@article{fdi:010095833,
  title = {{C}are 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},
  author = {{H}edible, {K}. {G}. {B}. and {S}awadogo, {A}. {G}. and {Z}air, {Z}. and {K}argougou, {D}. {G}. and {M}{\'e}da, {B}. and {B}okol, {L}. {P}. and {K}oli{\'e}, {J}. {S}. and {L}ouart, {S}. and {Y}ugbar{\'e}, {S}. {O}. and {D}iakite, {A}. {A}. and {D}iallo, {I}. {S}. and {S}ouleymane, {H}. {A}. and {B}usi{\`e}re, {S}. and {L}amontagne, {F}. and {S}hepherd, {S}. and {R}idde, {V}al{\'e}ry and {L}eroy, {V}. and {AIRE} {R}esearch {S}tudy {G}roup,},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground {T}he {A}m{\'e}lioration de l'{I}dentification des d{\'e}tresses {R}espiratoires de l'{E}nfant ({AIRE}) project introduced the routine use of pulse oximetry ({PO}) into {I}ntegrated {M}anagement of {C}hildhood {I}llness ({IMCI}) consultations within primary health centres ({PHC}s) in {B}urkina {F}aso, {G}uinea, {M}ali and {N}iger. {W}e analysed how severe cases were managed and 14-day mortality by hypoxaemia severity. {M}ethods {A}ll children aged under 5 years attending {IMCI} consultations integrating {PO} use at 16 research {PHC}s and classified as severe cases (severe {IMCI} cases or severe hypoxemia: {S}p{O}(2) <90%) were eligible for referral and enrolled in a 14-day prospective cohort with parental consent. {R}eferral decisions, admissions, access to oxygen therapy and {K}aplan-{M}eier probability of death were compared by hypoxaemia severity. {A}n adjusted mixed-effects {C}ox regression model with a random effect for {PHC} estimated adjusted {OR}s (a{OR}s) and 95% {CI}s of mortality by day 14. {R}esults {F}rom {J}uly 2021 to {J}uly 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%). {B}y day 14, 625 (31.3%) were referred, 463 (23.2%) hospitalised, and 95 children (4.8%) had died. {R}eferral 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). {S}imilarly, day 14 mortality rates were 26.1%, 7.5% and 2.3%, respectively. {T}he a{OR}s 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 {N}iger (4.06, 95% {CI} 1.41 to 11.67). {C}onclusion {R}egardless of severity, hypoxaemia was common among outpatients screened using {PO} and meeting criteria for severity. {I}ts presence was associated with mortality risk. {I}ncorporating {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. {S}tudy registration number {PACTR}202206525204526 registered retrospectively on 15 {J}une 2022.},
  keywords = {{C}hild health ; {O}ther diagnostic or tool ; {H}ealth systems evaluation ; {H}ealth {S}ervices {A}ccessibility ; {C}ohort study ; {BURKINA} {FASO} ; {GUINEA} ; {MALI} ; {NIGER} ; {AFRIQUE} {SUBSAHARIENNE} ; {AFRIQUE} {DE} {L}'{OUEST}},
  booktitle = {},
  journal = {{BMJ} {G}lobal {H}ealth},
  volume = {10},
  numero = {{S}uppl. 8},
  pages = {e017300 [14 p.]},
  ISSN = {2059-7908},
  year = {2025},
  DOI = {10.1136/bmjgh-2024-017300},
  URL = {https://www.documentation.ird.fr/hor/fdi:010095833},
}