Measuring a child’s respiratory rate correctly is an important diagnostic tool in determining whether a child has community-acquired pneumonia (CAP). Based on the latest Integrated Management of Childhood Illnesses (IMCI) protocols, a child aged under 5 years old is classified as having community-acquired pneumonia (CAP) based on the following respiratory rate cut-offs:

  • Children aged 2 – 11 months: ≥ 50 breaths per minute
  • Children aged 1 – 5 years: ≥ 40 breaths per minute

It is therefore important to ensure that a child’s respiratory rate is counted as precisely as possible. However, this is not always easy to implement at the level of a rural health facility due to certain limitations:

  • Counting the respiratory rate requires being able to measure a full minute using a timer or a watch. For rural health facilities and for frontline health workers, this may not always be available.
  • Frontline health workers aren’t always literate and using a watch or a timer to tell whether 60 seconds has elapsed might not always be helpful.

Various tools have been developed to address these limitations. One of these tools is the Breath Counter application on Android smartphones. Breath Counter is a simple application that helps health workers count the number of breaths a child makes in 60 seconds. It is both a sounding timer (beeps when 60 seconds is over) and a tactile tool that allows the user to manually count the breaths by tapping onto the screen of a mobile device everytime the child breaths.

This tutorial shows how the application is used.
 

1. Download and install Breath Counter on your mobile device

You wil first need to download and install Breath Counter on your mobile device. Breath Counter is available for mobile devices running Android operating systems.

A tutorial on how to download and install Breath Counter can be found here.
 

2. Open Breath Counter

Tap on the Breath Counter application icon on your mobile device.


 

You will then see the following Breath Counter interface on your mobile device.

A big green square (1) button will be the most visible component of the application interface. In the middle of this green square button are the words ‘Press to Start’. As indicated, this button is tapped to start the application. Tapping this button will start the timer (2) found below the green square button. This timer will indicate how many seconds has elapsed already since tapping the green square button.

Also underneath the big green square is another counter for the number of breaths (3). This counter counts how many times the user taps the green square button which is based on how many times the user has observed the child breathing.


 

3. Press the green square button to start the application

Now let’s try using the application.

Start the application by pressing on the green square button. Once you have pressed this, you will then notice that the timer starts counting the number of seconds. You will also see that a red rectangular button will become activated at the bottom of the screen of your mobile device. This signifies that the application has started.

To count the number of breaths, you need to tap the green square button everytime you observe the child’s chest rise and fall. This is considered one breath. When you are doing this, you don’t have to worry about looking at the screen or watching the timer. All you need to do is focus on the child’s chest and make sure you are tapping the green button every time you observe the child’s chest rise and fall. The application will stop once 60 second is over and then it will make a sound indicating that the 60 seconds is over. A voice prompt will also report how many breaths per 60 seconds have been counted.

After this, any tap on the green square button will not be counted.

Once you have the breath count, you can now record this data onto the form you are filling.

In the example below, the timer is already at 17.4 seconds (1) and 15 breaths have been counted (2). This means that the user has tapped the green square button 15 times within that time period.

If at any point within the 60 seconds you need to re-start the counting either because you have lost count or you got distracted, you can tap on the red rectangular button that says ‘Start Over’ (3). This will reset the application and the timer and the breath counter and you can again start the counting afterwards by tapping on the green square button.


 

Once the 60 second time period has elapsed, this is what you will see on the application screen.

The number of breaths per minute will be shown in the place where the green square button used to be (1). Below this will be a yellow rectangular button that says ‘Submit Results’ (2). This button is used to submit results of the breath counter to a specific application called CommCare. Unless you are using this specific application, this button will not be useful. Then below this will be a red rectangular button that says ‘Start Over’ (3). This will reset the timers and the counters and will bring you back to the opening interface of the application and allow you to count another child’s respiratory rate.

It should be noted that the application will also read out the results of the breath count. It will say how many breaths per minute were counted by the application. This is useful when the users are unable to read what is on the screen.


 

4. Record the breath count into the current form

Once you have the respiratory rate of the child, this can now be recorded in the current form you are entering data into.