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8th November 2016

No time to lose: counting breaths, saving children’s lives

Pneumonia kills more children than and other infectious disease. Simple counting beads could speed up diagnosis – and increase survival rates

920,136 children. That is the number of kids who died of pneumonia in 2015. Nine hundred and twenty thousand, one hundred and thirty-six.

Pneumonia accounts for 15% of all deaths of children under 5 years old. It’s a complex disease that doesn’t have a single cause. Prevention is vital. Immunisation, nutrition and improving the environment can help curb infection rates but this is not enough.

Even with excellent health systems, some children will contract pneumonia. Its deadly symptoms can be brought on by infection with viruses, bacteria or fungi, making it difficult to treat: only one third of cases are caused by bacteria and can be treated with antibiotics.

Central to getting the right treatment to the right child is quick and accurate diagnosis. However, advanced diagnostic tools – such as chest x-rays and laboratory tests – are not always available in low-resource settings.

An alternative way to diagnose pneumonia is for health workers to count how quickly a child’s chest rises and falls as they breathe.

Faster breathing indicates that pneumonia may be present. For children aged between 2-12 months, pneumonia is diagnosed when they breathe more than 50 times per minute. In children from 12 months to five years, the threshold is 40 breaths per minute.

Constant improvement

In many low-income countries, counting children’s breaths to check for pneumonia is a job for community health workers. To help count the breaths, UNICEF and the WHO developed a one-minute Acute Respiratory Infection (ARI) Timer in the 1990s.

More than half a million timers have been distributed to over 70 countries. However, in the spirit of constant improvement, UNICEF decided to re-design the ARI timer based on feedback from healthcare workers in the field.

Health workers said that the ticking sound that the original version of the device makes distracts them during the count. In addition, the alarm at 30 seconds is startling to the parents, and can also confuse the health workers as to whether the end of the minute has been reached or not.

It can also be challenging to count breaths for a full minute, particularly when assessing a sick infant who may become restless. Numerical literacy of community health workers is also a challenge in some cases. Quite simply, the risk of losing count – or missing a child’s quick breath – while counting to 60 or 70 is too high.

To solve this problem, Save the Children, the International Rescue Committee and UNICEF have piloted the use of counting beads. These low-tech beads are already in use in many of the target communities so the principle was already well accepted.

Pilot tests show that colour-coded and age-specific strands of beads can greatly improve the accuracy of pneumonia diagnosis, particularly in remote areas where access to education means health workers have few opportunities to learn about numbers and counting.

The health worker counts one bead for each breath. When they pass 40 breaths (in a child aged from 12 months to five years), they know the breathing rate is too fast. For parents too, the visual diagnosis provided by the coloured beads offers clarity. If the beads show the child is breathing too frequently, the parents and health workers know they must intervene; if the beads do not diagnose pneumonia, it is clear that antibiotics are not required.

Automated diagnostic technologies

In addition to these simple but valuable tools, UNICEF has been working with companies and NGOs to develop new automated diagnostic technologies, under a project called ARIDA (Acute Respiratory Infection Diagnostic Aid). The goal will be to find a way to diagnose pneumonia in clinics and in rural areas in a way that is accurate and quick.

UNICEF has invited proposals for new devices to be included in field trials which are being prepared in Ethiopia with a second phase to take place in Bolivia and further trials planned for Ivory Coast, Nepal and the Philippines.

Upon successful results from the field trials, UNICEF will follow up with another tender to procure ARIDA devices. The organisation told This Is Medtech that the development of the trials has been a collaborative effort with partners including the Bill & Melinda Gates Foundation and the la Caixa Foundation.

“The ARIDA project illustrates how partnerships and new procurement approaches can accelerate the availability of innovative life-saving products in markets,” said Kristoffer Gandrup-Marino, Chief of the Innovation Unit in UNICEF’s Supply Division. “Support from la Caixa Foundation has enabled us work with governments and technical experts to design and carry out field trials that will help identify fit-for-purpose products that should be procured and distributed at scale.”

He said UNICEF’s work with the diagnostic industry has helped to set out a clear vision of the health products children need “to prevent needless pneumonia deaths”.

“UNICEF’s advanced procurement commitment encourages companies who have promising products to accelerate their R&D – and bring pipeline products to market sooner,” Mr Gandrup-Marino added.

What is pneumonia?

Pneumonia is a form of acute respiratory infection that affects the lungs. The lungs are made up of small sacs called alveoli, which fill with air when a healthy person breathes. When an individual has pneumonia, the alveoli are filled with pus and fluid, which makes breathing painful and limits oxygen intake.Pneumonia is the single largest infectious cause of death in children worldwide. Pneumonia killed 920 136 children under the age of 5 in 2015, accounting for 15% of all deaths of children under five years old. Pneumonia affects children and families everywhere, but is most prevalent in South Asia and sub-Saharan Africa.World Pneumonia Day takes place on 12 November 2016

Photos Credit: UNICEF

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