The use of counting beads to improve the classification of fast breathing

As part of a community health worker (CHW) quality of care assessment in Uganda and South Sudan, IRC tested CHW’s ability to diagnose rapid breathing with counting beads as a job aide. CHWs were asked to count respiratory rates for children 2–11 months of age and for children 12-59 months of age respectively with an ARI timer, and those rates were compared against a clinician counting the rates simultaneously along with the CHW. Then, the CHW and the clinician were instructed to use counting beads with the ARI timer independently to recount the respiratory rate. The study showed an increase of correct classification from 13 percent to 63 percent in South Sudan and from 37 percent to 73 percent in Uganda when using counting beads.