Point‐of‐Care Pulse Oximetry for Children in Low‐Resource Settings

King, Carina; Graham, Hamish; McCollum, Eric D.

doi:10.1002/9781119282686.ch21

Cited by 4 publications

(3 citation statements)

References 42 publications

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“…The same considerations regarding care seeking at health facilities mentioned above apply to pulse oximetry and oxygen as an intervention to reduce pneumonia mortality. Additionally, referral mechanisms and referral adherence are highly important to reach the full potential of pulse oximetry and oxygen, as this intervention aims to filter out severely ill children at lower health care levels and treat them accordingly in higher level referral hospitals [61,62]. Following the experiences of the coronavirus disease 2019 (COVID-19) pandemic, increasing oxygen availability in settings where oxygen treatment is rarely used should be linked to capacity building [63]; the lessons learnt during the pandemic could be transferred to severe childhood pneumonia.…”

Section: Discussionmentioning

confidence: 99%

Predicting the potential impact of scaling up four pneumonia interventions on under-five pneumonia mortality: A prospective Lives Saved Tool (LiST) analysis for Bangladesh, Chad, and Ethiopia

Pfurtscheller,

Lam,

Shah

et al. 2024

J Glob Health

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Background Pneumonia remains the leading cause of mortality in under-five children outside the neonatal period. Progress has slowed down in the last decade, necessitating increased efforts to scale up effective pneumonia interventions. Methods We used the Lives Saved Tool (LiST), a modelling software for child mortality in low- and middle-income settings, to prospectively analyse the potential impact of upscaling pneumonia interventions in Bangladesh, Chad, and Ethiopia from 2023 to 2030. We included Haemophilus influenzae type B (Hib) vaccination, pneumococcal conjugate vaccine (PCV), oral antibiotics, pulse oximetry, and oxygen as pneumonia interventions in our analysis. Outcomes of interest were the number of pneumonia deaths averted, the proportion of deaths averted by intervention, and changes in the under-five mortality rate. Findings We found that 19 775 lives of children under-five could be saved in Bangladesh, 76 470 in Chad, and 97 343 in Ethiopia by scaling intervention coverages to ≥ 90% by 2030. Our estimated reductions in pneumonia deaths among children under five range from 44.61% to 57.91% in the respective countries. Increased coverage of oral antibiotics, pulse oximetry, and oxygen show similar effects in all three countries, averting between 18.80% and 23.65% of expected pneumonia deaths. Scaling-up PCV has a prominent effect, especially in Chad, where it could avert 14.04% of expected pneumonia deaths. Under-five mortality could be reduced by 1.42 per 1000 live births in Bangladesh, 22.52 per 1000 live births in Chad, and 5.48 per 1000 live births in Ethiopia. Conclusions This analysis shows the high impact of upscaling pneumonia interventions. The lack of data regarding coverage indicators is a barrier for further research, policy, and implementation, all requiring increased attention.

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Section: Discussionmentioning

confidence: 99%

Predicting the potential impact of scaling up four pneumonia interventions on under-five pneumonia mortality: A prospective Lives Saved Tool (LiST) analysis for Bangladesh, Chad, and Ethiopia

Pfurtscheller,

Lam,

Shah

et al. 2024

J Glob Health

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show abstract

“…The pulse oximeter waveform that provides an estimate of the intra-arterial waveform is not displayed on all devices in this study and its observation was not included in the checklist tasks. This can be seen as a limitation because the process of matching results with the waveform to increase accuracy has been discussed as a complicated process [ 40 ]. Including the observation of the waveform in the checklist thus might have resulted in lower task completion rates.…”

Section: Discussionmentioning

confidence: 99%

Usability of pulse oximeters used by community health and primary care workers as screening tools for severe illness in children under five in low resource settings: A cross-sectional study in Cambodia, Ethiopia, South Sudan, and Uganda

