Accuracy of non-physician health workers in respiratory rate measurement to identify paediatric pneumonia in low- and middle-income countries

Clinical Research Results Abstract Introduction: Non-physician health workers play an important role in identifying and treating pneumonia in children in low- and middle-income countries (LMICs). We conducted a systematic review to summarize the evidence of whether health workers can accurately measure respiratory rate (RR) and identify fast breathing (FB) to diagnose pneumonia in children under five years of age.Methods: We searched MEDLINE, EMBASE, Web of Science, and Scopus from January 1990 to August 2020 without any language restrictions. Studies evaluating the performance of health workers in measuring RR and/or identifying FB compared against a reference standard were included. A meta-analysis was conducted to report pooled estimates of sensitivity and specificity. Hierarchical summary receiver operating characteristic curve (HSROC) models were fitted, and subgroup and sensitivity analyses were performed.Results: We included 16 studies, of which eight reported the agreement in RR count between health workers and a reference standard. The median agreements were 39%, 47%, and 67% within ±2, ±3 and ±5 breaths per minute, respectively. Among the 16 included studies, we identified 15 studies that reported the accuracy of a health worker classifying breathing into either fast or normal categories compared to a reference standard. The median sensitivity, specificity, accuracy, and kappa value were 77%, 86%, 81%, and 0.75, respectively. Seven studies reporting the accuracy of identifying FB were included in the meta-analysis. The pooled estimates of sensitivity and specificity were 78% (95% CI 72 to 82) and 86% (95% CI 78 to 91), respectively.Discussion: Despite the problematic nature of reference standards and their variability across studies, our review suggests that health worker performance in counting RR accurately is relatively poor. However, their performance shows reasonable specificity and moderate sensitivity in identifying FB. Improving detection of FB in children among health workers is an important child health programme objective and should be given appropriate priority. Research Idea Abstract Service Development & Evaluation Abstract Declaration of Interest All authors have declared no competing interest. This research was commissioned by the UK NIHR Global Health Research Unit on Respiratory Health (RESPIRE), using UK Aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care. The review protocol was registered with PROSPERO database (registration number CRD42020211127). References and Clinical Trial Registry Information