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Introducing pulse oximetry for outpatient management of childhood pneumonia: An implementation research adopting a district implementation model in selected rural facilities in Bangladesh

BACKGROUND: Pulse oximetry has potential for identifying hypoxaemic pneumonia and substantially reducing under-five deaths in low- and middle-income countries (LMICs) setting. However, there are few examples of introducing pulse oximetry in resource-constrained paediatric outpatient settings, such a...

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Autores principales: Rahman, Ahmed Ehsanur, Ameen, Shafiqul, Hossain, Aniqa Tasnim, Perkins, Janet, Jabeen, Sabrina, Majid, Tamanna, Uddin, AFM Azim, Shaikh, Md. Ziaul Haque, Islam, Muhammad Shariful, Islam, Md. Jahurul, Ashrafee, Sabina, Md. Shah Alam, Husam, Saberin, Ashfia, Ahmed, Sabbir, Banik, Goutom, Kabir, ANM Ehtesham, Ahmed, Anisuddin, Chisti, Mohammod Jobayer, Cunningham, Steve, Dockrell, David H, Nair, Harish, Arifeen, Shams El, Campbell, Harry
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9251564/
https://www.ncbi.nlm.nih.gov/pubmed/35795715
http://dx.doi.org/10.1016/j.eclinm.2022.101511
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author Rahman, Ahmed Ehsanur
Ameen, Shafiqul
Hossain, Aniqa Tasnim
Perkins, Janet
Jabeen, Sabrina
Majid, Tamanna
Uddin, AFM Azim
Shaikh, Md. Ziaul Haque
Islam, Muhammad Shariful
Islam, Md. Jahurul
Ashrafee, Sabina
Md. Shah Alam, Husam
Saberin, Ashfia
Ahmed, Sabbir
Banik, Goutom
Kabir, ANM Ehtesham
Ahmed, Anisuddin
Chisti, Mohammod Jobayer
Cunningham, Steve
Dockrell, David H
Nair, Harish
Arifeen, Shams El
Campbell, Harry
author_facet Rahman, Ahmed Ehsanur
Ameen, Shafiqul
Hossain, Aniqa Tasnim
Perkins, Janet
Jabeen, Sabrina
Majid, Tamanna
Uddin, AFM Azim
Shaikh, Md. Ziaul Haque
Islam, Muhammad Shariful
Islam, Md. Jahurul
Ashrafee, Sabina
Md. Shah Alam, Husam
Saberin, Ashfia
Ahmed, Sabbir
Banik, Goutom
Kabir, ANM Ehtesham
Ahmed, Anisuddin
Chisti, Mohammod Jobayer
Cunningham, Steve
Dockrell, David H
Nair, Harish
Arifeen, Shams El
Campbell, Harry
author_sort Rahman, Ahmed Ehsanur
collection PubMed
description BACKGROUND: Pulse oximetry has potential for identifying hypoxaemic pneumonia and substantially reducing under-five deaths in low- and middle-income countries (LMICs) setting. However, there are few examples of introducing pulse oximetry in resource-constrained paediatric outpatient settings, such as Integrated Management of Childhood Illness (IMCI) services. METHODS: The National IMCI-programme of Bangladesh designed and developed a district implementation model for introducing pulse oximetry in routine IMCI services through stakeholder engagement and demonstrated the model in Kushtia district adopting a health system strengthening approach. Between December 2020 and June 2021, two rounds of assessment were conducted based on WHO's implementation research framework and outcome variables, involving 22 IMCI service-providers and 1680 children presenting with cough/difficulty-in-breathing in 12 health facilities. The data collection procedures included structured-observations, re-assessments, interviews, and data-extraction by trained study personnel. FINDINGS: We observed that IMCI service-providers conducted pulse oximetry assessments on all eligible children in routine outpatient settings, of which 99% of assessments were successful; 85% (95% CI 83,87) in one attempt, and 69% (95% CI 67,71) within one minute. The adherence to standard operating procedure related to pulse oximetry was 92% (95% CI 91,93), and agreement regarding identifying hypoxaemia was 97% (95% CI 96,98). The median performance-time was 36 seconds (IQR 20,75), which was longer among younger children (2-11 months: 44s, IQR 22,78; 12-59 months: 30s, IQR 18,53, p < 0.01) and among those classified as pneumonia/severe-pneumonia than as no-pneumonia (41s, IQR 22,70; 32s, IQR 20,62, p < 0.01). We observed improvements in almost all indicators in round-2. IMCI service-providers and caregivers showed positive attitudes towards using this novel technology for assessing their children. INTERPRETATION: This implementation research study suggested the adoption, feasibility, fidelity, appropriateness, acceptability, and sustainability of pulse oximetry introduction in routine IMCI services in resource-poor settings. The learning may inform the evidence-based scale-up of pulse oximetry linked with an oxygen delivery system in Bangladesh and other LMICs. FUNDING: This research was funded by the UK National Institute for Health Research (NIHR) (Global Health Research Unit on Respiratory Health (RESPIRE); 16/136/109) using UK aid from the UK Government to support global health research.
