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Rawat A, Ameha A, Karlström J, Taddesse L, Negeri EL, Detjen A, Gandrup-Marino K, Mataruse N, Källander K, Tariku A. Health System Considerations for Community-Based Implementation of Automated Respiratory Counters to Identify Childhood Pneumonia in 5 Regions of Ethiopia: A Qualitative Study. Int J Health Policy Manag 2023; 12:7385. [PMID: 38618793 PMCID: PMC10699823 DOI: 10.34172/ijhpm.2023.7385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/30/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND In Ethiopia, childhood pneumonia is diagnosed in primary healthcare settings by measuring respiratory rate (RR) along with the presence of cough, chest indrawing, difficulty breathing, and fast breathing. Our aim was to identify health system-level lessons from implementing two automated RR counters, Children's Automated Respiration Monitor (ChARM) by Phillips® and Rad-G by Masimo®, to provide considerations for integrating such devices into child health programmes and health systems. This study was part of an initiative called the Acute Respiratory Infection Diagnostic Aids (ARIDA). METHODS Key informant interviews (KIIs) were conducted with 57 participants (health workers in communities and facilities, trainers of health workers, district management, and key decision-makers) in five regions of Ethiopia. Data were analyzed in ATLAS.ti using thematic content analysis and themes were categorized using the Tanahashi bottleneck analysis. RESULTS All participants recommended scaling up the ARIDA initiative nationally as part of Integrated Management of Newborn and Childhood Illness (IMNCI) in primary healthcare. Health workers perceived the devices as: time saving, acceptable by parents and children, and facilitating diagnosis and referrals. Health workers perceived an increased demand for services and reduced numbers of sick children not seeking care. Participants recommended increasing the number of devices distributed and health workers trained. Strengthening drug supply chains, improving oxygen gas availability, and strengthening referral networks would maximize perceived benefits. While training improved knowledge, more supportive supervision, integration with current guidelines and more guidance related to community engagement was recommended. CONCLUSION Automatic RR counters for the decentralized diagnosis of childhood pneumonia could have positive impact on improving the quality of diagnosis and management of pneumonia in children. However, the study has shown that a health system approach is required to ensure all steps along the pneumonia pathway are adequate, including drug and oxygen supply, community engagement, health worker training and support, and referral pathways.
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Affiliation(s)
- Angeli Rawat
- UNICEF Supply Division Innovation Unit, Copenhagen, Denmark
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Agazi Ameha
- UNICEF Ethiopia Country Office, Addis Ababa, Ethiopia
| | - Jonas Karlström
- UNICEF Supply Division Innovation Unit, Copenhagen, Denmark
- Global Programmes and Research, SingHealth Duke-NUS Global Health Institute, Duke-NUS, Singapore, Singapore
| | - Lisanu Taddesse
- Federal Ministry of Health of Ethiopia, Addis Ababa, Ethiopia
| | | | - Anne Detjen
- Child and Community Health Unit, Health Programme Group, UNICEF, New York City, NY, USA
| | | | | | - Karin Källander
- Digital Health and Health Information Systems Unit, Health Programme Group, UNICEF, New York City, NY, USA
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Abraham Tariku
- Federal Ministry of Health of Ethiopia, Addis Ababa, Ethiopia
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Peck R, Storey HL, Barney B, Israeli S, Halas O, Oroszlan D, Brodsky S, Agarwal N, Murphy E, Sagalovsky M, Cohen J, Trias E, Schutzer A, Boyle DS. From biorepositories to data repositories: Open-access resources accelerate early R&D and validation of equitable diagnostic tools. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002044. [PMID: 37582061 PMCID: PMC10426984 DOI: 10.1371/journal.pgph.0002044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/31/2023] [Indexed: 08/17/2023]
Abstract
Diagnostics are critical tools that guide clinical decision-making for patient care and support disease surveillance. Despite its importance, developers and manufacturers often note that access to specimen panels and essential reagents is one of the key challenges in developing quality diagnostics, particularly in low-resource settings. A recent example, as the COVID-19 pandemic unfolded there was a need for clinical samples across the globe to support the rapid development of diagnostics. To address these challenges and gaps, PATH, a global nonprofit, along with its partners collaborated to create a COVID-19 biorepository to improve access to biological samples. Since then, the need for data resources to advance universal rapid diagnostic test (RDT) readers and noninvasive clinical measurement tools for screening children have also been identified and initiated. From biospecimens to data files, there are more similarities than differences in creating open-access repositories. And to ensure equitable technologies are developed, diverse sample panels and datasets are critical in the development process. Here we share one experience in creating open-access repositories as a case study to describe the steps taken, the key factors required to establish a biorepository, the ethical and legal frameworks that guided the initiative and the lessons learned. As diagnostic tools are evolving, more forms of data are critical to de-risk and accelerate early research and development (R&D) for products serving low resource settings. Creating physical and virtual repositories of freely available, well characterized, and high quality clinical and electronic data resources defray development costs to improve equitable access and test affordability.
