Introducing pulse oximetry for outpatient management of childhood pneumonia: An implementation research adopting a district implementation model in selected rural facilities in Bangladesh. (August 2022)

• Record Type: Journal Article
• Authors: Rahman, Ahmed Ehsanur; Ameen, Shafiqul; Hossain, Aniqa Tasnim; Perkins, Janet; Jabeen, Sabrina; Majid, Tamanna; Uddin, AFM Azim; Shaikh, Md. Ziaul Haque; Islam, Muhammad Shariful; Islam, Md. Jahurul; Ashrafee, Sabina; Md. Shah Alam, Husam; Saberin, Ashfia; Ahmed, Sabbir; Banik, Goutom; Kabir, ANM Ehtesham; Ahmed, Anisuddin; Chisti, Mohammod Jobayer; Cunningham, Steve; Dockrell, David H; Nair, Harish; Arifeen, Shams El; Campbell, Harry
• Is Part Of: EClinicalMedicine. Volume 50(2022)
• Publication Date: 2022-08
• Subjects: Pulse oximetry -- IMCI -- Pneumonia -- Feasibility -- Implementation research -- Bangladesh; Medicine -- Research -- Periodicals; Medical policy -- Periodicals; Clinical Medicine; Health Policy; Public Health; Medical policy; Medicine -- Research; Periodical; Electronic journals; Periodicals; 613
• DOI: 10.1016/j.eclinm.2022.101511
• Languages: English
• ISSNs: 2589-5370

Abstract

Summary: Background: Pulse oximetry has potential for identifying hypoxaemic pneumonia and substantially reducing under-five deaths in low- and middle-income countries (LMICs) setting. However, there are few examples of introducing pulse oximetry in resource-constrained paediatric outpatient settings, such as Integrated Management of Childhood Illness (IMCI) services. Methods: The National IMCI-programme of Bangladesh designed and developed a district implementation model for introducing pulse oximetry in routine IMCI services through stakeholder engagement and demonstrated the model in Kushtia district adopting a health system strengthening approach. Between December 2020 and June 2021, two rounds of assessment were conducted based on WHO's implementation research framework and outcome variables, involving 22 IMCI service-providers and 1680 children presenting with cough/difficulty-in-breathing in 12 health facilities. The data collection procedures included structured-observations, re-assessments, interviews, and data-extraction by trained study personnel. Findings: We observed that IMCI service-providers conducted pulse oximetry assessments on all eligible children in routine outpatient settings, of which 99% of assessments were successful; 85% (95% CI 83, 87) in one attempt, and 69% (95% CI 67, 71) within one minute. The adherence to standard operating procedure related to pulse oximetry was 92% (95% CI 91, 93), and agreement regarding identifying hypoxaemia was 97% (95% CI 96, 98). The median performance-time was 36 seconds (IQR 20, 75), which was longer among younger children (2-11 months: 44s, IQR 22, 78; 12-59 months: 30s, IQR 18, 53, p < 0.01) and among those classified as pneumonia/severe-pneumonia than as no-pneumonia (41s, IQR 22, 70; 32s, IQR 20, 62, p < 0.01). We observed improvements in almost all indicators in round-2. IMCI service-providers and caregivers showed positive attitudes towards using this novel technology for assessing their children. Interpretation: This implementation research study suggested the adoption, feasibility, fidelity, appropriateness, acceptability, and sustainability of pulse oximetry introduction in routine IMCI services in resource-poor settings. The learning may inform the evidence-based scale-up of pulse oximetry linked with an oxygen delivery system in Bangladesh and other LMICs. Funding: This research was funded by the UK National Institute for Health Research (NIHR) (Global Health Research Unit on Respiratory Health (RESPIRE); 16/136/109) using UK aid from the UK Government to support global health research.