Dr. Florida Joseph Muro
Position : Assistant Lecturer, KCM‐College, Tumaini University
Florida Joseph Muro is a Tanzanian registred at Tumaini University Makumira. She is a Senior Medical Officer, Internal Medicine Department and Assistant Lecturer, KCM‐College, Tumaini UniversityKilimanjaro Christian Medical Centre (KCMC) Tanzania
She studied medicine at Tumaini University and initially worked as a general practitioner in a rural health care centre in Tanzania. She saw many patients – Malaria, pneumonia and AIDS were the most devastating illnesses in children. She wanted to do something more and her rural practical experience underscored the importance of approaches to disease prevention, curing and ameliorating existing diseases.
Her first step towards acquiring public health and research knowledge was to join one of the consultant referral hospitals in Tanzania, KCMC where she was engaged in research activities as study coordinator. In 2009 she joined LSHTM to study MSc Public Health in Developing Countries. Her research project focus is on acute febrile illness in children, Tanzania.
Variability of the respiratory rate measurements in children suspected with non-severe pneumonia north-east Tanzania
Introduction: With so little time left for completion of the Millennium Development Goals (MDGs), World Health Organization (WHO) and others are giving increased attention towards respiratory rate (RR) measurement in children in order to identify and reduce pneumonia mortality. The introduction of new devices raises the need for validity assessment and this raises the need for a ‘gold standard’ measure of RR. There is no such standard that is internationally accepted but one option is the use of video of respiratory movement in children that can be later reviewed by experts and results compared with those obtained by primary care workers in their daily practice. We assess the use of such video recordings taken under controlled conditions and comparing results from two independent paediatricians.
Method: Using WHO recommendation of observation for 60 seconds, RR were recorded in children aged 2 – 59 months presenting with cough or difficulty breathing in a busy clinic and then repeated at 10 minute intervals over 1 hour in a quiet setting. Random effects linear regression was used to assess variability in RR measurements.
Results: A total of 167 children were enrolled of which 162 (97.0%) had at least one repeat measurement of RR in the quiet settings. Participant ages ranged from 2.2 months to 58 months, with a median age of 12.5 months. Half of the children were awake and calm durin the one hour of observation and about a quarter of children were agitated making video review difficult. The mean RR was 35.9 (SD± 9.7) breaths per minute (bpm) and 36.4 (SD± 10.1) bpm by first and second video reviewer respectively compared to 35.8 (SD± 10.7) by the research nurse. On multivariate analysis, the video reviewers recorded high RR than the research nurse (video reviewer 1= 0.53, 95% CI=0.23-0.84, video reviewer 2=0.85, 95% CI=0.53-1.17). Inter-observer variability in RR between the 2 expert video reviewers and the research nurse was high (SD=3 breaths per minute) after accounting for differences among children and over time.
Conclusion: Video does not appear to be a reliable gold standard of RR quality checks. Alternative tools need to be identified to facilitate correct and proper assessment of pneumonia in young children.
- Rachel Manongi, Frank Mtei, George Mtove, Behzad Nadjm, Florida Muro, Victor Alegana, Abdisalan M. Noor, Jim Todd and Hugh Reyburn. Inpatient child mortality by travel time to hospital in a rural area of Tanzania 2014. Tropical Medicine and International Health 2014 (5): 555–562 doi:10.1111/tmi.1229419