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Experiences From an Implementation Model of ARI Diagnostic Device in Pneumonia Case Management Among Under-5 Children
Harish Kumar1, Enisha Sarin1, Prasant Saboth1
1IPE Global, New Delhi, India.
Insights
Pulse oximetry is a feasible tool for primary care in India, improving pneumonia diagnosis and treatment for children under 5. Health workers found the device acceptable and easy to use, with no maintenance issues.
Area of Science:
- Pediatrics
- Public Health
- Medical Devices
Background:
- Pneumonia is a leading cause of mortality in children under 5 in India.
- Front-line healthcare workers often lack adequate skills for effective case management.
- Pulse oximetry has demonstrated effectiveness in managing pneumonia.
Purpose of the Study:
- To evaluate the implementation and usability of a multimodal pulse oximeter in Indian Health and Wellness Centers.
- To assess the device's impact on the diagnosis and treatment of pneumonia in young children.
- To determine the acceptability and feasibility of pulse oximetry for front-line healthcare workers.
Main Methods:
- A multimodal pulse oximeter was implemented in 19 Health and Wellness Centers across 7 Indian states.
- Healthcare workers received abridged Integrated Management of Neonatal and Childhood Illness (IMNCI) training.
- Data on case management and device feedback were collected over 15 months.
Main Results:
- Out of 4846 children, 0.1% had severe pneumonia and 23% had pneumonia.
- Correct referrals for severe pneumonia were made in 77.6% of cases; 81% of pneumonia cases received appropriate antibiotics.
- The pulse oximeter was highly acceptable, aiding timely classification and treatment, with no maintenance issues and long battery life.
Conclusions:
- Pulse oximeter implementation in primary care settings is feasible and acceptable to healthcare workers.
- Combining pulse oximetry with IMNCI training offers a viable strategy for equitable pediatric care.
- This approach can significantly improve pneumonia management for under-5 children in resource-limited settings.
Objectives:
To address pneumonia, a major killer of under-5 children in India, a multimodal pulse oximeter was implemented in Health and Wellness Centers. Given the evidence of pulse oximetry in effective pneumonia management and taking into account the inadequate skills of front-line healthcare workers in case management, the device was introduced to help them readily diagnose and treat a child and to examine usability of the device.
Design:
The implementation was integrated with the routine OPD of primary health centers for 15 months after healthcare workers were provided with an abridged IMNCI training. Monthly facility data was collected to examine case management with the diagnostic device. Feedback on usefulness of the device was obtained.
Setting:
Health and Wellness Centers (19) of 7 states were selected in consultation with state National Health Mission based on patient footfall.
Participants:
Under-5 children presenting with ARI symptoms at the OPD.
Results:
Of 4846 children, 0.1% were diagnosed with severe pneumonia and 23% were diagnosed with pneumonia. As per device readings, correct referrals were made of 77.6% of cases of severe pneumonia, and 81% of pneumonia cases were correctly given antibiotics. The Pulse oximeter was highly acceptable among health workers as it helped in timely classification and treatment of pneumonia. It had no maintenance issue and battery was long-lasting.
Conclusion:
Pulse oximeter implementation was doable and acceptable among health workers. Together with IMNCI training, PO in primary care settings is a feasible approach to provide equitable care to under-5 children.
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