Abstract
ObjectiveTo investigate implementation of outpatient pulse oximetry among children with pneumonia, in Malawi.MethodsIn 2011, 72 health-care providers at 18 rural health centres and 38 community health workers received training in the use of pulse oximetry to measure haemoglobin oxygen saturations. Data collected, between 1 January 2012 and 30 June 2014 by the trained individuals, on children aged 2–59 months with clinically diagnosed pneumonia were analysed.FindingsOf the 14 092 children included in the analysis, 13 266 (94.1%) were successfully checked by oximetry. Among the children with chest indrawing and/or danger signs, those with a measured oxygen saturation below 90% were more than twice as likely to have been referred as those with higher saturations (84.3% [385/457] vs 41.5% [871/2099]; P < 0.001). The availability of oximetry appeared to have increased the referral rate for severely hypoxaemic children without chest indrawing or danger signs from 0% to 27.2% (P < 0.001). In the absence of oximetry, if the relevant World Health Organization (WHO) guidelines published in 2014 had been applied, 390/568 (68.7%) severely hypoxaemic children at study health centres and 52/84 (61.9%) severely hypoxaemic children seen by community health workers would have been considered ineligible for referral.ConclusionImplementation of pulse oximetry by our trainees substantially increased the referrals of Malawian children with severe hypoxaemic pneumonia. When data from oximetry were excluded, retrospective application of the guidelines published by WHO in 2014 failed to identify a considerable proportion of severely hypoxaemic children eligible only via oximetry.
Highlights
Among children with pneumonia, hypoxaemia is common, predicts mortality and is a marker of severe illness.[1,2,3] Pulse oximetry – hereafter called oximetry – is the standard tool for non-invasively measuring peripheral arterial haemoglobin oxygen saturation
Among practitioners and caregivers faced with decisions on the care of a child with severe pneumonia, the results of oximetry may be more persuasive than a clinical assessment alone.[10]
We conducted a similar analysis of the data from the community health workers (CHW) but, for pneumonia cases seen by such workers, both the Malawian and WHO guidelines that we considered recommend referral because of indrawing
Summary
Hypoxaemia is common, predicts mortality and is a marker of severe illness.[1,2,3] Pulse oximetry – hereafter called oximetry – is the standard tool for non-invasively measuring peripheral arterial haemoglobin oxygen saturation. In rural areas in low-income countries, there is interest in training community and health-centre-based health workers in oximetry – and making oximetry more widely available – so that more hypoxaemic children at risk of death can be referred to hospitals.[8] Oximetry requires negligible infrastructure, is portable, non-invasive and user-friendly and offers a more accurate and objective way to identify hypoxaemia in children than clinical signs alone.[3,8,9] Among practitioners and caregivers faced with decisions on the care of a child with severe pneumonia, the results of oximetry may be more persuasive than a clinical assessment alone.[10]
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