Horizon 1 1 17 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES BMJ Global Health e017304 [14 p.] Africa South of the Sahara Delivery of Health Care Diagnostics and tools Child health AFRIQUE DE L'OUEST AFRIQUE SUBSAHARIENNE 2026 fdi:010097449 ENG BMJ Global Health 2059-7908 ISI:001793251800001 Suppl. 8 10.1136/bmjgh-2024-017304 https://www.documentation.ird.fr/hor/fdi:010097449 https://horizon.documentation.ird.fr/exl-doc/pleins_textes/2026-07/010097449.pdf 10 Horizon (IRD) Background Integrated Management of Childhood Illness (IMCI) guidelines, used alone, fail to reliably identify severe hypoxaemia (SpO(2)<90%), a predictor of mortality in children under five. The AIRE (Am & eacute;liorer l'Identification des D & eacute;tresses Respiratoires chez l'Enfant; in English, Improving Identification of Respiratory Distress in Children) operational research project introduced routine use of pulse oximetry (PO) within IMCI consultations in Burkina Faso, Guinea, Mali and Niger. We estimated the added value of incorporating PO within IMCI (IMCI+PO) for improving the diagnosis and subsequent management of severe hypoxaemia in primary healthcare centres (PHCs). Methods All children aged 0-59 months attending IMCI consultations were eligible for SpO(2) measurement, except those 2-59 months classified as simple non-respiratory cases using IMCI. Monthly aggregated data were collected from 202 AIRE PHC's through a cross-sectional study to estimate the added value of PO within IMCI in diagnosing severe cases (SCs) which should be referred. The added value was defined as the number of additional IMCI SCs with severe hypoxaemia, diagnosed using IMCI+PO, divided by the number of SCs diagnosed using IMCI alone. In a subset of 16 PHCs, we conducted a 14-day cohort follow-up for SCs. We analysed their management and mortality according to hypoxaemia status. Results Of the 514 901 IMCI consultations between June 2021 and December 2022, 74.2% were eligible for PO use. Of those, 5.4% were SCs diagnosed using IMCI+PO. The added value of PO was +4.9% (+962 SCs; 95% CI 4.6% to 5.2%). This was similar for all countries except Guinea (+0.9%). Healthcare workers' referral decisions were significantly higher for SCs with severe hypoxaemia (74.5%) than for those without (22.2%), p value <0.0001. In the research PHCs, the 142 SCs with severe hypoxaemia were significantly more likely to be referred and admitted to hospital, although their survival rates were similar. However, oxygen therapy remained suboptimal. Conclusion At PHC level, PO improves the diagnosis of SCs with severe hypoxaemia and is associated with improved management. However, subsequent care in these settings remains challenging. 056 UR196 Burkina Faso / Guinée / Mali / Niger / Sénégal