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Abstract
Objective To assess whether pulse oximetry improves health workers’ performance in diagnosing severe childhood pneumonia at health centres in Southern Ethiopia.
Design Parallel cluster-randomised trial.
Setting Government primary health centres.
Participants Twenty-four health centres that treat at least one pneumonia case per day in Southern Ethiopia. Children aged between 2 months and 59 months who present at health facilities with cough or difficulty breathing were recruited in the study from September 2018 to April 2019.
Intervention arm Use of the Integrated Management of Childhood Illness (IMCI) algorithm and pulse oximeter.
Control arm Use of the IMCI algorithm only.
Primary and secondary outcome measures The primary outcome was the proportion of children diagnosed with severe pneumonia. Secondary outcomes included referred cases of severe pneumonia and treatment failure on day 14 after enrolment.
Result Twenty-four health centres were randomised into intervention (928 children) and control arms (876 children). The proportion of children with severe pneumonia was 15.9% (148 of 928 children) in the intervention arm and 3.9% (34 of 876 children) in the control arm. After adjusting for differences in baseline variables children in the intervention arm were more likely to be diagnosed as severe pneumonia cases as compared with those in the control arm (adjusted OR: 5.4, 95% CI 2.0 to 14.3, p=0.001).
Conclusion The combined use of IMCI and pulse oximetry in health centres increased the number of diagnosed severe childhood pneumonia.
Trial registration number PACTR201807164196402.
- community child health
- public health
- respiratory infections
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Footnotes
Contributorship SHT conceptualised the idea, designed the study, wrote the protocol, coordinated the data collection, analysed and interpreted the data and drafted this manuscript. BL conceptualised the idea, guided the study design, wrote the protocol, analysed and interpreted the data, took part in the proposal writing and writing of this manuscript. EL provided methodological advice, supported the analysis and revised the draft paper. KAJ provided methodological advice and revised the draft paper. YG took part in the training of staff at the health centres, monitored data collection and revised the draft paper. All authors read and approved the submitted version of the manuscript.
Funding This work was supported by the Norwegian Programme for Capacity Development in Higher Education and Research for Development (NORHED).
Disclaimer The funder had no role in the design, data collection, analysis, interpretation, writing of the manuscript or decision to submit the paper for publication.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The study was approved by the institutional review board of the College of Medicine and Health Sciences at Hawassa University (ref: IRB/009//2017) and the Regional Committees for Medical Research Ethics, South East Norway (ref: 2017/2473/REK sør-øst). Children were included in the study after giving written informed consent by parents.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement The data for this trial are available at https://osf.io, https://osf.io/ahdtx/