The use of counting beads to improve the classification of fast breathing in low-resource settings: a multi-country review

• Published in: Health policy and planning 2015-07, Vol.30 (6), p.696-704
• Main Authors: Noordam, Aaltje Camielle, Laínez, Yolanda Barberá, Sadruddin, Salim, van Heck, Pabla Maria, Chono, Alex Opio, Acaye, Geoffrey Larry, Lara, Victor, Nanyonjo, Agnes, Ocan, Charles, Källander, Karin
• Format: Article
• Language: English
• Subjects: Africa - epidemiology; Child health; Child Mortality; Child, Preschool; Children; Childrens health; Community health care; Community Health Workers - education; Diagnostic Techniques and Procedures - instrumentation; Health administration; Humans; Illiterates; International organizations; Malaria; Medical personnel; Medicin och hälsovetenskap; Original; Original articles; Pneumonia - diagnosis; Respiration; Respiratory system; Studies; UNICEF
• ISSN: 0268-1080; 1460-2237; 1460-2237
• DOI: 10.1093/heapol/czu047

To decrease child mortality due to common but life-threatening illnesses, community health workers (CHWs) are trained to assess, classify and treat sick children. For pneumonia, CHWs are trained to count the respiratory rate of a child with cough and/or difficulty breathing, and determine whether the child has fast breathing or not based on how the child’s breath count relates to age-specific respiratory rate cut-off points. International organizations training CHWs to classify fast breathing realized that many of them faced challenges counting and determining how the respiratory rate relates to age-specific cut-off points. Counting beads were designed to overcome these challenges. This article presents findings from different studies on the utility of these beads, in conjunction with a timer, as a tool to improve classification of fast breathing. Studies conducted by the International Rescue Committee and Save the Children among illiterate CHWs assessed the effectiveness of counting beads to improve both counting and classifying respiratory rate against age-specific cut-off points. These studies found that the use of counting beads enabled and improved the assessment and classification of fast breathing. However, a Malaria Consortium study found that the use of counting beads decreased the accuracy of counting breaths among literate CHWs. Qualitative findings from these studies and two additional studies by UNICEF suggest that the design of the beads is crucial: beads should move comfortably, and a separate bead string, with colour coding, is required for the age groups with different cut-off thresholds—eliminating more complicated calculations. Further research, using standardized protocols and gold standard comparisons, is needed to understand the accuracy of beads in comparison to other tools used for classifying pneumonia, which CHWs benefit most from each different tool (i.e. disaggregating data by levels of literacy and numeracy) and what the impact is on improving appropriate treatment for pneumonia. Afin de faire baisser la mortalité infantile due à des maladies classiques mais potentiellement mortelles, les agents de santé communautaire (ASC) sont formés pour évaluer, classer et traiter les enfants malades. Pour la pneumonie, les ASC sont formés à compter la fréquence respiratoire d’un enfant avec une toux ou ayant des difficultés respiratoires et ils doivent être capables de déterminer si l’enfant a une respiration accélérée ou non en se basant