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Challenges and needs before implementing routine pulse oximetry within primary care for sick children in West Africa:
Kessièdé Gildas Boris Hedible1, Gildas Mahena Anago2, Severin Lenaud3
1Toulouse University, Inserm, Centre for Epidemiology and Research in Population Health (CERPOP), Toulouse, France.
Insights
The Améliorer l'Identification des détresses Respiratoires chez l'Enfant (AIRE) project found pulse oximetry (PO) lacking in primary health centers, hindering severe hypoxemia diagnosis. This highlights critical gaps in childhood illness management in sub-Saharan Africa.
Area of Science:
- Pediatric critical care
- Global health initiatives
- Resource-limited healthcare systems
Background:
- Integrated Management of Childhood Illness (IMCI) guidelines are used in primary health centers (PHCs) in resource-limited settings.
- Current IMCI algorithms under-diagnose severe hypoxemia, contributing to under-five mortality in sub-Saharan Africa.
- The AIRE project aimed to improve hypoxemia diagnosis by integrating pulse oximetry (PO) into IMCI consultations.
Purpose of the Study:
- To describe the intervention sites and assess their capacity to provide IMCI care before the AIRE project.
- To evaluate the baseline availability and utilization of pulse oximetry in PHCs and district hospitals (DHs).
- To identify challenges in managing severe childhood illnesses, including referral systems and oxygen access.
Main Methods:
- A cross-sectional quantitative survey was conducted in AIRE PHCs and their associated DHs.
- The survey took place from March to July 2020, encompassing 215 PHCs and 8 DHs.
- Data collected included IMCI training status, availability of pulse oximetry and ambulances, referral rates, and costs associated with care.
Main Results:
- Pulse oximetry was available in only 1% of PHCs and 50% of DHs at baseline.
- Only 16% of PHCs had functional ambulances for referrals, and oxygen availability was limited in one DH.
- Consultation fees varied, and out-of-pocket expenses for hospitalization were significant for parents.
Conclusions:
- The study revealed weak adoption of IMCI guidelines and a significant lack of pulse oximetry at the PHC level.
- Difficulties in managing severe cases, referrals, and oxygen access were prevalent.
- Findings informed the selection of AIRE research sites and guided PHC improvements, including IMCI training.
Background:
The Integrated Management of Childhood Illness (IMCI) guidelines are implemented within primary health centres (PHCs) in resource-limited settings. These symptom-based algorithms under-diagnose severe hypoxemia, which contributes to the under-five'mortality in sub-Saharan Africa. To improve the diagnosis and management of severe hypoxaemia, the Améliorer l'Identification des détresses Respiratoires chez l'Enfant (AIRE) project implemented the routine use of pulse oximetry (PO) within IMCI consultations in Burkina Faso, Guinea, Mali and Niger. We described the intervention sites and measured their capacity to offer IMCI care prior to project implementation.
Methods:
A cross-sectional quantitative survey was conducted in all the AIRE PHCs and their district hospitals (DHs) from March to July 2020.
Results:
Overall, 215 PHCs and 8 DHs were surveyed. Almost all the PHCs were public structures, mainly managed by nurses. At least one healthcare worker was IMCI trained in >99% of PHCs. At baseline, PO was available in only 2/215 (1%) PHCs and 4/8 (50%) DH. Median referral rate was estimated to 1.5% per PHC; 35/215 (16%) PHCs had functional ambulances for managing referrals to DHs, including two with mobile oxygen. IMCI consultations were free of fees in Burkina Faso and Niger, but charged for in Guinea and Mali (from US$0.5 to US$1). All the DHs had capacities to provide specialised paediatric care, although the use of PO was not systematic. Oxygen was available at all DHs except one. Parents of children requiring hospitalisation had to pay out of pocket costs ranging from US$1.7 to US$8.4 per day.
Conclusions:
This survey highlights the weak adoption of IMCI guidelines in these settings, the absence of PO's at PHC level and their low use at hospital level, as well as difficulties in managing severe cases, referral to hospital and accessing oxygen. It has guided the choice of the AIRE research PHCs and the upgrading of PHCs including IMCI training.
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