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 Glob Health 2025;

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Résumé

Background The Amélioration de l'Identification
des détresses Respiratoires de l'Enfant (AIRE) project
introduced the routine use of pulse oximetry (PO) into
Integrated Management of Childhood Illness (IMCI)
consultations within primary health centres (PHCs) in
Burkina Faso, Guinea, Mali and Niger. We analysed how
severe cases were managed and 14-day
mortality by
hypoxaemia severity.
Methods All children aged under 5 years attending IMCI
consultations integrating PO use at 16 research PHCs and
classified as severe cases (severe IMCI cases or severe
hypoxemia: SpO2 <90%) were eligible for referral and
enrolled in a 14-day
prospective cohort with parental
consent. Referral decisions, admissions, access to oxygen
therapy and Kaplan-Meier
probability of death were
compared by hypoxaemia severity. An adjusted mixed-effects
Cox regression model with a random effect for PHC estimated
adjusted ORs (aORs) and 95% CIs of mortality by day 14.
Results From July 2021 to July 2022, 1998 severe cases
were enrolled, including 10.6% aged <2 months; 7.1% had
severe hypoxaemia, and 10.5% had moderate hypoxaemia
(90%≤oxygen saturation≤93%). By day 14, 625 (31.3%)
were referred, 463 (23.2%) hospitalised, and 95 children
(4.8%) had died. Referral decisions, hospitalisations and
oxygen therapy rates were significantly higher for severe
hypoxaemic cases (83.8%, 82.3% and 34.5%, respectively)
than for moderate hypoxaemic cases (32.7%, 26.5% and
7.1%, respectively) and cases without hypoxaemia (26.3%,
17.5% and 1.4%, respectively). Similarly, day 14 mortality
rates were 26.1%, 7.5% and 2.3%, respectively. The aORs
for mortality were severe hypoxaemia (9.34, 95% CI 5.08
to 17.16), moderate hypoxaemia (2.32, 95% CI 1.16 to
4.64), age <2 months (3.68, 95% CI 1.67 to 8.13), severe
malaria (2.02, 95% CI 1.03 to 3.97) and living in Niger
(4.06, 95% CI 1.41 to 11.67).Conclusion Regardless of severity, hypoxaemia was
common among outpatients screened using PO and
meeting criteria for severity. Its presence was associated
with mortality risk. Incorporating PO within IMCI prompted
care management of severely hypoxaemic cases, but
hospital referrals and access to oxygen remain sub-optimal
and are crucial levers for reducing under-five
mortality.

Mots-clés

hospital referrals and access to oxygen remain sub-optimal and are crucial levers for reducing under-five mortality