Evaluating the impact of pulse oximetry on childhood pneumonia mortality in resource-poor settings.

Jessica Floyd,Rasa Izadnegahdar,Azra C Ghani,David Mukanga,Deborah Hay Burgess,Lindsey Wu

doi:10.1038/nature16043

Abstract

It is estimated that pneumonia is responsible for 15% of childhood deaths worldwide. Recent research has shown that hypoxia and malnutrition are strong predictors of mortality in children hospitalized for pneumonia. It is estimated that 15% of children under 5 who are hospitalized for pneumonia have hypoxaemia and that around 1.5 million children with severe pneumonia require oxygen treatment each year. We developed a deterministic compartmental model that links the care pathway to disease progression to assess the impact of introducing pulse oximetry as a prognostic tool to distinguish severe from non-severe pneumonia in under-5 year olds across 15 countries with the highest burden worldwide. We estimate that, assuming access to supplemental oxygen, pulse oximetry has the potential to avert up to 148,000 deaths if implemented across the 15 countries. By contrast, integrated management of childhood illness alone has a relatively small impact on mortality owing to its low sensitivity. Pulse oximetry can significantly increase the incidence of correctly treated severe cases as well as reduce the incidence of incorrect treatment with antibiotics. We also found that the combination of pulse oximetry with integrated management of childhood illness is highly cost-effective, with median estimates ranging from US$2.97 to $52.92 per disability-adjusted life year averted in the 15 countries analysed. This combination of substantial burden reduction and favourable cost-effectiveness makes pulse oximetry a promising candidate for improving the prognosis for children with pneumonia in resource-poor settings.

Highlights

It is estimated that pneumonia is responsible for 15% of childhood deaths worldwide
We proposed two scenarios: one in which the addition of pulse oximetry increases the sensitivity of integrated management of childhood illness (IMCI) to 70%, and one in which the sensitivity of the combination is increased to 85%, reflecting the potential of pulse oximetry to identify both people with hypoxic cases and cases with abnormal oxygen saturation (90–95%) who would benefit from referral[14]
Using a simple model that links care pathways to the progression of pneumonia in young children, we predict that a combination of pulse oximetry with current IMCI guidelines has the potential to avert up to 148,000 deaths per year in the 15 countries with the highest burden of pneumonia across Africa and Asia, under the assumption that there is more than 90% prognostic tool and supplementary oxygen availability

Summary

Introduction

It is estimated that pneumonia is responsible for 15% of childhood deaths worldwide. Recent research has shown that hypoxia and malnutrition are strong predictors of mortality in children hospitalized for pneumonia. Severe pneumonia is defined as cough or difficulty breathing in the presence of danger signs, and requires referral to a hospital or health facility for injectable antibiotics or other supportive care such as oxygen therapy[6] Identification of these IMCI symptoms remains inconsistent and unreliable among community health-care workers or carers without clinical training[7]. The use of pulse-oximetry devices (used to measure the oxygen level in the blood) in community health-care settings has been proposed as a method to identify hypoxic children at risk of treatment failure These devices may be beneficial at the frontline given that they require little training and reduce the reliance on clinical symptoms. The current pulse-oximetry systems are quick, non-invasive and require minimal infrastructure

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