Variability of respiratory rate measurements in children suspected with non-severe pneumonia in north-east Tanzania

Florida Muro, Neema Mosha, Helena Hildenwall, Frank Mtei, Nicole Harrison, David Schellenberg, Raimos Olomi, Hugh Reyburn, Jim Todd
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Measurement of respiratory rate is an important clinical sign in the diagnosis of pneumonia but suffers from interobserver variation. Here, we assess the use of video recordings as a quality assurance tool that could be useful both in research and in training of staff.


Respiratory rates (RR) were recorded in children aged 2–59 months presenting with cough or difficulty breathing at two busy outpatient clinics in Tanzania. Measurements were repeated at 10-min intervals in a quiet environment with simultaneous video recordings that were independently reviewed by two paediatricians.


Eight hundred and fifty-nine videos were sent to two paediatricians; 148 (17.2%) were considered unreadable by one or both. For the 711 (82.8%) videos that were readable by both paediatricians, there was perfect agreement for the presence of raised RR with a kappa value (κ) of 0.85 (P < 0.001); and in 476 (66.9%) cases, both paediatricians agreed on the RR within 2 breaths per minute (±2 bpm). A reported illness of 5 days or more was associated with unreadable video recordings (OR = 3.44, CI: 1.5–6.08; P < 0.001). The multilevel model showed that differences between observers accounted for only 13% of the variability in RR.


Video recordings are reliable tools for quality assurance of RR measurements in children with suspected pneumonia. Videos with a clear view of respiratory movements may also be useful in training primary healthcare staff.