Assessment of Respiratory Rate and Chest Indrawing in Children with ARI by Primary Care Physicians in Egypt

By Gadomski, A. M.; Khallaf, N. et al. | Bulletin of the World Health Organization, September-October 1993 | Go to article overview

Assessment of Respiratory Rate and Chest Indrawing in Children with ARI by Primary Care Physicians in Egypt


Gadomski, A. M., Khallaf, N., El Ansary, S., Black, R. E., Bulletin of the World Health Organization


Introduction

Timely treatment of acute lower respiratory tract infections in children relies upon the assessment of clinical findings, especially respiratory rate (RR) and chest indrawing. Elevated RR has been shown to be an important indicator of underlying pulmonary disease such as pneumonia, asthma, bronchiolitis, and pulmonary oedema. RR has been described as a "simple and useful, although nonspecific, pulmonary function test of thoracic and pulmonary compliance" [1]. Elevated rates, in combination with cough, have been used, and are currently being advocated by WHO, as an entry criterion for a treatment algorithm for pneumonia among infants an children.(a)

However, the measurement of RR is typically held in "low esteem" [2] by health workers who find that it is often a difficult and time-consuming manoeuvre, especially in infants. The conditions of crowded, noisy primary care settings also may not be conducive to counting the RR. The lure of high technology medicine also contributes to neglect of this basic clinical indicator. The use of simple instruments such as timers with audible cues has been suggested as a means of facilitating the counting of RR because the health worker does not have to look at the chest and a wrist-watch at the same time. However, the difference in accuracy between RRs counted using timers versus watches has not been assessed.

Chest-wall indrawing, defined as an inward movement of the lower chest wall, is the key sign for referring children with severe pneumonia to hospital using the WHO Acute Respiratory Infections (ARI) treatment algorithm. However, the recognition of this sign may not be uniform among health personnel owing to varying definitions, training and experience.

In the context of instituting a national programme for the control of ARI in Egypt, ways to increase the acceptance and performance of RR counting and to assess the recognition of chest-wall indrawing were sought. The purpose of this study was (1) to briefly survey the attitudes towards and the knowledge and practices of physicians in measuring the RR, (2) to examine the effect of a training videotape on the recognition of chest indrawing, and (3) to examine the effect of using different time intervals and providing audible timers on the accuracy of RR assessment. A test videotape focused on children of different ages and breathing rates was used to conduct these assessments so that potentially modifiable aspects of counting technique alone could be addressed.

Materials and methods

Primary health care in Egypt is delivered by physicians employed by the Ministry of Health. General practitioners, pediatricians and junior doctors in primary care centres in the study area were selected randomly from a list of staff serving five governorates (Alexandria, Assuit, Cairo, Ismailia and Menoufia) targeted for the initial implementation of the ARI control programme in Egypt. The 320 physicians in this study were distributed as follows: 45% in MCH units, 30% in urban health centres, 18% in rural health units, and 7% in the district hospital or in school health. The study participants, in groups of 16 in health centres in each of the governorates, were told about the ARI programme planning and were asked to evaluate the use of audible timers versus wrist-watches in measuring the RR of infants and children.

Descriptive survey. A questionnaire was first administered to survey the physicians' attitudes and practices regarding RR measurement, their use of watches while counting, and their knowledge of the age-appropriate RR cut-offs. The study participants were anonymously surveyed about (1) how they evaluated children with ARI using two open-ended questions on history and physical examination; (2) whether or not they counted the RR, and if so, how (multiple choice); (3) what constraints they faced in counting the RR (multiple choice); and (4) what was the usual RR of children aged <2 months, 2-6 months, and 2 years (open-ended). …

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Assessment of Respiratory Rate and Chest Indrawing in Children with ARI by Primary Care Physicians in Egypt
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.