Multicenter study of hypoxemia prevalence and quality of oxygen treatment for hospitalized Malawian children

Abstract

Background Although hypoxemic children have high mortality, little is known about hypoxemia prevalence and oxygen administration in African hospitals. We aimed to determine the hypoxemia prevalence and quality of oxygen treatment by local clinicians for hospitalized Malawian children. Methods The study was conducted in five Malawian hospitals during January–April 2011. We prospectively measured the peripheral oxygen saturation (SpO2) using pulse oximetry for all children <15 years old and also determined clinical eligibility for oxygen treatment using WHO criteria for children <5 years old. We determined oxygen treatment quality by Malawian clinicians by comparing their use of WHO criteria for patients <5 years old using two standards: hypoxemia (SpO2 <90%) and the use of WHO criteria by study staff. Results Forty of 761 (5.3%) hospitalized children <15 years old had SpO2 <90%. No hospital used pulse oximetry routinely, and only 9 of 40 (22.5%) patients <15 years old with SpO2 <90% were treated with oxygen by hospital staff. Study personnel using WHO criteria for children <5 years old achieved a higher sensitivity (40.0%) and lower specificity (82.7%) than Malawian clinicians (sensitivity 25.7%, specificity 94.1%). Conclusion Although hypoxemia is common, the absence of routine pulse oximetry results in most hospitalized, hypoxemic Malawian children not receiving available oxygen treatment.

Pulse oximetry for children with pneumonia treated as outpatients in rural Malawi

“…Among children with pneumonia, hypoxaemia is common, predicts mortality and is a marker of severe illness 1 – 3 . Pulse oximetry – hereafter called oximetry – is the standard tool for non-invasively measuring peripheral arterial haemoglobin oxygen saturation.…”

“…Pulse oximetry – hereafter called oximetry – is the standard tool for non-invasively measuring peripheral arterial haemoglobin oxygen saturation. In low-income countries, however, access to oximetry has lagged behind access to life-saving oxygen treatment 3 – 7 …”

“…Oximetry requires negligible infrastructure, is portable, non-invasive and user-friendly and offers a more accurate and objective way to identify hypoxaemia in children than clinical signs alone 3 , 8 , 9 . Among practitioners and caregivers faced with decisions on the care of a child with severe pneumonia, the results of oximetry may be more persuasive than a clinical assessment alone 10 …”

Fear of oxygen therapy for children in Malawi

“…Understanding of oxygen may be improved by specific training for healthcare staff providing oxygen9 12 and through public health education campaigns.…”

“…A recent study of 761 children in Malawi found that 5.3% were hypoxaemic at admission. In the under-5 age group, 18.6% were eligible for oxygen according to WHO criteria 9. Access to oxygen for acutely ill patients in Malawi is often limited due to practical issues such as lack of supplies, outdated or poorly maintained equipment and unreliable electricity 10–12.…”