Ahad Mahmud Khan

The online version contains supplementary material available at 10.1007/s44337-026-00595-8.

The World Health Organization’s Integrated Management of Childhood Illness guidelines emphasise respiratory rate (RR) counting for diagnosing childho

This dataset was generated as part of a study aimed at developing a video expert panel (VEP) to serve as a reference standard for respiratory rate assessme

Introduction: Inappropriate healthcare practices are major contributors to poor outcomes of maternal and pediatric patients. Where resources are scarce, provider-level targeted interventions, such as implementation of standardized, evidence-based protocols and quality improvement initiatives are particularly needed to address these gaps in care. Simulation-based tools have been shown to have a promising effect on improving clinical care management. This study aims to evaluate the effectiveness of a simulation-based platform called E-Patient Quality Improvement and Standardization (EQIS) in improving maternal and pediatric health care in Bangladesh. Methods and analysis: The study employs a prospective, open-cohort design and will be conducted across five tertiary-level hospitals in Dhaka, Bangladesh. All physicians engaged in providing maternal or pediatric care will be recruited. The EQIS platform will facilitate the development of online simulated cases, aiming to enhance physician practice and patient outcomes through involvement and immediate personalized feedback. The development of cases will consist of several stages of review by expert clinicians, ensuring that the cases align with national and local practice guidelines. Each participant physician will work on three cases per round, completing one of six rounds every four months for two years. Data will be collected and analyzed after each round. Descriptive and inferential analysis will be done to assess trends in clinical performance and pinpoint areas for improvement. In addition, patient-level pre- and post-impact data will be collected. These data will evaluate the impact of the EQIS platform on physician performance, as measured by changes in patient satisfaction, treatment costs, referrals, and facility utilization.

Objective: To describe the process of interpreting chest movement videos for respiratory rate (RR) assessment in children aged 0–59 months with suspected non-severe pneumonia by a video expert panel (VEP) and to evaluate the panel’s performance. Methods: Six physicians trained and standardised to RR assessment from recorded videos formed a VEP. The panel interpreted RR from recorded videos collected from health facilities in Bangladesh. The videos were distributed using a web-based system among the panel members. Each member was evaluated by assessing inter-reader agreement among the primary readers, each reader’s agreement with the final panel reading and intrareader agreement using per cent agreement. Agreement was defined as the video being interpretable and the difference in RR count between two readers being ≤2 breaths per minute. The panel’s performance was evaluated using Bland-Altman analysis against a panel of paediatricians who reviewed a randomly selected 10% subset of videos. Results: Among the 605 videos, the VEP classified 89.9% (n=544) of them as interpretable with RR count difference ≤2 breaths per minute, 2.0% (n=12) as interpretable with RR count difference >2 breaths per minute and 8.1% (n=49) as uninterpretable. For the video interpretability, inter-reader agreement among primary readers ranged from 88% to 95%, each reader’s agreement with the final panel was 90%–95%, and intrareader agreement was 98%–100%. For the RR measurement, five out of six VEP members demonstrated satisfactory inter-reader agreement (80%–83%), agreement with final panel reading (92%–97%) and intrareader agreement (92%–100%). One outlier reader showed lower agreement levels of 55%, 61% and 75%, respectively. The mean difference in RR counts between the VEP and paediatrician panel was −0.3 breaths per minute, and limits of agreement were −3.0–2.3 breaths per minute. Conclusion: The performance of VEP was satisfactory for evaluating RR counting. The study provided valuable insights into the development and evaluation of the VEP as a potential reference standard.

Background: According to the World Health Organization’s Integrated Management of Childhood Illness (IMCI) guidelines, childhood pneumonia diagnosis relies on counting respiratory rate (RR). Counting RR by health workers is frequently inaccurate, leading to misdiagnosis and poor outcomes. Automated RR counters could potentially overcome these limitations. To address this gap, we introduced an automated RR counter and developed a reference video expert panel (VEP) to evaluate its performance. Methods: We conducted a cross-sectional study involving children aged 0–59 months with suspected pneumonia in Bangladesh. The RR of children was counted using an automated counter (ChARM) and chest movements were simultaneously videotaped. These videos were interpreted by the VEP, trained to a standard procedure. We assessed ChARM’s accuracy in comparison to the RR generated by the VEP and summarised the time taken to count RR by ChARM. Results: Among 339 enrolled children, ChARM successfully counted the RR of 294 children (86.7%). The VEP reached a consensus (i.e., RR count difference within two breaths per minute (bpm) between two VEP members) in 257 of the 294 children (87.4%). ChARM and the VEP agreed on RR counts within two bpm in 68.1% of children (n = 175/257), with a mean difference of 1.7 bpm and limits of agreement ranging from -6.7 to 10.2 bpm. ChARM classified age-adjusted fast and normal breathing with a sensitivity of 95.8% (95% CI: 88.1–99.1) and a specificity of 93.5% (95% CI: 89.0–96.6), demonstrating high agreement (kappa = 0.86). The median time to count the RR by ChARM was 66 s (interquartile range: 61–73 s). Conclusions: ChARM counted RR accurately against a VEP reference, indicating a potential role in supporting health workers to diagnose pneumonia. However, it was unsuccessful for 1 in 8 cases, typically those more clinically challenging, suggesting a possible systematic bias. Further research is needed to address these issues and confirm ChARM’s reliability for broader use in real-world settings. Trial registration: Current Controlled Trials ISRCTN14120515, registered retrospectively on 19 September 2024.

