Publication Date
1-1-2023
Journal
Gates Open Research
DOI
10.12688/gatesopenres.13963.2
PMID
37974907
PMCID
PMC10651692
PubMedCentral® Posted Date
11-8-2023
PubMedCentral® Full Text Version
Post-print
Published Open-Access
yes
Keywords
infant, child, pneumonia, child mortality, oximetry, Malawi, Africa, World Health Organization
Abstract
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 (SpO
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
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.