beads.

This research project is comprised of a series of three research phases, using both qualitative and quantitative methodologies, occuring over a 26 month period. The project is funded by the Bill & Melinda Gates Foundation.

Photo: Malaria Consortium/Tine Frank

Context Overview

Photo: Malaria Consortium

Context Overview

This research project is comprised of a series of three research phases, using both qualitative and quantitative methodologies, occuring over an 26 month period. The project is funded by the Bill & Melinda Gates Foundation.

Photo: Malaria Consortium

Context Overview

This research project was comprised of a series of three research phases, using both qualitative and quantitative methodologies, occuring over a 26 month period. The project was funded by the Bill & Melinda Gates Foundation.

Photo: Malaria Consortium/Tine Frank

Project details

Countries
Cambodia
Ethiopia
South Sudan
Uganda

Donor
Bill & Melinda Gates Foundation

Partner Organisations
Ministries of Health
Scientific Advisory Committee

Start Date
08/11/2013

End Date
31/03/2016

Countries

Cambodia Ethiopia South Sudan Uganda

Project overview

This project identified the most accurate, acceptable, scalable and user-friendly respiratory rate (RR) timers and pulse oximeters for diagnosis of pneumonia symptoms in children by community health workers (CHWs) and first level health facility workers (FLHFW) in four low-income countries.

Pneumonia is one of the leading causes of death in children under five in both Southeast Asia and sub-Saharan Africa. A large number of the children who die from pneumonia do so as a result of inappropriate treatment due to misdiagnosis of symptoms. In order to tackle the large number of childhood deaths from this preventable and treatable disease, ministries of health are investing in community health workers to deliver lifesaving diagnosis and treatment with antibiotics.

Blog: Exciting times for new pneumonia diagnostic tools 17 November 2016
News: Pneumonia Diagnostics Project shares results at dissemination meetings in Cambodia 5 May 2016
News: Pneumonia diagnostics dissemination workshop held in Ethiopia 18 March 2016
News: World's first pneumonia innovations summit unveils next generation prevention, diagnostic and treatment innovations 12 November 2015

Research Phases

Phase 1: Device Selection

Objective:

To systematically review the landscape for existing RR and pulse oximeters devices appropriate for low-resource settings.
To identify, using pre-defined criteria, the most promising and appropriate devices for field-testing in sub-Saharan Africa and Southeast Asia.

Methodology:

Landscape analysis
Formative research
Stakeholder research
Device ranking
Laboratory testing

Findings:

Over 200 devices documented in the landscape analysis.
Formative research showed that CHWs strongly desire new diagnostic tools for pneumonia and described issues with the current ARI timer and breath counting process.
CHWs and national stakeholders expressed a preference for new diagnostic tools to be low cost; time efficient; accurate; simple to use; sustainable; durable; acceptable to CHWs, parents and children; and able to produce automated results.
While both CHWs and national stakeholders thought the fingertip pulse oximeter to be potentially usable and scalable at the community level, there is currently no experience in using pulse oximeters for the detection of the signs and symptoms of pneumonia.
Based on the 20 attributes defined through this process, 12 devices were selected for laboratory testing.
After lab testing nine devices were taken for accuracy evaluation in the field, four respiratory rate timers (respiratory beads, MK2 ARI timer, RRate smartphone app, feature phone app) and five pulse oximeters (Contec, Devon , Lifebox, Utech, Masimo phone POx).

Phase 2: Performance Evaluation

Objective: The study objective is to identify the accuracy of RR timers and pulse oximeters for the detection of pneumonia symptoms by CHWs and FLHFWs in four low-income countries.

Methodology:

Accuracy of the nine devices when used by community health workers and first level health facility workers were evaluated in a hospital setting in each country, against three reference standards. These reference standards included a medical professional counting, an automated monitoring device (Masimo’s Radical-7) to obtain RR and oxygen saturation (%SpO2) respectively, and thirdly, a sample of videos of the CHWs/FLHFWs using the new devices will be reviewed by a panel of experts.
Exit interviews were conducted with a sample of CHWs/FLHFWs at the end of their assessments in order to gain insights on their experience diagnosing pneumonia with the new tools.

Phase 3: Acceptability and Usability

Objective: To investigate the feasibility of introducing RR and pulse oximeters devices in routine practice for CHWs and FLHFWs and to explore their acceptability to caregivers in four countries across sub-Saharan Africa and Southeast Asia.

Research Methodology:

Standard assessment: CHW/FLHFWs use a set of devices, including one respiratory rate counter and one pulse oximeter, during routine care. The CHW/FLHFWs use one or more of the devices to assess a child, after obtaining consent, and records it in the data form – minimum 15 assessments in three months per CHW/FLHFW.
Structured assessment: On a monthly basis the research team observes CHW/FLHFWs assess children using one or both of their devices, after obtaining consent. These assessments are recorded on video to be reviewed by a panel of experts –total 375 assessments of CHWs/FLHFWs in four countries.
Five CHW/FLHFWs focus group discussions per country.