Implication of the 2014 World Health Organization Integrated Management of Childhood Illness Pneumonia Guidelines with and without pulse oximetry use in Malawi: A retrospective cohort study

Gates Open Research

article

Shubhada Hooli¹  Charles Makwenda²  Norman Lufesi³  Tim Colbourn⁴  Tisungane Mvalo⁵  Eric D. McCollum⁷  Carina King⁴ 

[1] Department of Pediatrics, Division of Emergency Medicine, Baylor College of Medicine;Parent and Child Health Initiative;Republic of Malawi Ministry of Health;Institute for Global Health, University College London;University of North Carolina Project Malawi;Department of Pediatrics, University of North Carolina School of Medicine;Global Program in Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University;Department of International Health, Johns Hopkins Bloomberg School of Public Health;Department of Global Public Health, Karolinska Institute

关键词: infant;    child;    pneumonia;    child mortality;    oximetry;    Malawi;    Africa;    World Health Organization;   

DOI  :  10.12688/gatesopenres.13963.1

学科分类：电子与电气工程

来源: American Journal Of Pharmtech Research

【 摘 要 】

Background: Under-5 pneumonia mortality remains high in low-income countries. In 2014 the World Health Organization (WHO) advised that children with chest indrawing pneumonia, but without danger signs or peripheral oxygen saturation (SpO2) < 90% be treated in the community, rather than hospitalized. In Malawi there is limited pulse oximetry availability. Methods: Secondary analysis of 13,413 under-5 pneumonia cases in Malawi. Pneumonia associated case fatality ratios (CFR) were calculated by disease severity under the assumptions of the 2005 and 2014 WHO Integrated Management of Childhood Illness (IMCI) guidelines, with and without pulse oximetry. We investigated if pulse oximetry readings were missing not at random (MNAR). Results: The CFR of patients classified as having non-severe pneumonia per the 2014 IMCI guidelines doubled under the assumption that pulse oximetry was not available (1.5% without pulse oximetry vs 0.7% with pulse oximetry, P<0.001). When 2014 IMCI guidelines were applied with pulse oximetry and a SpO2 < 90% as the threshold for referral and/or admission, the number of cases meeting hospitalization criteria decreased by 70.3%. Unrecorded pulse oximetry readings were MNAR with an adjusted odds for mortality of 4.9 (3.8, 6.3), similar to that of a SpO2 < 90%. Although fewer girls were hospitalized, female sex was an independent mortality risk factor. Conclusions: In Malawi, implementation of the 2014 WHO IMCI pneumonia guidelines, without pulse oximetry, will miss high risk cases. Alternatively, implementation of pulse oximetry may result in a large reduction in hospitalization rates without significantly increasing non-severe pneumonia associated CFR if the inability to obtain a pulse oximetry reading is considered a WHO danger sign.

【 授权许可】

CC BY