Pneumonia Prevention

Problem: Pneumonia, a severe form of acute respiratory infection that affects the lungs, kills more children than any other illness. Nearly 1.4 million children under five die from the disease each year, accounting for one in five child deaths globally. Catching pneumonia does not have to be fatal if a child is properly diagnosed and treated. Evidence, however, reveals a sobering reality: only 1 in 5 caregivers knows the danger signs of pneumonia, and only half of sick children receive appropriate medical care, including antibiotics.

Typical symptoms of pneumonia in children include rapid or difficult breathing, cough, fever, chills, headaches, loss of appetite, and wheezing. While advanced diagnostic tools for pneumonia exist, such as chest x-rays and laboratory tests, they are not readily available in resource-poor settings. Instead, health workers are trained to diagnose pneumonia by observing and counting how quickly a child’s chest rises and falls during one minute using the Acute Respiratory Infection (ARI) Timer. Fast breathing is a danger sign, and accurately determining respiratory rate is essential for a correct diagnosis.

The Timer is viewed as a useful tool, yet there is a need to re-design several of its features based on feedback from Community Health Workers (CHWs):

Ticking sound: an audible tick sounds every second to ensure that timing is in progress. However, CHWs cite the ticking as a distraction, causing them to count ticks instead of breaths, or to lose count altogether.
Beeping: a beeping sound, which signals the 30-second mark, is also a distraction.
No way to connect with lapsed time: the Timer does not indicate lapsed time, so the CHW cannot determine progress during 1 minute.
Powering the Timer: there is a general lack of awareness among the CHWs about how the Timer is powered and a reluctance towards battery replacement.
The risk of error in breath counts due to crying children, erratic and speedy breaths, or lack of concentration.
Limited parental knowledge of pneumonia, distrust of health workers, and lack of understanding of how the ARI Timer works.
Reference countries: Sub-Saharan Africa and South Asia

Key partnerships:

WHO – in collaboration with our partners on the spot, developed the Global Action Plan for Prevention and Control of Pneumonia (GAPP). It provides a global framework for action around which partners coordinate their efforts.
International and non-governmental organisations, especially International Rescue Committee – provide assistance to developing countries to help build and sustain national capacity for control of pneumonia in young children.
Choose an entry point:

How can we improve the ARI timer to effectively diagnose pneumonia? Suggestions for modification include:

entry-bulletAn automatic counting function to ensure accuracy.

entry-bulletSupport to determine breaths – a gadget in the ear that connects to breaths so the CHW can ensure accuracy even if the child moves; or a gadget that can be put on the child’s chest.

entry-bulletA soothing mechanism to keep children calm while counting breaths, like removing the 30-second beep and making the 60-second alarm ‘friendlier’.

entry-bulletProviding indicator for parents – green/red light.

entry-bulletReplace ticking sound with a visual indicator that glows in the dark.

entry-bulletEnsure longer life span of the Timer.

Additional resources:

Essential Interventions, Commodities (incl. ARI Timer), and Guidelines for Reproductive, Maternal, Newborn and Child Health
Joint Statement: Management of Pneumonia in Community Settings
IRC Counting Beads Test South Sudan
IRC Counting Beads Test Uganda
Synovate ARI Timer Uganda
Diagram for ARI Timer
Innovation for Pneumonia Diagnosis in Community-Based Case Management
ARI Timer in Pneumonia CCM
Report on ARI Timer