Assessment of respiratory rate and chest indrawing in children with ARI by primary care physicians in Egypt

Bull World Health Organ. 1993;71(5):523-7.


In a baseline study for training purposes, two indicators of acute respiratory infections (the respiratory rate (RR) and chest indrawing) were assessed by Ministry of Health physicians in Egypt using a WHO test videotape. Chest indrawing, as defined by the WHO Acute Respiratory Infections (ARI) programme, was not widely recognized by current health personnel. Viewing a WHO training videotape led to significantly more correct assessments of chest indrawing compared with a group that had not viewed this videotape. The accuracy of using a timer versus a watch, and a 30-second versus 60-second counting interval was also evaluated. Rates counted over 60 seconds were more accurate than 30-second counts although the difference between them was not clinically significant. Counting of rates using timers with audible cues was comparable to using watches with second hands. Careful training of primary health workers in the assessment of RR and chest indrawing is essential if these clinical findings are to be used as reliable indicators in pneumonia treatment algorithms.

PIP: The timely treatment of acute lower respiratory tract infections (ALRI) in children depends upon the correct assessment of clinical findings. In the context of launching a national ALRI control program in Egypt, the authors surveyed the knowledge, attitudes, and practices of physicians in measuring respiratory rates (RR); examined the effect of a World Health Organization training videotape upon the recognition of chest indrawing; and examined the effect of different time intervals and providing audible timers on the accuracy of RR assessment. 320 Ministry of Health physicians participated in the study; 45% from maternal-child health care units, 30% from urban health centers, 18% in rural health units, and 7% in the district hospital or in school health. It was found that chest indrawing was not widely recognized by current health personnel and that the training compared with groups of physicians which were not exposed to the intervention. It was also found that counting RR for 60 seconds was more accurate than 30-second counts, but the difference between the 2 approaches was not clinically significant. Rate counting with audible cue timers was comparable to using watches with second hands. It is clear that primary health workers need to be carefully trained in assessing RR and chest indrawing if these clinical findings are to be used as reliable indicators in pneumonia treatment algorithms.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Acute Disease
  • Child, Preschool
  • Clinical Competence
  • Education, Medical, Continuing / methods
  • Education, Medical, Continuing / standards
  • Egypt
  • Evaluation Studies as Topic
  • Family Practice* / education
  • Family Practice* / methods
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Infant
  • Physical Examination* / methods
  • Physical Examination* / standards
  • Practice Patterns, Physicians'*
  • Reproducibility of Results
  • Respiration*
  • Respiratory Mechanics*
  • Respiratory Tract Infections / diagnosis*
  • Respiratory Tract Infections / physiopathology
  • Videotape Recording