A technological 'ChARM' to help diagnose pneumonia in the community

The ChARM is a clever device with a decade plus of history behind it– like many global health innovations, an original inspiration takes years to bring to fruition.

A call by UNICEF back in 2014 articulated the criteria for an automated respiratory rate monitor to make it easy for community health workers to count breath rates.

Here’s how UNICEF stated the problem: “….counting breaths in children is difficult. The [respiratory rate] RR can alter depending on the environment and technique used by the person who counts which leaves space for human error that often leads to mis-diagnosing. Furthermore, there is no set definition of a breath, meaning it is not possible to validate when a breath has been counted correctly. In many cases, counting simply does not happen.”

Two key innovations were put forth as a result of the UNICEF call, or ‘target product profile.’  One of the devices was the ChARM, developed by Philips, with input from Save the Children.  After all of the trials were undertaken, the device was further improved and is now manufactured by a new company called ChARM International. 

The ChARM uses an accelerometer to measure chest accelerations and decelerations– respiratory rate.  The device is calibrated for three different age groups (0-2 months, 2-12 months and 12 months to five years old).  The ChARM is strapped around a child’s chest.  A community health worker is taught to choose the right age group for the child. And then a simple press of a button on the side of the device starts the measurement.  .

Multiple studies have been conducted to assess the accuracy and usability of the ChARM. 

In Nepal, the majority of health workers, across all regions, preferred the ChARM to the previously used “timer” devices.  

In Ethiopia, health extension workers were interviewed after a formal study– they noted that the use of the ChARM attracted more child health visits from the community.  

In a second Ethiopian study, the usability of the ChARM was specifically analyzed relative to the ability to follow the manufacturer’s instructions for use and adherence to the World Health Organization’s required assessment of fast breathing.  In this study, after two months, the health workers increased adherence to 74.6%, an 18 % increase compared to the baseline two months prior.  

Perhaps a health worker summarized the usability results best, saying, “Before ChARM we counted RR manually.  Now the ChARM shows us the result and the classification…. It makes things easier.  I see no barriers and the community is willing.”    Esther, Goyda Health Center, Ethiopia.