Document Type : Original Article

Authors

1 Independent Research Consultant, UNICEF Supply Division Innovation Unit, Copenhagen, Denmark

2 UNICEF Ethiopia Country Office, Addis Ababa, Ethiopia

3 UNICEF Supply Division Innovation Unit, Copenhagen, Denmark

4 Federal Ministry of Health of Ethiopia, Sudan Street, Addis Ababa, Ethiopia

5 Frontieri Consult, Addis Ababa, Ethiopia

6 Child and Community Health Unit, Health Programme Group, UNICEF, New York, USA

7 UNICEF Supply Division, Copenhagen Denmark

8 Digital Health and Health Information Systems Unit, Health Programme Group, UNICEF, New York City, NY, USA

9 Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden

Abstract

Background
In Ethiopia, childhood pneumonia is diagnosed in primary health care 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 were conducted with 57 participants (health workers in communities and facilities, trainers of health workers, and 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 in Primary Health Care. 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.

Conclusion
Automatic respiratory rate 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.

Keywords