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Pulse oximetry for children with pneumonia treated as outpatients in rural Malawi
Eric D McCollum1, Carina King2, Rashid Deula3
1Department of Pediatrics, Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins School of Medicine, Rubenstein Building, 200 North Wolfe Street, Baltimore, MD 21287, United States of America .
Insights
Pulse oximetry implementation in Malawi significantly improved referral rates for children with severe hypoxemic pneumonia. This vital tool identified many children who would have been missed by standard World Health Organization guidelines.
Area of Science:
- Pediatric Pulmonology
- Global Health
- Medical Device Implementation
Background:
- Pneumonia is a leading cause of child mortality in low-resource settings.
- Accurate assessment of hypoxemia is crucial for timely pneumonia management.
- Outpatient management of pneumonia requires accessible diagnostic tools.
Purpose of the Study:
- To evaluate the implementation of outpatient pulse oximetry for children with pneumonia in Malawi.
- To assess the impact of pulse oximetry on referral decisions for pediatric pneumonia cases.
- To compare the effectiveness of pulse oximetry with existing World Health Organization (WHO) guidelines.
Main Methods:
- Training of 72 healthcare providers and 38 community health workers on pulse oximetry use.
- Data collection on children aged 2-59 months with diagnosed pneumonia from January 2012 to June 2014.
- Analysis of referral rates based on oxygen saturation levels measured by pulse oximetry.
Main Results:
- Pulse oximetry successfully measured oxygen saturation in 94.1% of 14,092 children.
- Children with saturation <90% were over twice as likely to be referred compared to those with higher saturations.
- Referral rates for severely hypoxemic children increased significantly with oximetry use, even in the absence of other danger signs.
Conclusions:
- Implementation of pulse oximetry substantially increased referrals for Malawian children with severe hypoxemic pneumonia.
- Retrospective application of 2014 WHO guidelines missed a significant proportion of severely hypoxemic children identifiable only by oximetry.
- Pulse oximetry is a valuable tool for improving pneumonia case management in resource-limited settings.
Objective:
To investigate implementation of outpatient pulse oximetry among children with pneumonia, in Malawi.
Methods:
In 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.
Findings:
Of 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.
Conclusion:
Implementation 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.
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