Applicability of WHO criteria by community health workers for diagnosis of acute lower respiratory infections

ABSTRACT

Applicabiligy of simple clinical signs (WHO, 1990 ARI classification) by community health workers (CHWs) for the diagnosis of Acute Lower Respiratory Infections (ALRI) especially pneumonia, were evaluated in ort-patient department of Yangon Children's Hospital from November 1990 to February 1991. 944 under-five children presenting with Acute Respiratory Infection related symptoms of less than 7 days duration were included in the study. The percentage agreement of diagnosis status by CHWs with reference to project Medical Officers (gold standard) were Kappa 0.5126 (p<0.001) in less than 2 months old infants and Kappa 0.5442 (p<0.001) in children aged 2 months to 5 years. CHWs were able to detect important cllinical sings like chest indrawing in percentage agreement of 85.1 Percent. However, perecentage agreement in respiratory rate was found to be 60.2 Percent and there was incorrectness in counting the respiratory rate as the rate increased. Divverences in the level of agreement on these important clinical signs misclassified the disease category resulting in low percentage agreement in discriminating the disease severity.