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spelling pubmed-92515642022-07-05 Introducing pulse oximetry for outpatient management of childhood pneumonia: An implementation research adopting a district implementation model in selected rural facilities in Bangladesh Rahman, Ahmed Ehsanur Ameen, Shafiqul Hossain, Aniqa Tasnim Perkins, Janet Jabeen, Sabrina Majid, Tamanna Uddin, AFM Azim Shaikh, Md. Ziaul Haque Islam, Muhammad Shariful Islam, Md. Jahurul Ashrafee, Sabina Md. Shah Alam, Husam Saberin, Ashfia Ahmed, Sabbir Banik, Goutom Kabir, ANM Ehtesham Ahmed, Anisuddin Chisti, Mohammod Jobayer Cunningham, Steve Dockrell, David H Nair, Harish Arifeen, Shams El Campbell, Harry eClinicalMedicine Articles BACKGROUND: Pulse oximetry has potential for identifying hypoxaemic pneumonia and substantially reducing under-five deaths in low- and middle-income countries (LMICs) setting. However, there are few examples of introducing pulse oximetry in resource-constrained paediatric outpatient settings, such as Integrated Management of Childhood Illness (IMCI) services. METHODS: The National IMCI-programme of Bangladesh designed and developed a district implementation model for introducing pulse oximetry in routine IMCI services through stakeholder engagement and demonstrated the model in Kushtia district adopting a health system strengthening approach. Between December 2020 and June 2021, two rounds of assessment were conducted based on WHO's implementation research framework and outcome variables, involving 22 IMCI service-providers and 1680 children presenting with cough/difficulty-in-breathing in 12 health facilities. The data collection procedures included structured-observations, re-assessments, interviews, and data-extraction by trained study personnel. FINDINGS: We observed that IMCI service-providers conducted pulse oximetry assessments on all eligible children in routine outpatient settings, of which 99% of assessments were successful; 85% (95% CI 83,87) in one attempt, and 69% (95% CI 67,71) within one minute. The adherence to standard operating procedure related to pulse oximetry was 92% (95% CI 91,93), and agreement regarding identifying hypoxaemia was 97% (95% CI 96,98). The median performance-time was 36 seconds (IQR 20,75), which was longer among younger children (2-11 months: 44s, IQR 22,78; 12-59 months: 30s, IQR 18,53, p < 0.01) and among those classified as pneumonia/severe-pneumonia than as no-pneumonia (41s, IQR 22,70; 32s, IQR 20,62, p < 0.01). We observed improvements in almost all indicators in round-2. IMCI service-providers and caregivers showed positive attitudes towards using this novel technology for assessing their children. INTERPRETATION: This implementation research study suggested the adoption, feasibility, fidelity, appropriateness, acceptability, and sustainability of pulse oximetry introduction in routine IMCI services in resource-poor settings. The learning may inform the evidence-based scale-up of pulse oximetry linked with an oxygen delivery system in Bangladesh and other LMICs. FUNDING: This research was funded by the UK National Institute for Health Research (NIHR) (Global Health Research Unit on Respiratory Health (RESPIRE); 16/136/109) using UK aid from the UK Government to support global health research. Elsevier 2022-06-29 /pmc/articles/PMC9251564/ /pubmed/35795715 http://dx.doi.org/10.1016/j.eclinm.2022.101511 Text en © 2022 Published by Elsevier Ltd. https://creativecommons.org/licenses/by/3.0/igo/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/3.0/igo/).
spellingShingle Articles
Rahman, Ahmed Ehsanur
Ameen, Shafiqul
Hossain, Aniqa Tasnim
Perkins, Janet
Jabeen, Sabrina
Majid, Tamanna
Uddin, AFM Azim
Shaikh, Md. Ziaul Haque
Islam, Muhammad Shariful
Islam, Md. Jahurul
Ashrafee, Sabina
Md. Shah Alam, Husam
Saberin, Ashfia
Ahmed, Sabbir
Banik, Goutom
Kabir, ANM Ehtesham
Ahmed, Anisuddin
Chisti, Mohammod Jobayer
Cunningham, Steve
Dockrell, David H
Nair, Harish
Arifeen, Shams El
Campbell, Harry
Introducing pulse oximetry for outpatient management of childhood pneumonia: An implementation research adopting a district implementation model in selected rural facilities in Bangladesh
title Introducing pulse oximetry for outpatient management of childhood pneumonia: An implementation research adopting a district implementation model in selected rural facilities in Bangladesh
title_full Introducing pulse oximetry for outpatient management of childhood pneumonia: An implementation research adopting a district implementation model in selected rural facilities in Bangladesh
title_fullStr Introducing pulse oximetry for outpatient management of childhood pneumonia: An implementation research adopting a district implementation model in selected rural facilities in Bangladesh
title_full_unstemmed Introducing pulse oximetry for outpatient management of childhood pneumonia: An implementation research adopting a district implementation model in selected rural facilities in Bangladesh
title_short Introducing pulse oximetry for outpatient management of childhood pneumonia: An implementation research adopting a district implementation model in selected rural facilities in Bangladesh
title_sort introducing pulse oximetry for outpatient management of childhood pneumonia: an implementation research adopting a district implementation model in selected rural facilities in bangladesh
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9251564/
https://www.ncbi.nlm.nih.gov/pubmed/35795715
http://dx.doi.org/10.1016/j.eclinm.2022.101511
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