title: Variability of respiratory rate measurements in children suspected with non-severe pneumonia in north-east Tanzania.
abstract: Measurement of respiratory rate is an important clinical sign in the diagnosis of pneumonia but suffers from interobserver variation. Here, we assess the use of video recordings as a quality assurance tool that could be useful both in research and in training of staff.
  
  
  
  Respiratory rates (RR) were recorded in children aged 2-59 months presenting with cough or difficulty breathing at two busy outpatient clinics in Tanzania. Measurements were repeated at 10-min intervals in a quiet environment with simultaneous video recordings that were independently reviewed by two paediatricians.
  
  
  
  Eight hundred and fifty-nine videos were sent to two paediatricians; 148 (17.2%) were considered unreadable by one or both. For the 711 (82.8%) videos that were readable by both paediatricians, there was perfect agreement for the presence of raised RR with a kappa value (κ) of 0.85 (P < 0.001); and in 476 (66.9%) cases, both paediatricians agreed on the RR within 2 breaths per minute (±2 bpm). A reported illness of 5 days or more was associated with unreadable video recordings (OR = 3.44, CI: 1.5-6.08; P < 0.001). The multilevel model showed that differences between observers accounted for only 13% of the variability in RR.
  
  
  
  Video recordings are reliable tools for quality assurance of RR measurements in children with suspected pneumonia. Videos with a clear view of respiratory movements may also be useful in training primary healthcare staff.
authors.affiliation: Kilimanjaro Christian Medical University College, Moshi, Tanzania.|Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
authors.forename: Florida
authors.initials: F
authors.lastname: Muro
authors.affiliation: Kilimanjaro Christian Medical University College, Moshi, Tanzania.
authors.forename: Neema
authors.initials: N
authors.lastname: Mosha
authors.affiliation: Global Health - Health System and Policy Research Group, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Helena
authors.initials: H
authors.lastname: Hildenwall
authors.affiliation: Joint Malaria Programme, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
authors.forename: Frank
authors.initials: F
authors.lastname: Mtei
authors.affiliation: Department of Medicine I, Medical University of Vienna, Vienna, Austria.|London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Nicole
authors.initials: N
authors.lastname: Harrison
authors.affiliation: London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: David
authors.initials: D
authors.lastname: Schellenberg
authors.affiliation: Kilimanjaro Christian Medical University College, Moshi, Tanzania.|Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
authors.forename: Raimos
authors.initials: R
authors.lastname: Olomi
authors.affiliation: Joint Malaria Programme, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.|London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Hugh
authors.initials: H
authors.lastname: Reyburn
authors.affiliation: Kilimanjaro Christian Medical University College, Moshi, Tanzania.|London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Jim
authors.initials: J
authors.lastname: Todd
mesh_terms: D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015588:Observer Variation; D011014:Pneumonia / Q000175:diagnosis* / Q000503:physiopathology; D011237:Predictive Value of Tests; D056152:Respiratory Rate / Q000502:physiology*; D012720:Severity of Illness Index; D013636:Tanzania / Q000453:epidemiology
keywords: children; integrated management of childhood illness; pneumonia; respiratory rate; variability; video