Pfurtscheller,

Baker,

Habte

et al. 2023

PLOS Glob Public Health

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Timely recognition and referral of severely ill children is especially critical in low-resource health systems. Pulse-oximeters can improve health outcomes of children by detecting hypoxaemia, a severity indicator of the most common causes of death in children. Cost-effectiveness of pulse-oximeters has been proven in low-income settings. However, evidence on their usability in community health settings is scarce.This study explores the usability of pulse-oximeters for community health and primary care workers in Cambodia, Ethiopia, South Sudan, and Uganda. We collected observational data, through a nine-task checklist, and survey data, using a five-point Likert scale questionnaire, capturing three usability aspects (effectiveness, efficiency, and satisfaction) of single-probe fingertip and multi-probe handheld devices. Effectiveness was determined by checklist completion rates and task completion rates per checklist item. Efficiency was reported as proportion of successful assessments within three attempts. Standardized summated questionnaire scores (min = 0, max = 100) determined health worker’s satisfaction. Influencing factors on effectiveness and satisfaction were explored through hypothesis tests between independent groups (device type, cadre of health worker, country). Checklist completion rate was 78.3% [CI 72.6–83.0]. Choosing probes according to child age showed the lowest task completion rate of 68.7% [CI 60.3%-76.0%]. In 95.6% [CI 92.7%-97.4%] of assessments a reading was obtained within three attempts. The median satisfaction score was 95.6 [IQR = 92.2–99.0]. Significantly higher checklist completion rates were observed with single-probe fingertip devices (p<0.001) and children 12–59 months (p<0.001). We found higher satisfaction scores in South Sudan (p<0.001) and satisfaction varied slightly between devices. From a usability perspective single-probe devices for all age groups should be prioritized for scaled implementation. Further research on easy to use and accurate devices for infants is much needed.

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“…The same considerations regarding care seeking at health facilities mentioned above apply to pulse oximetry and oxygen as an intervention to reduce pneumonia mortality. Additionally, referral mechanisms and referral adherence are highly important to reach the full potential of pulse oximetry and oxygen as this intervention aims to filter out severely ill children at lower health care levels and treat them accordingly in higher level referral hospitals (55,56). Following the experiences of the COVID-19 pandemic increasing oxygen availability in settings where currently oxygen treatment is rarely used should be linked to capacity building (57) and the lessons learnt during the pandemic could be transferred to severe childhood pneumonia.…”

Section: Number Of Pneumonia Deaths and Estimated Lives Savedmentioning

confidence: 99%

Predicting the potential impact of scaling up four pneumonia interventions on under-five pneumonia mortality: A prospective LiST analysis for Bangladesh, Chad, and Ethiopia

Pfurtscheller

Lam

Shah

et al. 2023

Preprint

View full text Add to dashboard Cite

Pneumonia remains the leading cause of mortality in children under five outside the neonatal period. Progress has slowed down in the last decade and increased efforts to scale-up effective pneumonia interventions are needed. We used the Lives Saved Tool (LiST), a modelling software for child mortality in low- and middle-income settings, to prospectively analyse the potential impact of upscaling pneumonia interventions in Bangladesh, Chad, and Ethiopia from 2023-2030. Haemophilus influenzae type B (Hib) vaccination, pneumococcal conjugate vaccine (PCV), oral antibiotics, pulse oximetry and oxygen were included as pneumonia interventions in our analysis. Outcomes were number of pneumonia deaths averted, proportion of deaths averted by intervention, and changes in the under-five mortality rate. Our results show that 19,775 lives of children under five could be saved in Bangladesh, 76,470 in Chad, and 97,343 in Ethiopia by scaling intervention coverages to ≥90% by 2030. Our estimated reductions in pneumonia deaths among children under five range from 44.61% to 57.91% in the respective countries. Increased coverage of oral antibiotics, pulse oximetry, and oxygen show similar effects in all three countries, averting between 18.80% and 23.65% of expected pneumonia deaths. Scaling-up PCV has a prominent effect, especially in Chad where it could avert 14.04% of expected pneumonia deaths. Under-five mortality could be reduced by 1.42/1000, live births in Bangladesh, 22.52/1000, in Chad, and 5.48/1000, in Ethiopia. This analysis shows the high impact of upscaling pneumonia interventions. The lack of data regarding coverage indicators is a barrier for further research, as well as policy and implementation, all requiring increased attention.

show abstract

Point‐of‐Care Pulse Oximetry for Children in Low‐Resource Settings

Cited by 4 publications

References 42 publications

Predicting the potential impact of scaling up four pneumonia interventions on under-five pneumonia mortality: A prospective Lives Saved Tool (LiST) analysis for Bangladesh, Chad, and Ethiopia

Predicting the potential impact of scaling up four pneumonia interventions on under-five pneumonia mortality: A prospective Lives Saved Tool (LiST) analysis for Bangladesh, Chad, and Ethiopia

Usability of pulse oximeters used by community health and primary care workers as screening tools for severe illness in children under five in low resource settings: A cross-sectional study in Cambodia, Ethiopia, South Sudan, and Uganda

Predicting the potential impact of scaling up four pneumonia interventions on under-five pneumonia mortality: A prospective LiST analysis for Bangladesh, Chad, and Ethiopia

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