@article{fdi:010095830,
  title = {{M}issed opportunities for hospital referral of young children with severe pneumonia identified at primary care using pulse oximetry: an analysis from the {AIRE} study in {W}est {A}frica},
  author = {{D}ahourou, {D}. {L}. and {N}eboua, {D}. and {H}edible, {K}. {G}. {B}. and {Z}air, {Z}. and {L}ouart, {S}. and {G}uilavogui, {J}. {P}. {Y}. and {S}awadogo, {A}. {G}. and {M}eda, {B}. and {Y}ugbar{\'e}, {S}. {O}. and {D}iallo, {I}. {S}. and {D}iakite, {A}. {A}. and {S}ouleymane, {H}. {A}. and {R}idde, {V}al{\'e}ry and {L}eroy, {V}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground {I}n line with the {I}ntegrated {M}anagement of {C}hildhood {I}llness ({IMCI}) guidelines, healthcare workers ({HCW}s) should refer all severe pneumonia among children under 5 seen in primary care in resource-limited settings. {W}e investigated the frequency and correlates of missed opportunities for hospital referral ({MOHR}) of clinical severe pneumonia. {O}ur study was embedded within the {A}m{\'e}lioration de l'{I}dentification des d{\'e}tresses {R}espiratoires de l'{E}nfant project, which involved the routine implementation of pulse oximetry ({PO}) within {IMCI} consultations at primary healthcare centres ({PHC}s) in {W}est {A}frica: {B}urkina {F}aso, {G}uinea, {M}ali and {N}iger. {M}ethods {A}ll children aged 2-59 months attending {IMCI} consultations in 16 {PHC}s and classified as severe cases using {IMCI}+{PO} were enrolled into a prospective cohort for 14 days, with parental consent. {W}e estimated the rate of {MOHR} for {IMCI}-defined severe pneumonia, which was either not referred, or referred but did not make it to hospital. {C}orrelates of {MOHR} at day 14 were investigated using logistic mixed regression with random effect for {PHC}s. {R}esults {F}rom {J}une 2021 to {J}une 2022, among the 1786 children aged 2-59 months classified as severe cases by {IMCI}+{PO}, 682 (38.2%) were severe pneumonia. {O}f these, 35 (5.1%) also had severe anaemia, 47 (6.9%) severe hypoxaemia ({S}p{O}2 <90%) and 602 (88.3%) severe malaria. {HCW} made the referral decision for 125 (18.3%) children, refused by three (2.4%) families; 560 (82.1%) were {MOHR}. {S}evere anaemia reduced the odds of {MOHR} (adjusted {OR} (a{OR}): 0.02; 95% {CI} 0.01 to 0.07) whereas having an {S}p{O}2 between 90% and 93% (a{OR}:12.16; 95% {CI} 3.47 to 42.61) or greater than 94% (a{OR}:11.81; 95%{CI} 3.98 to 35.02) or severe malaria (a{OR}:2.55; 95%{CI} 1.04 to 6.26) significantly increased it. {C}onclusion {MOHR} for severe pneumonia was extremely high at {PHC} level in these settings, mainly explained by {HCW}'s decisions. {S}trengthening the referral system and training {HCW} to reinforce their adherence to {IMCI} guidelines remains essential to improve the management of severe pneumonia.},
  keywords = {{C}hild health ; {D}ecision {M}aking ; {H}ealth systems evaluation ; {O}ther diagnostic or tool ; {A}frica {S}outh of the {S}ahara ; {BURKINA} {FASO} ; {GUINEE} ; {MALI} ; {NIGER} ; {AFRIQUE} {SUBSAHARIENNE} ; {AFRIQUE} {DE} {L}'{OUEST}},
  booktitle = {},
  journal = {{BMJ} {G}lobal {H}ealth},
  volume = {10},
  numero = {{S}uppl. 8},
  pages = {e017301 [13 p.]},
  ISSN = {2059-7908},
  year = {2025},
  DOI = {10.1136/bmjgh-2024-017301},
  URL = {https://www.documentation.ird.fr/hor/fdi:010095830},
}