Recognition of pneumonia by primary health care workers in Swaziland with a simple clinical algorithm

In developing countries primary health care workers are being trained to manage and treat acute respiratory infections with a protocol developed by the WHO. We tested the ability of nurses and nursing assistants in Swaziland to recognise the signs and symptoms of pneumonia; with the results of a paediatrician's examination as "gold standard", sensitivities and specificities were calculated. Danger signs of stridor and abnormal sleepiness were poorly recognised (sensitivity 0-50%) by the health care workers, as was audible wheeze. Severe undernutrition, tachypnoea, and chest wall indrawing were well recognised. Overall, the recognition of pneumonia was good (sensitivity 71-83%, specificity 84-85%). These findings highlight topics for emphasis in training.