Prevalence and factors associated with severe illness in West African children under 5 years of age detected with routine pulse oximetry in primary care

---

Résumé

Background The 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.
Methods In 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.
Results From 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.
Conclusion The 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.

Mots-clés

These indicators will be useful for assessing the added value of integrating PO into IMCI consultations in LMICs, and for supporting the scaling up of routine PO use in both national and international IMCI guidelines.