Opportunities and barriers in paediatric pulse oximetry for pneumonia in low-resource clinical settings: a qualitative evaluation from Malawi and Bangladesh

Abstract

Objective: To gain an understanding of what challenges pulse oximetry for paediatric pneumonia management poses, how it has changed service provision and what would improve this device for use across paediatric clinical settings in low-income countries.

Design: Focus group discussions (FGDs), with purposive sampling and thematic analysis using a framework approach.

Setting: Community, front-line outpatient, and hospital outpatient and inpatient settings in Malawi and Bangladesh, which provide paediatric pneumonia care.

Participants: Healthcare providers (HCPs) from Malawi and Bangladesh who had received training in pulse oximetry and had been using oximeters in routine paediatric care, including community healthcare workers, non-physician clinicians or medical assistants, and hospital-based nurses and doctors.

Results: We conducted six FGDs, with 23 participants from Bangladesh and 26 from Malawi. We identified five emergent themes: trust, value, user-related experience, sustainability and design. HCPs discussed the confidence gained through the use of oximeters, resulting in improved trust from caregivers and valuing the device, although there were conflicts between the weight given to clinical judgement versus oximeter results. HCPs reported the ease of using oximeters, but identified movement and physically smaller children as measurement challenges. Challenges in sustainability related to battery durability and replacement parts, however many HCPs had used the same device longer than 4 years, demonstrating robustness within these settings. Desirable features included back-up power banks and integrated respiratory rate and thermometer capability.

Conclusions: Pulse oximetry was generally deemed valuable by HCPs for use as a spot-check device in a range of paediatric low-income clinical settings. Areas highlighted as challenges by HCPs, and therefore opportunities for redesign, included battery charging and durability, probe fit and sensitivity in paediatric populations.

Trial registration number: NCT02941237.

Keywords: Pulse oximeter; South Asia; children; oxygen saturation; pneumonia; sub-Saharan Africa.

Figure 1

Pulse oximeters and probes used by healthcare providers in routine clinical care. (A) Lifebox oximeter and adult universal clip probe used in Malawi (accessed on 1 July 2017 from www.lifebox.org). (B) Masimo Rad5 oximeter and LNCS Y-I Multisite wrap probe used in Bangladesh (accessed on 1 July 2017 from www.pacificmedicalsupply.com).