Health System Considerations for Community-Based Implementation of Automated Respiratory Counters to Identify Childhood Pneumonia in 5 Regions of Ethiopia: A Qualitative Study

Document Type : Original Article

Authors

1 UNICEF Supply Division Innovation Unit, Copenhagen, Denmark

2 School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada

3 UNICEF Ethiopia Country Office, Addis Ababa, Ethiopia

4 Global Programmes and Research, SingHealth Duke-NUS Global Health Institute, Duke-NUS, Singapore, Singapore

5 Federal Ministry of Health of Ethiopia, Addis Ababa, Ethiopia

6 Frontieri Consult, Addis Ababa, Ethiopia

7 Child and Community Health Unit, Health Programme Group, UNICEF, New York City, NY, USA

8 UNICEF Supply Division, Copenhagen, Denmark

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

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

Abstract

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.

Keywords

References

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History

  • Receive Date: 13 May 2022
  • Revise Date: 07 June 2023
  • Accept Date: 30 September 2023
  • First Publish Date: 02 October 2023

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