Rapid Responses to:

PAPERS:
Stanley Usen, Martin Weber, Kim Mulholland, Shabbar Jaffar, Anslem Oparaugo, Charles Omosigho, Richard Adegbola, and Brian Greenwood
Clinical predictors of hypoxaemia in Gambian children with acute lower respiratory tract infection: prospective cohort study
BMJ 1999; 318: 86-91 [Abstract] [Full text]
*Rapid Responses: Submit a response to this article

Rapid Responses published:

[Read Rapid Response] Practical Implications?
Elizabeth Lim   (21 January 1999)

Practical Implications? 21 January 1999
Top
Elizabeth Lim,
Medical Student
Epidemiology and Public Health

Send response to journal:
Re: Practical Implications?

Sir The study of Usen et al.(1) adds weight to their previous work (2), with a larger sample and better blinding of investigators, considering of a wide range of clinical predictors of hypoxaemia. However, we question the practical significance of this work in terms of current WHO guidelines (3)for community health workers. Their simple algorithm improves specificity which would allow more efficient use of resources, albeit at the expense of sensitivity, the significance of which is debatable. If the authors are suggesting that their chosen predictors should be incorporated into, or even replace, WHO guidelines for community health workers then we would question whether a change in these guidelines is justified. Retraining involves significant financial and practical costs. Furthermore, frequent changes in policy carry risks of confusion and disagreement among community health workers and may decrease their credibility in the community.

Brettle P., Guinness L., Lim L., Robb S.

Department of Epidemiology and Public Health University of Newcastle upon Tyne

1. Usen S., Weber M. W., Mulholland E. K., Jaffar S., Oparaugo A., Omosigho C., Adegbola R., Greenwood B. Clinical predictors of hypoxaemia in Gambian children with acute lower respiratory tract infection: prospective cohort study. BMJ 1999 318:86-91.

2. Weber M.W., Usen S., Palmer A., Jaffar S., Mulholland E. K. Predictors of hypoxaemia in hospital admissions with acute lower respiratory tract infection in a developing country. Arch Dis Child (1997) 76:1-5.

3. World Health Organisation programme for the control of acute respiratory tract infections. Acute respiratory tract infection in children: case management in small hospitals in developing countries. Geneva: WHO/ ARI/ 90.5, 1990.