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Affiliation(s)
- Roger Peck
- PATH, Seattle, Washington, United States of America
| | | | - Becky Barney
- PATH, Seattle, Washington, United States of America
| | | | - Olivia Halas
- PATH, Seattle, Washington, United States of America
| | | | | | - Neha Agarwal
- PATH, Seattle, Washington, United States of America
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Khan SR, Wang X, Jiang T, Ju W, Radacsi N, Kadir MA, Rabbani KSE, Cunningham S, Mitra S. Multi-Modal Portable Respiratory Rate Monitoring Device for Childhood Pneumonia Detection. MICROMACHINES 2023; 14:708. [PMID: 37420941 PMCID: PMC10144858 DOI: 10.3390/mi14040708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 02/26/2023] [Accepted: 03/21/2023] [Indexed: 07/09/2023]
Abstract
Accurate assessment of Respiratory Rate (RR) is the most important mechanism in detecting pneumonia in low-resource settings. Pneumonia is a disease with one of the highest mortality rates among young children under five. However, the diagnosis of pneumonia for infants remains challenging, especially in low- and middle-income countries (LMIC). In such situations, RR is most often measured manually with visual inspection. Accurate RR measurement requires the child to remain calm without any stress for a few minutes. The difficulty in achieving this with a sick child in a clinical environment can result in errors and misdiagnosis, even more so when the child is crying and non-cooperating around unfamiliar adults. Therefore, we propose an automated novel RR monitoring device built with textile glove and dry electrodes which can make use of the relaxed posture when the child is resting on the carer's lap. This portable system is non-invasive and made with affordable instrumentation integrated on customized textile glove. The glove has multi-modal automated RR detection mechanism that simultaneously uses bio-impedance and accelerometer data. This novel textile glove with dry electrodes can easily be worn by a parent/carer and is washable. The real-time display on a mobile app shows the raw data and the RR value, allowing a healthcare professional to monitor the results from afar. The prototype device has been tested on 10 volunteers with age variation of 3 years to 33 years, including male and female. The maximum variation of measured RR with the proposed system is ±2 compared to the traditional manual counting method. It does not create any discomfort for either the child or the carer and can be used up to 60 to 70 sessions/day before recharging.
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Affiliation(s)
- Sadeque Reza Khan
- School of Engineering and Physical Sciences, Institute of Sensors, Signals and Systems, Heriot-Watt University, Edinburgh EH14 4AS, UK
| | - Xiaohan Wang
- School of Engineering, Institute of Integrated Micro and Nano Systems, The University of Edinburgh, Edinburgh EH9 3FF, UK
| | - Tiantao Jiang
- School of Engineering, Institute of Integrated Micro and Nano Systems, The University of Edinburgh, Edinburgh EH9 3FF, UK
| | - Wei Ju
- School of Engineering, Institute of Integrated Micro and Nano Systems, The University of Edinburgh, Edinburgh EH9 3FF, UK
| | - Norbert Radacsi
- School of Engineering, Institute for Materials and Processes, The University of Edinburgh, Robert Stevenson Road, Edinburgh EH9 3FB, UK
| | - Muhammad Abdul Kadir
- Department of Biomedical Physics and Technology, University of Dhaka, Dhaka 1000, Bangladesh
| | | | - Steve Cunningham
- Centre for Inflammation Research, The University of Edinburgh, Edinburgh EH9 3FF, UK
| | - Srinjoy Mitra
- School of Engineering, Institute of Integrated Micro and Nano Systems, The University of Edinburgh, Edinburgh EH9 3FF, UK
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Mathew JL. Feasibility of Pulse Oximeter Derived Respiratory Parameters in Young Children: A Pilot Study. Indian Pediatr 2022. [DOI: 10.1007/s13312-022-2670-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Khan AM, O’Donald A, Shi T, Ahmed S, McCollum ED, King C, Baqui AH, Cunningham S, Campbell H. Accuracy of non-physician health workers in respiratory rate measurement to identify paediatric pneumonia in low- and middle-income countries: A systematic review and meta-analysis. J Glob Health 2022. [PMCID: PMC9037577 DOI: 10.7189/jogh.12.04037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Ahad M Khan
