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. 2024 Dec 30;2(2):e001210.
doi: 10.1136/bmjph-2024-001210. eCollection 2024 Dec.

Pulse oximetry and oxygen services for under-five children with community-acquired pneumonia attending primary and secondary level health facilities in Lagos, Nigeria (INSPIRING-Lagos): a pre-implementation and post implementation study

Tim Colbourn  1 , Adegoke G Falade  2   3 , Hamish R Graham  3   4 , Omotayo Emmanuel Olojede  2 , Ayobami Adebayo Bakare  5   6 , James Beard  7 , Eric D McCollum  8 , Agnese Iuliano  1 , Adamu Isah  9 , Adams Osebi  9 , Ibrahim Seriki  9 , Ibrahim Haruna  9 , Tahlil Ahmed  10 , Samy Ahmar  10 , Paula Valentine  10 , Temitayo Folorunso Olowookere  11 , Obioma C Uchendu  2   5 , Rochelle Ann Burgess  1 , Carina King  1   6 ; INSPIRING Project Consortium
Collaborators, Affiliations

Pulse oximetry and oxygen services for under-five children with community-acquired pneumonia attending primary and secondary level health facilities in Lagos, Nigeria (INSPIRING-Lagos): a pre-implementation and post implementation study

Tim Colbourn et al. BMJ Public Health. .

Abstract

Introduction: Childhood pneumonia is a leading cause of child mortality in Nigeria and poor quality of care is a persistent issue. We aimed to understand whether introducing primary care stabilisation rooms equipped with pulse oximetry and oxygen systems alongside healthcare worker (HCW) training improved the quality of care for children with pneumonia in Lagos State.

Methods: Setting: Ikorodu local government area, Lagos. Population: children aged 0-59 months with clinically diagnosed pneumonia. Intervention: establishment of 'stabilisation rooms' within government (n=7) and private (n=7) primary care facilities, designed for short-term oxygen delivery for hypoxaemic children prior to hospital transfer, alongside HCW training on integrated management of childhood illness (IMCI), pulse oximetry and oxygen therapy. Two secondary facilities with inpatient oxygen systems received training and pulse oximeters. Primary outcome: composite 'correct management' of hypoxaemic pneumonia including oxygen therapy administration, referral and admission to hospital. Analysis: mixed-effects logistic regression comparing baseline (September 2020-August 2021) and implementation (September 2021-November 2022) periods, adjusted for clustering by facility.

Results: We screened 20 158 children, of which 160 children with hypoxaemic pneumonia (SpO2<90%) were recruited. The proportion of hypoxaemic children with 'correct management' remained low and unchanged: 9/98 (9%) with data on referral and admission at baseline, and 6/52 (12%) during implementation (mixed effects logistic regression adjusted OR (aOR): 1.17 (95% CI 0.30, 4.52), p=0.822). Oxygen use for children with hypoxaemia increased from baseline 10/105 (10%) to 13/55 (24%) during implementation (aOR 3.01 (95% CI 1.05, 8.65), p=0.040). But subsequent referral and hospital admission remained low. Low pulse oximetry use by health workers in children with clinical pneumonia persisted through baseline (73/798, 9%) and implementation (122/1125, 11%).

Conclusion: Equipping primary care stabilisation rooms with pulse oximetry and oxygen increased oxygen use for children with hypoxaemia but did not improve referral or hospital admission rates. Persistent failure to assess children with pulse oximetry likely contributed to under-recognition of hypoxaemia and therefore failure to initiate correct care. Further work to improve initial triage, assessment and treatment of children with severe pneumonia in Lagos is urgently needed.

Trial registration number: ACTRN12621001071819.

Keywords: Endemic Diseases; Epidemiology; Public Health.

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Conflict of interest statement

The project was funded through the GSK-Save the Children Partnership, and employees of both organisations contributed to co-design. The research team had responsibility for evaluation and data analysis, and all project partners participated in interpretation and content of published findings. AGF declares grant support (WHO, Save the Children UK), travel support (Karolinska Instituet, WHO), and leadership roles (Oxygen for Life Initiative board member, Lancet Global Health Oxygen Commission Commissioner) related to pulse oximetry and oxygen. AAB declares grant support (WHO, Save the Children UK). EDM declares grant support (National Institutes of Health (USA), The Bill and Melinda Gates Foundation, US Centers for Disease Control, USAID, Thrasher Research Fund, Moderna) and leadership roles (WHO Guideline Development Group for Childhood Diarrhea and Pneumonia member, The Union Child Pneumonia Working Group co-chair, Lifebox Foundation advisor, Lancet Global Health Oxygen Commission advisor) all related to child lung health, child pneumonia, pulse oximetry, and oxygen. AIsah, AO, SA, PV were employed by Save the Children and oversaw the INSPIRING project activities. TFO, MM were employed by GSK, the project funder, and TFO is a GSK shareholder. TC declares grant support (Save the Children UK and Wellcome Trust), consulting fees (United Nations Economic Commission for Africa, and The Global Fund), and unpaid work as the chair of a Trial Steering Committee for a trial in Nepal on adolescent health. CK declares grant support (Save the Children UK, Swedish Research Council, NIH, EU, FCDO), and leadership roles (Lifebox Foundation advisor, Lancet Global Health Oxygen Commission chair) related to pulse oximetry and oxygen. HRG declares grant support (NHMRC, RCH Foundation, Swedish Research Council, Gates Foundation) and leadership roles (Oxygen for Life Initiative board member, Lifebox Foundation advisor, Lancet Global Health Oxygen Commission chair) related to pulse oximetry and oxygen. RB, OEO and AIuliano declare no competing interests.

Figures

Figure 1
Figure 1. Map of study clinics. LGA, local government area; PHC, primary health centre.
Figure 2
Figure 2. Participant recruitment and inclusion, Integrated Sustainable Reduction in Childhood Pneumonia and Infectious Diseases in Nigeria-Lagos study.
Figure 3
Figure 3. Clinical data collector identified hypoxaemic cases.
See this image and copyright information in PMC

Comment in

References

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