The use of counting beads to improve the classification of fast breathing in low-resource settings: a multi-country review

Authors: Aaltje Camielle Noordam, Yolanda Barbera ́ La ́ınez, Salim Sadruddin, Pabla Maria van Heck, Alex Opio Chono, Geoffrey Larry Acaye, Victor Lara, Agnes Nanyonjo, Charles Ocan, and Karin Ka ̈llander

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. 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.