- Projahnmo Research Foundation, Dhaka, Bangladesh
- The University of Edinburgh, Edinburgh, UK
| | | | - Ting Shi
- The University of Edinburgh, Edinburgh, UK
| | - Salahuddin Ahmed
- Projahnmo Research Foundation, Dhaka, Bangladesh
- The University of Edinburgh, Edinburgh, UK
| | - Eric D McCollum
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Abdullah H Baqui
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Field Experiences with Handheld Diagnostic Devices to Triage Children under Five Presenting with Severe Febrile Illness in a District Hospital in DR Congo. Diagnostics (Basel) 2022; 12:diagnostics12030746. [PMID: 35328299 PMCID: PMC8947034 DOI: 10.3390/diagnostics12030746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 12/10/2022] Open
Abstract
As part of a field study (NCT04473768) in children presenting with severe febrile illness to Kisantu hospital (DR Congo), we retrospectively compiled user experiences (not performance) with handheld diagnostic devices assisting triage: tympanic thermometer, pulse oximeter (measuring heart rate, respiratory rate and oxygen saturation), hemoglobinometer and glucometer. Guidance documents for product selection were generic and scattered. Stock rupture, market withdrawal and unaffordable prices interfered with procurement. Challenges at implementation included environmental temperature, capillary blood sampling (antisepsis, order of multiple tests, filling microcuvettes and glucose strips), calibration (environmental temperature, cold chain) and liability-oriented communication with a manufacturer. Instructions for use were readable and contained symbol keys; two devices had printed French-language instructions. Shortcomings were poor integration of figures with text and distinct procedures for the oximeter and its sensor. Usability interview revealed appreciations for quick results, visibility of the display and memory function (three devices) but also problems of capillary blood sample transfer, cleaning, too long of a time-to-results (respiratory rate) and size, fitting and disposal of thermometer probes. Pictorial error messages were preferred over alphanumeric error codes but interpretation of symbols was poor. Alarm sounds of the oximeter caused unrest in children and caretakers perceived the device as associated with poor prognosis.
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Analysis of Common Respiratory Infected Pathogens in 3100 Children after the Coronavirus Disease 2019 Pandemic. Curr Med Sci 2022; 42:1094-1098. [PMID: 36184728 PMCID: PMC9527073 DOI: 10.1007/s11596-022-2635-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/06/2022] [Indexed: 11/05/2022]
Abstract
Objective To investigate the epidemiological features in children after the coronavirus disease 2019 (COVID-19) pandemic. Methods This study collected throat swabs and serum samples from hospitalized pediatric patients of Renmin Hospital of Wuhan University, Wuhan, Hubei province, China before and after the COVID-19 pandemic. Respiratory infected pathogens [adenovirus (ADV), influenza virus A/B (Flu A/B), parainfluenza virus 1/2/3 (PIV1/2/3), respiratory syncytial virus (RSV), Mycoplasma pneumoniae (MP), and Chlamydia pneumoniae (CP)] were detected. The pathogens, age, and gender were used to analyze the epidemiological features in children after the COVID-19 pandemic. Results The pathogen detection rate was significantly higher in females than in males (P<0.05), and the infection of PIV1 and MP was mainly manifested. After the COVID-19 pandemic, PIV1, PIV3, RSV, and MP had statistically different detection rates among the age groups (P<0.05), and was mainly detected in patients aged 0–6 years, 0–3 years, 0–3 years, and 1–6 years, respectively. When comparing before the COVID-19 pandemic, the total detection rate of common respiratory pathogens was lower (P<0.05). Except for the increase in the detection rate of PIV1 and CP, the infection rate of other pathogens had almost decreased. Conclusion The prevention and control measures for the COVID-19 pandemic effectively changed the epidemiological features of common respiratory tract infectious diseases in pediatric children.
