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Usability and acceptability of an automated respiratory rate counter to assess children for symptoms of pneumonia: A cross-sectional study in Ethiopia

Journal article
Authors C. Ward
K. Baker
H. Smith
A. Maurel
D. Getachew
T. Habte
C. McWhorter
P. LaBarre
J. Karlstrom
J. Black
Q. Bassat
A. Ameha
A. Tariku
Max Petzold
K. Kallander
Published in Acta Paediatrica
Pages 11
ISSN 0803-5253
Publication year 2019
Published at Institute of Medicine, School of Public Health and Community Medicine
Pages 11
Language en
Keywords pneumonia, health extension worker, community health worker, respiratory, rate, diagnostics, integrated community case management, access, care, call, Pediatrics
Subject categories Public Health, Global Health, Social Medicine and Epidemiology, Respiratory Medicine and Allergy


Aim Manually counting respiratory rate (RR) is commonly practiced by community health workers to detect fast breathing, an important sign of childhood pneumonia. Correctly counting and classifying breaths manually is challenging, often leading to inappropriate treatment. This study aimed to determine the usability of a new automated RR counter (ChARM) by health extension workers (HEWs), and its acceptability to HEWs, first-level health facility workers (FLHFWs) and caregivers in Ethiopia. Methods A cross-sectional study was conducted in one region of Ethiopia between May and August 2018. A total of 131 HEWs were directly observed conducting 262 sick child consultations after training and 337 after 2 months. Usability was measured as adherence to the WHO requirements to assess fast breathing and device manufacturer instructions for use (IFU). Acceptability was measured through semi-structured interviews. Results After 2 months, HEWs were shown to adhere to the requirements in 74.6% consultations; an increase of 18.6% after training (P < .001). ChARM is acceptable to users and caregivers, with HEWs suggesting that ChARM increased client flow and stating a willingness to use ChARM in future. Conclusion Further research on the performance, cost-effectiveness and implementation of this device is warranted to inform policy decisions in countries with a high childhood pneumonia burden.

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