ArticleEClinicalMedicine2019
Performance of Four Respiratory Rate Counters to Support Community Health Workers to Detect the Symptoms of Pneumonia in Children in Low Resource Settings: A Prospective, Multicentre, Hospital-Based, Single-Blinded, Comparative Trial.
Article in EClinicalMedicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers.
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Who cites it
25 citing papers in PubMed, 36 citations in OpenAlex.
- Exploring reference standards for the measurement of respiratory rate in children under 5 years of age: a scoping review.BMJ paediatrics open · 2026Article
- Multimodal pulse oximeters to support the integrated management of childhood illnesses: A usability and diagnostic accuracy assessment from a multi-country hybrid type 2 study.PLOS global public health · 2026Article
- Evaluating the performance of community health care providers in detecting fast breathing in children using a reference video expert panel in Bangladesh.Discover public health · 2026Article
- Evaluating the performance of a video expert panel in assessing respiratory rate from recorded videos for the diagnosis of non-severe paediatric pneumonia.BMJ open respiratory research · 2025Article
- Article
- Community health worker and caregiver experiences and perceptions of a multimodal handheld pulse oximeter used in sick child consultations in rural Burundi: A qualitative evaluation.PLOS global public health · 2025Article
- Understanding pulse oximetry adoption in primary healthcare facilities in Nigeria: a realist process evaluation of the INSPIRING-Lagos stabilisation room project.BMJ public health · 2024Article
- Introducing the Pi-CON Methodology to Overcome Usability Deficits during Remote Patient Monitoring.Sensors (Basel, Switzerland) · 2024Review
- Implementation of a fast triage score for patients arriving to a low resource hospital in Uganda.African journal of emergency medicine : Revue africaine de la medecine d'urgence · 2024Article
- Health System Considerations for Community-Based Implementation of Automated Respiratory Counters to Identify Childhood Pneumonia in 5 Regions of Ethiopia: A Qualitative Study.International journal of health policy and management · 2023Article
- Performance and usability of a new mobile application for measuring respiratory rate in young children with acute lower respiratory infections.Pediatric pulmonology · 2022Observational
- Article
- Development and an initial validation of the Responses to Illness Severity Quantification (RISQ) score for severely malnourished children.Acta paediatrica (Oslo, Norway : 1992) · 2022Article
- Variability of respiratory rate measurements in neonates- every minute counts.BMC pediatrics · 2022Article
- Performance of Automated Point-of-Care Respiratory Rate Counting versus Manual Counting in Children under Five Admitted with Severe Febrile Illness to Kisantu Hospital, DR Congo.Diagnostics (Basel, Switzerland) · 2021Article
- Article
- Evaluating the Interrater Agreement and Acceptability of a New Reference Tool for Assessing Respiratory Rate in Children under Five with Cough and/or Difficulty Breathing.Journal of tropical pediatrics · 2021Article
- Back to Basics in Paediatric Pneumonia-Defining a Breath and Setting Reference Standards to Innovate Respiratory Rate Counting.Journal of tropical pediatrics · 2021Article
- Identification of thresholds for accuracy comparisons of heart rate and respiratory rate in neonates.Gates open research · 2021Article
- The Importance of Respiratory Rate Monitoring: From Healthcare to Sport and Exercise.Sensors (Basel, Switzerland) · 2020Review
Corrections and comments
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Authors and funding
16 authors at 8 institutions in 7 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPneumonia is one of the leading causes of death in children under-five globally. The current diagnostic criteria for pneumonia are based on increased respiratory rate (RR) or chest in-drawing in children with cough and/or difficulty breathing. Accurately counting RR is difficult for community health workers (CHWs). Current RR counting devices are frequently inadequate or unavailable. This study analysed the performance of improved RR timers for detection of pneumonia symptoms in low-resource settings.
methodsFour RR timers were evaluated on 454 children, aged from 0 to 59 months with cough and/or difficulty breathing, over three months, by CHWs in hospital settings in Cambodia, Ethiopia, South Sudan and Uganda. The devices were the Mark Two ARI timer (MK2 ARI), counting beads with ARI timer, Rrate Android phone and the Respirometer feature phone applications. Performance was evaluated for agreement with an automated RR reference standard (Masimo Root patient monitoring and connectivity platform with ISA CO
findingsWhile most CHWs managed to achieve a RR count with the four devices, the agreement was low for all; the mean difference of RR measurements from the reference standard for the four devices ranged from 0.5 (95% C.I. - 2.2 to 1.2) for the respirometer to 5.5 (95% C.I. 3.2 to 7.8) for Rrate. Performance was consistently lower for young infants (0 to < 2 months) than for older children (2 to ≤ 59 months). Agreement of RR classification into fast and normal breathing was moderate across all four devices, with Cohen's Kappa statistics ranging from 0.41 (SE 0.04) to 0.49 (SE 0.05).
interpretationNone of the four devices evaluated performed well based on agreement with the reference standard. The ARI timer currently recommended for use by CHWs should only be replaced by more expensive, equally performing, automated RR devices when aspects such as usability and duration of the device significantly improve the patient-provider experience.
fundingBill & Melinda Gates Foundation [OPP1054367].
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