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Stratil AS, Ward C, Habte T, Maurel A, Antson M, Naydenova E, Baker K. Evaluating the Interrater Agreement and Acceptability of a New Reference Tool for Assessing Respiratory Rate in Children under Five with Cough and/or Difficulty Breathing. J Trop Pediatr 2021; 67:6297970. [PMID: 34124753 PMCID: PMC8201841 DOI: 10.1093/tropej/fmab046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Manual assessment of respiratory rate (RR) in children is unreliable, but remains the main method to diagnose pneumonia in low-resource settings. While automated RR counters offer a potential solution, there is currently no gold standard to validate these diagnostic aids. A video-based reference tool is proposed that allows users to annotate breaths and distortions including movement periods, allowing the exclusion of distortions from the computation of RR measures similar to how new diagnostic aids account for distortions automatically. This study evaluated the interrater agreement and acceptability of the new reference tool. METHODS Annotations were based on previously recorded reference videos of children under five years old with cough and/or difficulty breathing (n = 50). Five randomly selected medical experts from a panel of ten annotated each video. RR measures (breaths per minute, bpm) were computed as the number of annotated certain breaths divided by the length of calm periods after removing annotated distorted periods. RESULTS Reviewers showed good interrater agreement on continuous RR {standard error of measurement (SEM) [4.8 (95%CI 4.4-5.3)]} and substantial agreement on classification of fast breathing (Fleiss kappa, κ 0.71). Agreement was lowest in the youngest age group [< 2 months: SEM 6.2 (5.4-7.4) bpm, κ 0.48; 2-11 months: 4.7 (4.0-5.8) bpm, κ 0.84; 12-59 months: 2.6 (2.2-3.1) bpm, κ 0.8]. Reviewers found the functionalities of the tool helpful in annotating breaths, but remained uncertain about the validity of their annotations. CONCLUSIONS Before the new tool can be considered a reference standard for RR assessments, interrater agreement in children younger than 2 months must be improved.
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Affiliation(s)
- Ann-Sophie Stratil
- Malaria Consortium, E2 9DA, London, UK,Correspondence: Ann-Sophie Stratil, Malaria Consortium, The Green House, 244-254 Cambridge Heath Road, London, E2 9DA, UK. E-mail
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Camacho-Cruz J, Briñez S, Alvarez J, Leal V, Villamizar Gómez L, Vasquez-Hoyos P. Use of the ReSVinet Scale for parents and healthcare workers in a paediatric emergency service: a prospective study. BMJ Paediatr Open 2021; 5:e000966. [PMID: 34131594 PMCID: PMC8166609 DOI: 10.1136/bmjpo-2020-000966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 04/08/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Most scales for acute respiratory infection (ARI) are limited to healthcare worker (HCW) use for clinical decision-making. The Respiratory Syncytial Virus network (ReSVinet) Scale offers a version for parents that could potentially help as an early warning system. OBJECTIVE To determine whether or not the ReSVinet Scale for ARI in infants can be reliably used by HCWs and parents in an emergency service. METHODS A prospective study was done of infants with ARI who were admitted to a paediatric emergency room to assess the ReSVinet Scale when used by faculty (paediatric doctor-professors), residents (doctors doing their first specialty in paediatrics) and parents. Spearman's correlation and a weighted kappa coefficient were used to measure interobserver agreement. Internal consistency was also tested by Cronbach's alpha test. RESULTS Overall, 188 patients, 58% male, were enrolled. A Spearman's correlation of 0.92 for faculty and resident scoring and 0.64 for faculty or resident and parent scoring was found. The weighted kappa coefficients were 0.78 for faculty versus residents, 0.41 for faculty versus parents, and 0.41 for residents versus parents. Cronbach's alpha test was 0.67 for faculty, 0.62 for residents and 0.69 for parents. CONCLUSION There was good correlation in the ReSVinet scores between health professionals when used in the paediatric emergency area. Agreement between parents and health professionals was found to be more variable. Future studies should focus on finding ways to improve its reliability when used by parents before the scale is used in the emergency room.
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Affiliation(s)
- Jhon Camacho-Cruz
- Department of Pediatrics, Sociedad de Cirugía de Bogotá - Hospital de San José, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogota, Colombia
| | - Shirley Briñez
- Department of Pediatrics, Sociedad de Cirugía de Bogotá - Hospital de San José, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogota, Colombia
| | - Jorge Alvarez
- Department of Pediatrics, Sociedad de Cirugía de Bogotá - Hospital de San José, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogota, Colombia
| | - Victoria Leal
- Department of Pediatrics, Sociedad de Cirugía de Bogotá - Hospital de San José, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogota, Colombia
| | - Licet Villamizar Gómez
- Research Division, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogota, Colombia
| | - Pablo Vasquez-Hoyos
- Department of Pediatrics, Sociedad de Cirugía de Bogotá - Hospital de San José, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogota, Colombia
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