Published: 2019-09-20 08:11 | Updated: 2019-09-20 10:58

"More work needs to be done to ensure that better pneumonia diagnostics aids are developed and launched to frontline health workers"

Hi there Kevin Baker, doctoral student at the Department of Public Health Sciences at Karolinska Institutet. Today Friday 20 September you will defend your thesis. Tell us, what is the main focus of your thesis?

“My thesis sought to identify and evaluate the most accurate, acceptable and user-friendly respiratory rate counting devices and pulse oximeters for diagnosis of pneumonia symptoms and severity in children by frontline health workers in low-resource settings.

"Health workers report finding it difficult to accurately count the number of breaths and current RR counting aids are often difficult to use or unavailable."

Portrait of Kevin Baker
Kevin Baker, Doctoral student with the Health Systems and Policy group, Department of Public Health Sciences.

Pneumonia is the leading cause of infectious death in children under-five in sub-Saharan Africa and Southeast Asia. Currently, the diagnostic criterion for pneumonia is based on increased respiratory rate (RR) in children with cough and/or difficulty breathing. Low oxygen saturation, usually measured using pulse oximeters, is an indication of severe pneumonia.

Health workers report finding it difficult to accurately count the number of breaths and current RR counting aids are often difficult to use or unavailable. Improved RR counting aids and lower-cost pulse oximeters are now available but their suitability in these settings and for these populations are untested.”

What are the most important findings?

“Frontline health workers were able to use the nine test devices to measure RR and oxygen saturation in children under 5, but with variable performance, and found it more difficult to get a successful measurement in younger children. Frontline health workers were better supported by assisted RR counters, such as Rrate and respirometer, compared to their standard practice diagnostic aid, MK2 ARI timer. Handheld pulse oximeters with multiple probes performed better than fingertip pulse oximeters, especially in younger children.

The views of different stakeholder groups should be considered when looking to take these types of pneumonia diagnostic aids to scale. A consensus view on a robust research method and reference standard to evaluate future pneumonia diagnostic aids needs to be reached. While laboratory testing of new diagnostic aids can be valuable it should not replace field testing with frontline health workers in routine practice.”

How can this knowledge contribute to/be useful for improving people’s health?

"More work needs to be done to ensure automated, easy to use, robust and affordable pneumonia diagnostics aids are developed and launched at scale to better support frontline health workers to address the high pneumonia burden in resource poor settings.

What are your plans for the future? Will you continue to conduct research in some way?

I will continue this work focused on pneumonia diagnostics and hope to support the introduction of better diagnostic aids in future.