Usability and acceptability of an automated respiratory rate counter to assess children for symptoms of pneumonia: a prospective, cohort study in Ethiopia.

AIM: Manually counting respiratory rate (RR) is commonly practiced by community health workers to detect fast breathing, an important sign of childhood pneumonia. Correctly counting and classifying breaths manually is challenging, often leading to inappropriate treatment. This study aimed to determine the usability of a new automated RR counter (ChARM) by health extension workers (HEWs), and its acceptability to HEWs, first-level health facility workers (FLHFWs) and caregivers in Ethiopia.

METHODS: A prospective, cohort study was conducted in one region of Ethiopia between May and August 2018. 131 HEWs were observed conducting 262 sick child consultations after training and 337 after two months. Usability was measured as adherence to the required WHO case management guidelines and device manufacturer instructions for use (IFU). Acceptability was measured through semi-structured interviews.

RESULTS: After two months, HEWs were shown to adhere to the required guidelines in 74.6% consultations; an increase of 18.6% after training (p<0.001). ChARM is acceptable to users and caregivers, with HEWs suggesting that ChARM increased client flow and stating a willingness to use ChARM in future.

CONCLUSION: Further research on the performance, cost-effectiveness and implementation of this device is warranted to inform policy decisions in countries with a high childhood pneumonia burden.