Objective
This secondary analysis of data of a randomized controlled trial (RCT) retrospectively investigated the performance of pulse oximetry in identifying children with severe illnesses, with and without respiratory signs/symptoms, in a cohort of children followed for morbid episodes in an intervention trial assessing the efficacy of Intermittent Preventive Treatment for malaria in infants (IPTi) in Papua New Guinea (PNG) from June 2006 to May 2010.
Setting
The IPTi study was conducted in a paediatric population visiting two health centres on the north coast of PNG in the Mugil area of the Sumkar District.
Participants
A total of 669 children visited the clinic and a total of 1921 illness episodes were recorded. Inclusion criteria were: age between 3 and 27 months, full clinical record (signs/symptoms) and pulse oximetry used systematically to assess sick children at all visits. Children were excluded if they visited the clinic in the previous 14 days.
Outcomes
The outcome measures were severe illness, severe pneumonia, pneumonia, defined by the Integrated Management of Childhood Illness (IMCI) definitions, and hospitalization.
Results
Out of 1921 illness episodes, 1663 fulfilled the inclusion criteria. A total of 139 severe illnesses were identified, of which 93 were severe pneumonia. The ROC curves of pulse oximetry (continuous variable) showed an AUC of 0.63, 0.68 and 0.65 for prediction of severe illness, severe pneumonia and hospitalization, respectively. Pulse oximetry allowed better discrimination between severe and non-severe illness, severe and non-severe pneumonia, admitted and non-admitted patients, in children ≤12-months of age relative to older patients. For the threshold of peripheral arterial oxygen saturation ≤ 94% measured by pulse oximetry (SpO
2
), unadjusted odds ratios for severe illness, severe pneumonia and hospitalization were 6.1 (95% Confidence Interval (CI) 3.9–9.8), 8.5 (4.9–14.6) and 5.9 (3.4–10.3), respectively.
Conclusion
Pulse oximetry was helpful in identifying children with severe illness in outpatient facilities in PNG. A SpO
2
of 94% seems the most discriminative threshold. Considering its affordability and ease of use, pulse oximetry could be a valuable additional tool assisting the decision to admit for treatment.
Sur le causse Méjan, Julien Blanc s'est attaché à écouter les éleveurs et à rendre compte de leurs savoirs sur la conduite pastorale de leurs troupeaux. Ce sont là des savoirs hybrides, savoirs transmis ou bien provenant de l'expérience personnelle d'observation du comportement alimentaire de leurs animaux, mais aussi savoirs acquis soit auprès des techniciens du développement agricole ou au cours de leur cursus de formation. Le résultat est exemplaire et nous montre la richesse des savoirs de ces éleveurs qui savent bien prendre en compte les interactions de leurs animaux avec le milieu dans lequel ils trouvent leurs ressources. Toutefois, l'hybridation est telle que les discours techniques comme ceux des éleveurs semblent dénier toute valeur fourragère aux ressources issues des plantes autres que les herbacées ? pourtant bien connues des brebis ! Voilà de quoi justifier des recherches à venir sur la diversité et la complexité des systèmes de connaissance sur lesquels repose la durabilité de ces systèmes d'élevage.
La RédactionMots-clés : éleveurs ovins ; causse Méjan ; pâturages ; savoirs écologiques ; savoirs relationnels ; Résumé -Nous montrons ici comment les connaissances et les représentations qu'ont des éleveurs du causse Méjan de leurs pâturages se construisent dans les rapports étroits et « situés » qu'ils entretiennent avec leurs animaux et le milieu naturel. Les éleveurs « apprennent le milieu » en grande partie à travers l'observation des comportements au pâturage de leurs animaux et considèrent leurs « parcours » à la fois en tant qu'espace de ressources et espace de vie pour ces derniers. L'engagement affectif et corporel avec les processus vivants, qui opèrent à travers un quotidien partagé avec les animaux et les milieux écologiques, constitue un aspect essentiel dans la construction de savoirs et de savoir-faire en matière d'élevage. Nous soutenons que ces aspects doivent être mieux pris en compte afin d'améliorer la qualité du dialogue entre scientifiques, encadrement agricole et éleveurs.
Keywords:sheep farmers; causse Méjan; France; rangelands; ecological knowledge; relational knowledge Abstract -Relational knowledge and commitment with the living environment: the forgotten dimensions of sheep farming practice. Our paper shows how the representations and knowledge French sheep farmers have of their rangelands are embedded in the relations they build with their animals and the natural environment. These sheep farmers, who work and live in the causse Méjan, a low mountain area in southern France, describe their grazinglands not only as pools of feeding resources, but also as a set of more or less adequate ecological conditions for their animals' wellbeing. The perception they have of the rangeland heterogeneity involves a systemic and dynamic perspective that takes into account both these dimensions, and insists upon the importance of the seasonal changes which occur along the year in the natural environment. They learn the "milieu" to a great extent from observing their animals' feeding behav...
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