The prevalence of hypoxaemia among ill children in developing countries: a systematic review

Subhi, Rami; Adamson, Matt; Campbell, Harry; Weber, Martin; Smith, Katherine R.; Duke, Trevor

doi:10.1016/s1473-3099(09)70071-4

Cited by 180 publications

(206 citation statements)

References 49 publications

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“…Currently, identification of these IMCI symptoms remains inconsistent and unreliable among community health-care workers or carers without clinical training 7 . Therefore, improved prognostic and diagnostic tools for case-management are necessary to substantially reduce pneumonia-associated morbidity and mortality.Hypoxaemia and malnutrition are strong predictors of mortality in children who are hospitalized for pneumonia 8,9 . This has led to increasing support for the use of oxygen therapy and monitoring oxygen saturation in the management of severe cases.…”

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confidence: 99%

“…Hypoxaemia and malnutrition are strong predictors of mortality in children who are hospitalized for pneumonia 8,9 . This has led to increasing support for the use of oxygen therapy and monitoring oxygen saturation in the management of severe cases.…”

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confidence: 99%

“…It is estimated that 15% of children who are hospitalized for pneumonia have hypoxaemia (oxygen saturation, or SpO2, of <90% (ref. 10) and that around 1.5 million children with severe pneumonia require oxygen treatment each year 11 . The use of pulse-oximetry devices (used to measure the oxygen level in the blood) in community health-care settings has been proposed as a method to identify hypoxic children at risk of treatment failure.…”

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Evaluating the impact of pulse oximetry on childhood pneumonia mortality in resource-poor settings

Floyd

Burgess

et al. 2015

Nature

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D espite interventions being available, it is estimated that pneumonia is responsible for 15% of childhood deaths worldwide 1 . Reductions in annual mortality remain modest, with nearly 950,000 under-5 year olds dying of pneumonia in 2013 (ref. 2). Despite the unprecedented rate of Haemophilus influenzae type B (Hib) and pneumococcal vaccine (PCV) introduction, achieving high levels of coverage in developing countries is still challenging 3 . Therefore, in regions where vaccine introduction and scale-up lags behind other countries, improved access to diagnosis and treatment is crucial. This includes interventions at multiple points in the continuum of care -improving care-seeking practices, increasing the availability of suitable diagnostics, and guiding both formal and informal care providers in appropriate disease management. Unfortunately, current treatment coverage remains low, and, more importantly, most childhood pneumonia deaths result from a lack of, or delay in, accurate diagnosis 4 .A crucial component of improving pneumonia outcomes is the early identification of patients at risk of treatment failure and the timely provision of supportive care. However, in the absence of appropriate prognostic tools at the frontline, currently recommended World Health Organization (WHO) guidelines for integrated management of childhood illness (IMCI) often lead to an overuse of antibiotics and the under-referral of patients with severe pneumonia who require hospital care 5 . The most recent 2015 technical update of IMCI guidelines defines non-severe pneumonia as the presence of fast breathing or chest in-drawing or both, which is treatable with oral antibiotics.Severe pneumonia is defined as cough or difficulty breathing in the presence of danger signs, and requires referral to a hospital or health facility for injectable antibiotics or other supportive care such as oxygen therapy 6 . Currently, identification of these IMCI symptoms remains inconsistent and unreliable among community health-care workers or carers without clinical training 7 . Therefore, improved prognostic and diagnostic tools for case-management are necessary to substantially reduce pneumonia-associated morbidity and mortality.Hypoxaemia and malnutrition are strong predictors of mortality in children who are hospitalized for pneumonia 8,9 . This has led to increasing support for the use of oxygen therapy and monitoring oxygen saturation in the management of severe cases. It is estimated that 15% of children who are hospitalized for pneumonia have hypoxaemia (oxygen saturation, or SpO2, of <90% (ref. 10) and that around 1.5 million children with severe pneumonia require oxygen treatment each year 11 . The use of pulse-oximetry devices (used to measure the oxygen level in the blood) in community health-care settings has been proposed as a method to identify hypoxic children at risk of treatment failure. These devices may be particularly beneficial at the frontline given that they require little training and reduce the reliance on clinical symptoms. The...

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Evaluating the impact of pulse oximetry on childhood pneumonia mortality in resource-poor settings

Floyd

Burgess

et al. 2015

Nature

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“…As shown in table 3, criteria for clinical diagnosis of pneumonia in study subjects were comparable to those in HIC [16,17]; antibiotics selection to target organisms of interest for specific age groups were comparable and appropriate [18][19][20]; however, vancomycin was not prescribed for late-onset pneumonia empirically as recommended in HIC. Median duration of therapy was 7 days contrasted with 10-14 days in HIC [21,22].…”

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Clinical Profile of Hospitalized Community Acquired Childhood Pneumonia in Dhaka, Bangladesh

Choudhury¹

2017

CSMC

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Introduction: The 2 major bacterial causes of childhood pneumonia are Hemophilus influenzae type b (Hib) and Streptococcus pneumonia (SPN). The objective of this study was to describe clinical profile of hospitalized CAP cases in children in a Low Middle Income Country (LMIC) and compare to practices in High Income Countries (HIC). The goal was to justify maternal immunization during pregnancy. Methods:Medical records of patients admitted between March' 2014 and August' 2014 were reviewed. 219 cases were identified with lower respiratory tract diseases, among which 83 were diagnosed as bacterial CAP and enrolled into this study. Intercooled stata" version 8.0 was used for statistical analyses.Result: Mean age for male was 5.9 months and for female was 11.7 months; mean weight for male was 5.8 kilograms and for female was 6.5 kilograms. Eighty-nine percent of this population was under 12 months, 69 percent was under 6 months and 22 percent was under 2 months of age. Infants under 6 months were more likely to be tachypneic (p=0.04) and hypoxic (p=0.05) when compared to infants and children over 6 months of age. Younger infants under 2 months were even more likely to be tachypneic (p= 0.002) but less likely wheezing (p=0.001) when compared to infants over 2 months of age. Infants under 2 months were 14x at higher risk (Odds ratio [OR]) (p=0.002) for tachypnea. Infants under 6 months were 3x at higher risk (OR) for tachypnea (p=0.02) and hypoxia (p=0.03) when compared to infants and children over 6 months of age. Underweight (< 3 rd percentile for age) children were (p=0.01) 2.4 times (OR) more likely to be in respiratory distress than children with normal weight. Conclusion:Prevalence of vaccine preventable CAP is common under 12 months of age. Maternal immunization during pregnancy with SPN and Hib vaccines is deemed to be justifiable and a cost effective strategy for community acquired childhood pneumonia prevention in LMIC.

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“…In a systematic review, the median prevalence of hypoxemia in WHO defined severe and very severe pneumonia was 13% [6]. Hypoxemia is associated with 2-5 fold increase in risk of death [7].…”

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Risk factors for mortality in children hospitalized with pneumonia

Patwari

2012

Indian Pediatr

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The prevalence of hypoxaemia among ill children in developing countries: a systematic review

Cited by 180 publications

References 49 publications

Evaluating the impact of pulse oximetry on childhood pneumonia mortality in resource-poor settings

Evaluating the impact of pulse oximetry on childhood pneumonia mortality in resource-poor settings

Clinical Profile of Hospitalized Community Acquired Childhood Pneumonia in Dhaka, Bangladesh

Risk factors for mortality in children hospitalized with pneumonia

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