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  • The use of counting beads to improve the classification of fast breathing in low-resource settings: a multi-country review

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Publication Date:
07/07/2014

Type:
Journal article
Publication

The use of counting beads to improve the classification of fast breathing in low-resource settings: a multi-country review
Author(s): Aaltje Camielle Noordam, Yolanda Barbera Lainez, Salim Sadruddin, Pabla Maria van Heck, Alex Opio Chono, Geoffrey Larry Acaye, Victor Lara, Agnes Nanyonjo, Charles Ocan and Karin Kallander

Publication Date:
07/07/2014
Type:
Journal article

Abstract

To decrease child mortality due to common but life-threatening illnesses, community health workers (CHWs) are trained to assess, classify and treat sick children. For pneumonia, CHWs are trained to count the respiratory rate of a child with cough and/or difficulty breathing, and determine whether the child has fast breathing or not based on how the child’s breath count relates to age-specific respiratory rate cut-off points. International organisations training CHWs to classify fast breathing realised that many of them faced challenges counting and determining how the respiratory rate relates to age-specific cut-off points. Counting beads were designed to overcome these challenges. This article presents findings from different studies on the utility of these beads, in conjunction with a timer, as a tool to improve classification of fast breathing. Studies conducted by the International Rescue Committee and Save the Children among illiterate CHWs assessed the effectiveness of counting beads to improve both counting and classifying respiratory rate against age-specific cut-off points. These studies found that the use of counting beads enabled and improved the assessment and classification of fast breathing. However, a Malaria Consortium study found that the use of counting beads decreased the accuracy of counting breaths among literate CHWs. Qualitative findings from these studies and two additional studies by UNICEF suggest that the design of the beads is crucial: beads should move comfortably, and a separate bead string, with colour coding, is required for the age groups with different cut-off thresholds—eliminating more complicated calculations. Further research, using standardised protocols and gold standard comparisons, is needed to understand the accuracy of beads in comparison to other tools used for classifying pneumonia, which CHWs benefit most from each different tool (i.e. disaggregating data by levels of literacy and numeracy) and what the impact is on improving appropriate treatment for pneumonia.

Published in Health Policy and Planning

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Country: South Sudan | Uganda

Keywords: Community delivery | Pneumonia | Diagnosis | SDG3

 

 

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