While these statistics are sobering, progress is within reach. Building simple digital instruments to measure and improve pediatric respiratory health could potentially save many lives. However, many well-intentioned tools don’t work properly or aren’t sufficiently fit for purpose to be feasible for data collection among this target.
Limited resources make timely pneumonia diagnosis a “much greater challenge” in low- and middle-income countries, researchers note in The Lancet’s eClinicalMedicine.
A key resource challenge is reliance on community health workers (CHWs) to provide primary healthcare. CHWs are not always fully trained in detecting pneumonia, which can make it more difficult for them to accurately identify the signs and symptoms of the disease. Additionally, community-based workers may find it challenging to stay current on, and effectively deploy, medical best practices, especially when these protocols are open to interpretation.
For instance, the World Health Organization (WHO) recommends using respiratory rate to help diagnose pneumonia. However, respiratory rate (RR) measurement can take many forms. In a systematic review of tools, researchers summarize 19 ways to measure RR, from manual breath count to humidity sensors, digital stethoscopes, and barometric pressure sensors. Some methods even capture the respiratory system’s effects on cardiovascular physiology using tools such as pulse oximetry systems.
In low-resource settings, healthcare workers don’t have access to these tools, so they must diagnose pneumonia using “subjective clinical signs and symptoms” derived from WHO guidelines. Although manual breath count is the most common way to measure RR, it poses challenges for accuracy and reliability. Measuring a child’s RR through visual observation “requires focused concentration and can be challenging in a child who may be moving, crying, or breathing rapidly,” according to the systematic review. “Inaccurate or imprecise measurements can stem from factors including poor visibility of the start or end of a breath, an irritable or moving child, or difficulty counting or remembering the count.”
Vulnerability to human error can compromise the effectiveness of these methods:
Medical manufacturers have launched an array of wearable digital devices that could contribute to improving diagnosis for respiratory illnesses such as pneumonia, including:
However, these devices lack adequate clinical trials, and the existing trials lack representative participant pools that include underserved pediatric populations. Research in The Lancet’s eClinical Medicine notes that these tools have not been validated in low- to middle-income countries. Many of the existing trials were conducted on relatively affluent children, who have better access to digital health tools than their counterparts in developing countries. The limited available information on clinical outcomes points to a significant need for portable, affordable, user-centric devices.
A lack of standardization also limits the effectiveness of RR measurement tools:
Surveying the current state of research and care delivery, we’ve identified significant gaps in the technology and methodology leveraged to diagnose pediatric respiratory illness in remote communities. These gaps include difficulty in measuring respiratory rate and the lack of standardized, clinically validated devices to support accurate, timely diagnosis.
Writing in Breathe, researchers conclude that “there is undoubtedly the need for clinical evaluation of most wearable devices” through a systematic process to collect and assess clinical data that verifies a device’s safety, performance, and clinical benefits.
This situation leaves considerable opportunity for the medical device industry. ObvioHealth is exploring creative ways to combine signals from multiple devices in our mission to advance data collection in our upcoming trials.
Interested in learning more about or collaborating in our pediatric symptomology research? Contact our research team or visit further reading pages: Pediatric Clinical Trial Support, Virtual Clinical Trials.