ArticleBMJ global health2025
Prevalence and factors associated with severe illness in West African children under 5 years of age detected with routine pulse oximetry in primary care.
Article in BMJ global health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Beyond pulse oximetry: lessons from the AIRE project on translating innovation into improved child survival.BMJ global health · 2026Article
- Household costs of care in children under five attending primary care in Burkina Faso, Guinea, Mali and Niger: a cross-sectional study nested in the AIRE project.BMJ global health · 2025Article
- Pulse oximetry to optimise first-line care and save children's lives: evidence from the AIRE project in West Africa.BMJ global health · 2025Article
- Care management and determinants of day 14 mortality in severely ill children aged under 5 years subsequent to hypoxaemia diagnosed using routine pulse oximetry in primary care: evidence from the AIRE project.BMJ global health · 2025Article
- Care pathways for critically ill children aged 0-5 years arriving at district hospitals in Burkina Faso, Guinea, Mali, and Niger (2022): a cross-sectional study.BMC public health · 2025Article
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Abstract
backgroundThe Integrated Management of Childhood Illness (IMCI) guidelines are symptom-based algorithms used to identify critically ill children under five in primary health centres (PHC) in resource-limited countries. Hypoxaemia, a life-threatening event, is clinically underdiagnosed. The Amélioration de l'Identification des détresses Respiratoires de l'Enfant/Improving Identification of Respiratory Distress in Children (AIRE) project implemented the routine use of pulse oximetry (PO) within IMCI consultations to improve the diagnosis and management of severe hypoxaemia (pulse blood oxygen saturation <90%) at PHC level in Burkina Faso, Guinea, Mali and Niger. In this context, we measured the prevalence of severe cases and their associated social and structural factors among outpatients.
methodsIn 16 AIRE research PHC (4/country), all the children under five attending IMCI consultations, except those aged 2-59 months classified as simple case without cough or breathing difficulties, were eligible for the use of PO and enrolled in a cross-sectional study with parental consent. Severe IMCI+PO cases were IMCI severe cases or those with severe hypoxaemia.
resultsFrom June 2021 to June 2022, 968 neonates (0-59 days) and 14 868 children (2-59 months) were included. Prevalence of severe IMCI+PO cases was heterogeneous between countries: 5.0% in Burkina Faso, 6.1% in Niger, 18.9% in Mali and 44.6% in Guinea. Among neonates, 21.9% (95% CI 19.3 to 24.6) were severe cases versus 12.0% (95% CI 11.4 to 12.5) in older children, of which 3.3% versus 0.8%, respectively (p<0.001), had severe hypoxaemia. The adjusted social and structural factors associated with disease severity common to all four countries were as follows: age <2 months or >2 years, IMCI consultation delay >2 days, home to PHC travel time >30 min.
conclusionThe prevalence of seriously ill children under five, including severe hypoxaemia, was high in PHC, particularly in neonates. The high between-country heterogeneity may be explained by differences in case definitions (Guinea) and structural factors (accessibility). Improving early access to primary care could be an actionable lever to improve the health of West African children.
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