Table 3.
Prognostic indicator | Overall favorability | Selected performance comments | Selected feasibility comments |
---|---|---|---|
Fever | Unfavorable | Low specificity for identifying children who will not fail treatment | High feasibility since already implemented and measurement tools simple |
Rapid breathing | Minimally favorable | Normal range highly variable | Measurement tools inaccurate |
Low sensitivity for hypoxemic children | Low feasibility with respect to sequential monitoring of respiratory rates over time | ||
Performance profile improves with sequential monitoring of respiratory rates over time | |||
Lower chest wall indrawing | Favorable | Low specificity for identifying children who will not fail treatment | Subjective sign with variable inter-provider agreement levels |
Abnormal oxygen saturation | Highly favorable | High specificity for identifying children who will not fail treatment | Objective measurement but inter-provider agreement levels unknown |
Later indicator decreases sensitivity for identifying children who will fail treatment at the community-level | Robust, precise, low-cost point-of-care instrument needed | ||
Likely costly to implement and sustain | |||
High blood lactate levels | Unfavorable | Low specificity for identifying children who will not fail treatment | Point-of-care tool appropriate for community use not available, likely costly |
Very late indicator decreases sensitivity for identifying children who will fail treatment at the community-level | |||
Moderate malnutrition | Highly favorable | Mid-range sensitivity and specificity which likely improves greatly in combination with other indicators | High feasibility since measurement tools simple and accurate |
High positive predictive value | |||
HIV-affected | Minimally favorable | Geographically limited in relevancy (e.g. primarily in eastern and southern Africa) | Low feasibility since difficult to obtain HIV status at community-level (e.g. stigma) |
High positive predictive value |
HIV: Human Immunodeficiency Virus