Abstract
Pneumonia is the leading cause of infectious disease mortality in children. Currently, health care providers (HCPs) are trained to use World Health Organization Integrated Management of Childhood Illness (IMCI) paper-based protocols and manually assess respiratory rate to diagnose pneumonia in low-resource settings (LRS). However, this approach of relying on clinical signs alone has proven problematic. Hypoxemia, a diagnostic indicator of pneumonia severity associated with an increased risk of death, is not assessed because pulse oximetry is often not available in LRS. To improve HCPs’ ability to diagnose, classify, and manage pneumonia and other childhood illnesses, “mPneumonia” was developed. mPneumonia is a mobile health application that integrates a digital version of the IMCI algorithm with a software-based breath counter and a pulse oximeter. A design-stage qualitative pilot study was conducted to assess feasibility, usability, and acceptability of mPneumonia in six health centers and five community-based health planning and services centers in Ghana. Nine health administrators, 30 HCPs, and 30 caregivers were interviewed. Transcribed interview audio recordings were coded and analyzed for common themes. Health administrators reported mPneumonia would be feasible to implement with approval and buy-in from national and regional decision makers. HCPs felt using the mPneumonia application would be feasible to integrate into their work with the potential to improve accurate patient care. They reported it was “easy to use” and provided confidence in diagnosis and treatment recommendations. HCPs and caregivers viewed the pulse oximeter and breath counter favorably. Challenges included electricity requirements for charging and the time needed to complete the application. Some caregivers saw mPneumonia as a sign of modernity, increasing their trust in the care received. Other caregivers were hesitant or confused about the new technology. Overall, this technology was valued by users and is a promising innovation for improving quality of care in frontline health facilities.
Highlights
Pneumonia is the leading infectious cause of childhood mortality worldwide
In spite of it being a critical component in the management of severe pneumonia and the World Health Organization (WHO) encouraging its use, pulse oximetry is not included in the current Integrated Management of Childhood Illness (IMCI) algorithm
To improve health care providers (HCPs)’ ability to diagnose, classify, and manage childhood pneumonia, we developed “mPneumonia,” an innovative and user-friendly mobile health application using Android technology that integrates a digital version of the IMCI algorithm with a software-based breath counter and a pulse oximeter. mPneumonia is designed to be a free, open-source platform adapted for various countries and/or contexts
Summary
Pneumonia is the leading infectious cause of childhood mortality worldwide. Estimates suggest that 935,000 children less than five years of age died from pneumonia in 2013, accounting for 15 percent of child deaths globally.[1]. Paper-based protocols employing World Health Organization (WHO) Integrated Management of Childhood Illness (IMCI) and integrated Community Case Management (iCCM) algorithms are used to diagnose pneumonia, and rely on a HCP’s ability to visually observe the child’s breathing and manually count the respiratory rate, typically for one minute.[3,4,5,6,7,8,9,10,11] Fast-breathing is under recognized, and measuring a child’s respiratory rate accurately can be difficult in a fast-breathing, moving child, and studies have demonstrated that algorithms based only on respiratory rate do not appropriately identify children with pneumonia.[2, 12,13,14] Clinical assessments alone are not enough to appropriately establish the severity of the disease or the risk of complications. In spite of it being a critical component in the management of severe pneumonia and the WHO encouraging its use, pulse oximetry is not included in the current IMCI algorithm
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