Background: The videography of child chest movements and its interpretation by experts could be an ideal reference standard to evaluate respiratory rate (RR) count to aid childhood pneumonia diagnosis. The study aimed to determine the factors associated with interpretability and agreement of RR counts derived by experts from recorded videos of chest movements in children under five years of age. Methods: Thirty hospitalized children aged 1–59 months with suspected pneumonia were video-recorded breathing four times. Two paediatricians subsequently evaluated the videos and counted RR. Interpretability was defined as both paediatricians being able to interpret RR and agreement was defined as the difference in RR counts of ≤2 breaths per minute (bpm). Results: Eighty-five videos of RR measurements were recorded. There was agreement in the ability to interpret RR in 73/85 (85.9%) videos, and agreement for RR counts in 54/73 (74.0%) of interpretable videos. A higher adjusted odds ratio (aOR) for the ability of interpretability in RR counts was found if the child was calm or sleeping compared to moving (aOR = 73.6; 95% CI 9.1, 594.0; p < 001), or lying on the bed compared to on the parent’s lap (aOR = 22.8; 95% CI 2.9, 179.0; p = 0.003). A higher aOR for agreement in RR counts was found if the RR was p = 0.002) and 40–59 bpm (aOR = 7.4; 95% CI 1.2, 45.2; p = 0.030), compared to RR ≥ 60 bpm. Conclusion: Child movements, child position and higher RR affect interpretability and/or agreement in RR counts between experts. These factors should be considered during the videography of RR measurement and its interpretation.

Background The weight-for-height z-score (WHZ) is considered the gold standard for detecting acute malnutrition in children. However, an accurate assessment of WHZ can often be challenging, especially in community settings. Mid-upper arm circumference (MUAC) is a simple and easy-to-perform method to identify children with acute malnutrition. The objective of the study was to evaluate the accuracy of MUAC in detecting acute malnutrition compared to WHZ among children aged 6-59 months in Bangladesh. Methods We used anthropometric data for 239 children aged 6-59 months from a cross-sectional study conducted in 2013 in an urban slum in Dhaka, Bangladesh. The sensitivity and specificity of MUAC to detect acute malnutrition were calculated, considering WHZ as the gold standard. Results The mean age of the children was 29.4 +/- 12.7 months, with a male-to-female ratio of 1:1.2. The prevalence of acute malnutrition was 17.1% and 22.5% based on WHZ and MUAC, respectively. The total area under the receiver operating characteristic curve was 0.816. For detecting acute malnutrition, the sensitivity of MUAC was 61.0% and the specificity was 85.4% for the World Health Organization (WHO) recommended cutoff of <125 mm. Using the Youden index, the best MUAC cutoff point to detect acute malnutrition was <128 mm with a sensitivity of 75.6% and a specificity of 74.7%. Conclusions Our study demonstrated a low sensitivity of MUAC to identify acute malnutrition at the WHO cutoff of <125 mm. The cutoff could be increased to <128 mm to capture more children with acute malnutrition.

Introduction Manual counting of respiratory rate (RR) in children is challenging for health workers and can result in misdiagnosis of pneumonia. Some novel RR counting devices automate the counting of RR and classification of fast breathing. The absence of an appropriate reference standard to evaluate the performance of these devices is a challenge. If good quality videos could be captured, with RR interpretation from these videos systematically conducted by an expert panel, it could act as a reference standard. This study is designed to develop a video expert panel (VEP) as a reference standard to evaluate RR counting for identifying pneumonia in children. Methods and analysis Using a cross-sectional design, we will enrol children aged 0–59 months presenting with suspected pneumonia at different levels of health facilities in Dhaka and Sylhet, Bangladesh. We will videorecord a physician/health worker counting RR manually and also using an automated RR counter (Children’s Automated Respiration Monitor) from each child. We will establish a standard operating procedure for capturing quality videos, make a set of reference videos, and train and standardise the VEP members using the reference videos. After that, we will assess the performance of the VEP as a reference standard to evaluate RR counting. We will calculate the mean difference and proportions of agreement within±2 breaths per minute and create Bland-Altman plots with limits of agreement between VEP members. Ethics and dissemination The study protocol was approved by the National Research Ethics Committee of Bangladesh Medical Research Council, Bangladesh (registration number: 39315022021) and Edinburgh Medical School Research Ethics Committee (EMREC), Edinburgh, UK (REC Reference: 21-EMREC-040). Dissemination of the study findings will be through conference presentations and publications in peer-reviewed scientific journals.