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Standardized diagnosis of pneumonia in developing countries
E K Mulholland1, E A Simoes, M O Costales
1MRC Laboratories, Banjul, The Gambia.
Insights
The World Health Organization
Area of Science:
- Pediatrics
- Global Health
- Infectious Diseases
Background:
- Pneumonia diagnosis in developing countries relies on World Health Organization (WHO) guidelines.
- These guidelines recommend using raised respiratory rate and chest wall indrawing for pneumonia detection.
- Evaluating these diagnostic indicators in diverse settings is crucial for effective child healthcare.
Purpose of the Study:
- To assess the effectiveness of WHO pneumonia diagnostic guidelines in the Philippines and Swaziland.
- To compare the sensitivity and specificity of raised respiratory rate and chest wall indrawing in two distinct developing countries.
- To determine the reliability of these indicators when used by pediatricians versus general health workers.
Main Methods:
- An identical protocol was used in Manila, Philippines, and Mbabane, Swaziland.
- Raised respiratory rate defined as ≥50/min (2-12 months) and ≥40/min (12 months-5 years).
- Chest wall indrawing defined as inward movement of the lower chest during inspiration.
Main Results:
- In the Philippines, pediatrician-applied indicators showed 0.81 sensitivity and 0.77 specificity for pneumonia.
- In Swaziland, pediatrician-applied indicators showed 0.77 sensitivity and 0.80 specificity.
- Health workers achieved similar sensitivity but lower specificity compared to pediatricians.
Conclusions:
- WHO's Acute Respiratory Infection (ARI) case management guidelines demonstrate consistent performance in diverse developing countries.
- Raised respiratory rate and chest wall indrawing are valuable tools for pneumonia diagnosis in resource-limited settings.
- Training and consistent application by health workers are essential to maintain diagnostic accuracy.
Abstract:
The World Health Organization recommends the use of raised respiratory rate and chest wall indrawing to enable health workers in developing countries to diagnose pneumonia. We evaluated the current World Health Organization guidelines for management of the child with cough or difficult breathing in Manila, Philippines and Mbabane, Swaziland using an identical protocol in both countries. Raised respiratory rate was defined as greater than or equal to 50/minute for children ages 2 to 12 months and greater than or equal to 40/minute for children 12 months to 5 years. Chest wall indrawing was defined as inward movement of the bony structures of the lower chest wall with inspiration. In the Philippines raised respiratory rate or chest wall indrawing, when applied by a pediatrician, was found to have a sensitivity of 0.81 and specificity of 0.77 for predicting pneumonia as determined by a pediatrician with the aid of a chest roentgenogram. In Swaziland the sensitivity was 0.77 and the specificity was 0.80. When applied by health workers the sensitivity was similar but the specificity was lower. The current World Health Organization ARI case management guidelines predicted pneumonia with similar sensitivity and specificity in two very different developing countries, the Philippines and Swaziland.