Identification of severe cases with routine Pulse Oximetry use into the Integrated Management of Childhood Illness at Primary Health Centres level in West Africa: A cross-sectional study within the AIRE project in Burkina Faso, Guinea, Mali and Niger, 2021 - 2022
Authors: Boris Hedible Gildas , Guaniyi Sawadogo Abdoul , Zineb Zair , Désiré Kargougou G , Honorat Agbeci , Bertrand Méda , Lucie Peters-Bokol , Kolié Jacques S , Sarah Louart , Solange Ouédraogo Yugbaré , Aziz Diakite Abdoul , Sory Diallo Ibrahima , Hannatou Abarry Souleymane , Désiré Neboua , Marine Vignon , Sandrine Busière , Franck Lamontagne , Valéry Ridde , Valériane Leroy ,   AIRE Research Study Group
Published: October 2024

Background

The Integrated Management of Childhood Illness (IMCI) guidelines is a symptom-based algorithm guiding healthcare workers in resource-limited countries to identify critically ill children under-5 in primary healthcare centre (PHC). Hypoxemia, a life-threatening event, is often clinically underdiagnosed. The AIRE project has implemented the routine use of Pulse Oximeter (PO) in IMCI consultations to improve the diagnosis of severe hypoxemia (SpO2< 90%) and the management of severe cases at PHC level in Burkina Faso, Guinea, Mali and Niger. We measured the prevalence of IMCI+PO severe cases, and their associated social and structural factors among IMCI outpatients.

Methods

In 16 AIRE research PHC (4/country), all the children under-5 attending IMCI consultations, except those aged 2-59 months classified as simple case without cough or breathing difficulties, were eligible for PO use and enrolled in a cross-sectional study with parental consent. Severe IMCI+PO cases were defined as IMCI severe cases or those with severe hypoxemia.

Results

From June 2021 to June 2022, 968 neonates (0-59 days) and 14,868 children (2-59 months) were included. Prevalence of severe IMCI+PO cases was heterogeneous between countries: 5.0% in Burkina Faso, 6.1% in Niger, 18.9% in Mali and 44.6% in Guinea. Among neonates, 21.9% (95%CI: 19.3-24.6) were classified as IMCI+PO severe cases versus 12.0% (95%CI: 11.4-12.5) in older children. Severe hypoxemia was identified in 3.3% of neonates versus 0.8% in older children (p<0.001). The adjusted social and structural factors associated with disease severity commons to all four countries were: age <2 months or >2 years, IMCI-consultation delay >2 days, home to PHC travel time >30 minutes.

Conclusion

Despite between-country heterogeneity, the prevalence of seriously ill children under-5 including severe hypoxemia was high, particularly in neonates, and those without accessibility to PHC. Improving earlier access to primary healthcare and management of severe cases remains needed in West Africa.

What is already known on this topic

A few studies have reported the prevalence and correlates of severe illnesses with the IMCI guidelines using routine integration of pulse oximetry (PO) among all children under-5 at primary healthcare Centres (PHC) level in low-middle income countries (LMICs), and to our knowledge none has been done in West Africa.

What this study adds

This study:

reports a high prevalence of severe cases using IMCI including PO among outpatient children under-5 attending IMCI consultation, and heterogeneous between countries (Burkina Faso, Guinea, Mali, Niger)

shows that overall prevalence of severe cases was significantly twice higher in neonates (21.9%) than in children aged 2-59 months (12.0%). Similarly, the prevalence of severe hypoxemia was higher in neonates (3.3%) than in older children (0.8%).

highlights the accessibility challenges to primary healthcare for children with serious illnesses, and inadequate decision about their specific care management.

How this study might affect research, practice or policy

This study provides original and reliable estimates for policy-makers to invest in earlier access to primary healthcare and better referral decision of severe IMCI cases to improve child health in West Africa.

These indicators will be useful in assessing the added-value of PO integration into IMCI in LMICs and support scaling-up of PO into both national and international IMCI guidelines.