Added value of routine pulse oximetry use within Integrated Management of Childhood Illness guidelines in primary care in West Africa
Insight from Aire
Bibliographic Data
BACKGROUND: <90%), a predictor of mortality in children under five. The AIRE (Améliorer l'Identification des Détresses Respiratoires chez l'Enfant; in English, Improving Identification of Respiratory Distress in Children) operational research project introduced routine use of pulse oximetry (PO) within IMCI consultations in Burkina Faso, Guinea, Mali and Niger. We estimated the added value of incorporating PO within IMCI (IMCI+PO) for improving the diagnosis and subsequent management of severe hypoxaemia in primary healthcare centres (PHCs). METHODS: measurement, except those 2-59 months classified as simple non-respiratory cases using IMCI. Monthly aggregated data were collected from 202 AIRE PHC's through a cross-sectional study to estimate the added value of PO within IMCI in diagnosing severe cases (SCs) which should be referred. The added value was defined as the number of additional IMCI SCs with severe hypoxaemia, diagnosed using IMCI+PO, divided by the number of SCs diagnosed using IMCI alone. In a subset of 16 PHCs, we conducted a 14-day cohort follow-up for SCs. We analysed their management and mortality according to hypoxaemia status. RESULTS: Of the 514 901 IMCI consultations between June 2021 and December 2022, 74.2% were eligible for PO use. Of those, 5.4% were SCs diagnosed using IMCI+PO. The added value of PO was +4.9% (+962 SCs; 95% CI 4.6% to 5.2%). This was similar for all countries except Guinea (+0.9%). Healthcare workers' referral decisions were significantly higher for SCs with severe hypoxaemia (74.5%) than for those without (22.2%), p value <0.0001. In the research PHCs, the 142 SCs with severe hypoxaemia were significantly more likely to be referred and admitted to hospital, although their survival rates were similar. However, oxygen therapy remained suboptimal. CONCLUSION: At PHC level, PO improves the diagnosis of SCs with severe hypoxaemia and is associated with improved management. However, subsequent care in these settings remains challenging. TRIAL REGISTRATION NUMBER: PanAfrican Clinical Trial Registry (PACTR202206525204526)
Cohort · Health care · Integrated Management of Childhood Illness · Primary care · Pulse oximetry · Referral · Respiratory distress · Neonatal Respiratory Health Research · Pneumonia and Respiratory Infections · Respiratory viral infections research
Prevalence and factors associated with severe illness in West African children under 5 years of age detected with routine pulse oximetry in primary care
Missed opportunities for hospital referral of young children with severe pneumonia identified at primary care using pulse oximetry
Care management and determinants of day 14 mortality in severely ill children aged under 5 years subsequent to hypoxaemia diagnosed using routine pulse oximetry in primary care
Understanding health innovation adoption
Acceptability of the routine use of pulse oximetry by healthcare workers and caregivers within primary healthcare in West Africa
Challenges and needs before implementing routine pulse oximetry within primary care for sick children in West Africa
What are the risk factors for death among children with pneumonia in low- and middle-income countries? A systematic review
The Tools for Integrated Management of Childhood Illness (Timci) study protocol
Incidence of unintended pregnancies and pregnancy experience among adolescents living with perinatally-acquired HIV in West Africa
| Highly cited | No |
|---|