Diagnosis of pneumonia by community health volunteers: experience of BRAC, Bangladesh

The study assessed the validity of community health volunteers' diagnosis of pneumonia in children through simple clinical signs. Data were collected by a group of research physicians who observed the case management performance of 120 health volunteers in Bangladesh where the Bangladesh Rural Advancement Committee has been providing community-based acute respiratory infection control since mid-1992. 1,166 children age 3-60 months were assessed at household level by both a community health volunteer and a research physician. Using physician diagnosis as gold standard, health volunteers' diagnosis of pneumonia was 67.6% sensitive and 95.2% specific. Cohen's kappa for agreement between volunteers and physicians was 0.67. Of the clinical signs elicited, chest in drawing and noisy breathing predicted physician's diagnosis of pneumonia most strongly ([positive predictive value (PPV)] 84% and 79%, respectively). The study concludes that less educated health volunteers can be effectively used in diagnosing pneumonia at grassroots level in developing countries.