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Health System Considerations for Community-Based Implementation of Automated Respiratory Counters to Identify
Angeli Rawat1,2, Agazi Ameha3, Jonas Karlström1,4
1UNICEF Supply Division Innovation Unit, Copenhagen, Denmark.
Insights
Automated respiratory rate counters can improve childhood pneumonia diagnosis in Ethiopia. Integrating these devices requires a comprehensive health system approach, including training and supply chain support, to maximize benefits for child health programs.
Area of Science:
- Pediatric respiratory health
- Health systems research
- Point-of-care diagnostics
Background:
- Childhood pneumonia diagnosis in Ethiopia relies on manual respiratory rate (RR) measurement alongside clinical signs.
- The Acute Respiratory Infection Diagnostic Aids (ARIDA) initiative piloted automated RR counters (ChARM and Rad-G) in primary healthcare settings.
- This study aimed to extract health system lessons for integrating automated RR counters into child health programs.
Purpose of the Study:
- To identify health system-level lessons from implementing automated RR counters for childhood pneumonia diagnosis.
- To provide considerations for integrating devices like ChARM and Rad-G into Ethiopian child health programs and broader health systems.
Main Methods:
- Key informant interviews (KIIs) were conducted with 57 stakeholders across five Ethiopian regions.
- Participants included health workers, trainers, district management, and decision-makers.
- Data analysis involved thematic content analysis using ATLAS.ti and categorization via the Tanahashi bottleneck analysis.
Main Results:
- Participants strongly recommended national scale-up of the ARIDA initiative within the Integrated Management of Newborn and Childhood Illness (IMNCI) program.
- Health workers found the automated RR counters time-saving, acceptable to caregivers and children, and beneficial for diagnosis and referrals.
- Recommendations included increasing device distribution, enhancing health worker training, strengthening supply chains, ensuring oxygen availability, and improving referral networks.
Conclusions:
- Automated RR counters show potential for improving the quality of pneumonia diagnosis and management in decentralized primary healthcare settings.
- Successful integration necessitates a holistic health system approach, addressing drug and oxygen supply, community engagement, health worker support, and referral pathways.
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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