Noordam Aaltje Camielle, Barberá Laínez Yolanda, Sadruddin Salim, van Heck Pabla Maria, Chono Alex Opio, Acaye Geoffrey Larry, Lara Victor, Nanyonjo Agnes, Ocan Charles, Källander Karin
Health Section, United Nations Children Fund (UNICEF), Three United Nations Plaza, New York, NY 10017, USA, International Rescue Committee (IRC), 122 East 42nd Street, New York, NY 10168, USA, Save the Children, 501 Kings Highway East, Suite 400, Fairfield CT 06825, USA, UNICEF Supply Division, Oceanvej 10-12, 2100 København Ø, Denemarken, International Rescue Committee (IRC), Plot 7 Lower East Naguru Road, P.O. Box 24672, Kampala, Uganda, UNICEF Tamale Field Office, Norrip Building Complex, Bolgatanga Road, P.O. Box 1098, Tamale, Ghana, Population Service International (PSI), Whitefield Place, School Lane, Westlands, P.O. Box 14355-00800, Nairobi, Kenya, Malaria Consortium, Plot 25, Upper Naguru East road, P.O Box 8045, Kampala, Uganda, Department of Public Health Sciences, Karolinska Institutet, 17177 Stockholm, Sweden, Save the Children, 501 Kings Highway East, Suite 400, Fairfield CT 06825, USA, Malaria Consortium, plot 25, Upper Naguru East road, P.O Box 8045, Kampala, Uganda and Department of Public Health Sciences, Karolinska Institutet, 17177 Stockholm, Sweden
Health Section, United Nations Children Fund (UNICEF), Three United Nations Plaza, New York, NY 10017, USA, International Rescue Committee (IRC), 122 East 42nd Street, New York, NY 10168, USA, Save the Children, 501 Kings Highway East, Suite 400, Fairfield CT 06825, USA, UNICEF Supply Division, Oceanvej 10-12, 2100 København Ø, Denemarken, International Rescue Committee (IRC), Plot 7 Lower East Naguru Road, P.O. Box 24672, Kampala, Uganda, UNICEF Tamale Field Office, Norrip Building Complex, Bolgatanga Road, P.O. Box 1098, Tamale, Ghana, Population Service International (PSI), Whitefield Place, School Lane, Westlands, P.O. Box 14355-00800, Nairobi, Kenya, Malaria Consortium, Plot 25, Upper Naguru East road, P.O Box 8045, Kampala, Uganda, Department of Public Health Sciences, Karolinska Institutet, 17177 Stockholm, Sweden, Save the Children, 501 Kings Highway East, Suite 400, Fairfield CT 06825, USA, Malaria Consortium, plot 25, Upper Naguru East road, P.O Box 8045, Kampala, Uganda and Department of Public Health Sciences, Karolinska Institutet, 17177 Stockholm, Sweden.
Health Policy Plan. 2015 Jul;30(6):696-704. doi: 10.1093/heapol/czu047. Epub 2014 Jun 27.
To decrease child mortality due to common but life-threatening illnesses, community health workers (CHWs) are trained to assess, classify and treat sick children. For pneumonia, CHWs are trained to count the respiratory rate of a child with cough and/or difficulty breathing, and determine whether the child has fast breathing or not based on how the child's breath count relates to age-specific respiratory rate cut-off points. International organizations training CHWs to classify fast breathing realized that many of them faced challenges counting and determining how the respiratory rate relates to age-specific cut-off points. Counting beads were designed to overcome these challenges. This article presents findings from different studies on the utility of these beads, in conjunction with a timer, as a tool to improve classification of fast breathing. Studies conducted by the International Rescue Committee and Save the Children among illiterate CHWs assessed the effectiveness of counting beads to improve both counting and classifying respiratory rate against age-specific cut-off points. These studies found that the use of counting beads enabled and improved the assessment and classification of fast breathing. However, a Malaria Consortium study found that the use of counting beads decreased the accuracy of counting breaths among literate CHWs. Qualitative findings from these studies and two additional studies by UNICEF suggest that the design of the beads is crucial: beads should move comfortably, and a separate bead string, with colour coding, is required for the age groups with different cut-off thresholds-eliminating more complicated calculations. Further research, using standardized protocols and gold standard comparisons, is needed to understand the accuracy of beads in comparison to other tools used for classifying pneumonia, which CHWs benefit most from each different tool (i.e. disaggregating data by levels of literacy and numeracy) and what the impact is on improving appropriate treatment for pneumonia.
为降低因常见但危及生命的疾病导致的儿童死亡率，社区卫生工作者（CHW）接受培训以评估、分类和治疗患病儿童。对于肺炎，CHW接受培训来计算咳嗽和/或呼吸困难儿童的呼吸频率，并根据儿童的呼吸计数与特定年龄的呼吸频率临界值的关系来确定该儿童是否呼吸急促。培训CHW进行快速呼吸分类的国际组织意识到，他们中的许多人在计数以及确定呼吸频率与特定年龄临界值的关系方面面临挑战。计数珠被设计出来以克服这些挑战。本文介绍了关于这些珠子与定时器结合作为一种改善快速呼吸分类工具的效用的不同研究结果。国际救援委员会和救助儿童会在不识字的CHW中进行的研究评估了计数珠在根据特定年龄临界值改善呼吸频率计数和分类方面的有效性。这些研究发现，使用计数珠能够并改善了对快速呼吸的评估和分类。然而，疟疾防治联盟的一项研究发现，在识字的CHW中使用计数珠会降低呼吸计数的准确性。这些研究以及联合国儿童基金会的另外两项研究的定性结果表明，珠子的设计至关重要：珠子应便于移动，并且对于具有不同临界阈值的年龄组需要单独的带颜色编码的珠串，从而消除更复杂的计算。需要使用标准化方案和金标准比较进行进一步研究，以了解与用于肺炎分类的其他工具相比珠子的准确性、哪些CHW从每种不同工具中受益最大（即按识字和算术水平对数据进行分类）以及对改善肺炎的适当治疗有何影响。
