Childhood pneumonia diagnostics: community health workers’ and national stakeholders’ differing perspectives of new and existing aids

Abstract

Background: Pneumonia heavily contributes to global under-five mortality. Many countries use community case management to detect and treat childhood pneumonia. Community health workers (CHWs) have limited tools to help them assess signs of pneumonia. New respiratory rate (RR) counting devices and pulse oximeters are being considered for this purpose.Objective: To explore perspectives of CHWs and national stakeholders regarding the potential usability and scalability of seven devices to aid community assessment of pneumonia signs.Design: Pile sorting was conducted to rate the usability and scalability of 7 different RR counting aids and pulse oximeters amongst 16 groups of participants. Following each pile-sorting session, a focus group discussion (FGD) explored participants’ sorting rationale. Purposive sampling was used to select CHWs and national stakeholders with experience in childhood pneumonia and integrated community case management (iCCM) in Cambodia, Ethiopia, Uganda and South Sudan. Pile-sorting data were aggregated for countries and participant groups. FGDs were audio recorded and transcribed verbatim. Translated FGDs transcripts were coded in NVivo 10 and analysed using thematic content analysis. Comparative analysis was performed between countries and groups to identify thematic patterns.Results: CHWs and national stakeholders across the four countries perceived the acute respiratory infection (ARI) timer and fingertip pulse oximeter as highly scalable and easy for CHWs to use. National stakeholders were less receptive to new technologies. CHWs placed greater priority on device acceptability to caregivers and children. Both groups felt that heavy reliance on electricity reduced potential scalability and usability in rural areas. Device simplicity, affordability and sustainability were universally valued.Conclusions: CHWs and national stakeholders prioritise different device characteristics according to their specific focus of work. The views of all relevant stakeholders, including health workers, policy makers, children and parents, should be considered in future policy decisions, research and development regarding suitable pneumonia diagnostic aids for community use.

Opportunities and barriers in paediatric pulse oximetry for pneumonia in low-resource clinical settings: a qualitative evaluation from Malawi and Bangladesh

“…In order to better understand current barriers to the use of pulse oximetry by healthcare providers (HCPs) in a range of healthcare settings and explore opportunities that this technology provides, input from end-users is needed. 20 With the ultimate goal of designing a universal paediatric probe for all levels of healthcare services in resource-poor settings, we aimed to gain an understanding of the challenges of pulse oximetry, how its use has changed service provision and how current devices could be improved for these settings. This end-user perspective is currently limited in the literature and is essential to ensure investment in pulse oximetry is sustainable and effective.…”

Performance, Acceptability, and Usability of Respiratory Rate Timers and Pulse Oximeters When Used by Frontline Health Workers to Detect Symptoms of Pneumonia in Sub-Saharan Africa and Southeast Asia: Protocol for a Two-Phase, Multisite, Mixed-Methods Trial

“…A number of activities were conducted before the field trials to select the test devices. First, the formative research was conducted to inform the attributes used in the subsequent device scoring [ 20 ]. Second, an initial landscape review was conducted where 188 possible devices were identified [ 21 ]; these devices were further evaluated in a review of technical specifications [ 22 ].…”

A factorial cluster-randomised controlled trial combining home-environmental and early child development interventions to improve child health and development: rationale, trial design and baseline findings

“…Both, health and project field staff were trained, monitored and supervised monthly in the use of PPOs to assess ARI cases equally. PPOs have been underutilised in resource-limited health care settings for a variety of reasons, including high cost, inadequate supply and lack of training [55]. Our design overcomes these limitations and furthers the research on the usefulness and effectiveness of PPOs for ARI case assessments.…”