Abstract
BackgroundIn adequately resourced clinical environments, diagnosis of hypoxemia via pulse oximetry is routine. Unfortunately, pulse oximetry is rarely utilized in under-resourced hospitals in developing countries.AimThe prevalence of undiagnosed hypoxemia among adults and children with illnesses other than pneumonia in these environments remains poorly described.MethodsThis cross-sectional analysis of the prevalence of hypoxemia was conducted in Kapiri Mposhi, Zambia, at the 60-bed District Hospital, which serves a population of 320,000. The resting room air oxygen saturations of two consecutive samples of all adult and pediatric inpatients were measured in December 2008 and March 2009 using handheld pulse oximetry. Hypoxemia was defined as resting room air SpO2 less than 90%.ResultsA total of 192 patients were enrolled: 68 young children (<5 years old), 15 older children (5–17 years old), and 109 adults (≥18 years old). Five young children (7%), 0 older children (0%), and 10 adults (9%) were hypoxemic. No hypoxemic patients were receiving oxygen therapy at the time of diagnosis. Pneumonia, tuberculosis, and malnutrition were the most common conditions among those with hypoxemia. Oximetry data changed clinical management in all observed cases of hypoxemia and several cases of normoxemia, leading to application of supplemental oxygen, initiation of further diagnostic testing, prolongation of inpatient stay, or expedited discharge home.ConclusionsUndiagnosed hypoxemia is present among inpatients at this district hospital in rural Zambia with high prevalence in both adults and young children. These results support routine screening for hypoxemia in similar facilities in both age groups. Further investigation is warranted into the clinical impact and cost-effectiveness of pulse oximetry, provision of oxygen concentrators, and training on their use in developing countries.
Highlights
Pulse oximetry is a technology that is used routinely for diagnosis of hypoxemia in high-income countries [1]
Undiagnosed hypoxemia is present among inpatients at this district hospital in rural Zambia with high prevalence in both adults and young children
Further investigation is warranted into the clinical impact and cost-effectiveness of pulse oximetry, provision of oxygen concentrators, and training on their use in developing countries
Summary
Pulse oximetry is a technology that is used routinely for diagnosis of hypoxemia in high-income countries [1]. The potential benefit of introducing the technology has been recognized by the field of anesthesiology, which has recently launched the Global Oximetry Initiative to promote oximetry utilization and reduce oximetry costs in low-income countries [5]. This effort focuses on increasing the availability of oximetry in perioperative settings, though randomized controlled trials in high-income countries have yet to demonstrate that oximetry reduces morbidity or mortality in this setting [6, 7]. Overall, the literature evaluating the impact of pulse oximetry in resource-limited settings is sparse, and the prevalence of hypoxemia among adults in low-income countries remains largely unknown. Prior Presentations Mediterranean Emergency Medicine Congress V, Valencia, Spain, September 2009 and American Public Health Association Annual Meeting, Philadelphia, November 2009
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