Surviving hypoxemia can be a challenge in some parts of the world. Hypoxemia is a lack of oxygen in the blood that can be fatal if not treated correctly. The results of operational research conducted by ALIMA (The Alliance for International Medical Action), Terre des hommes, Solthis, and Inserm, show that using pulse oximeters during medical consultations for children can help improve child survival in sub-Saharan Africa. On 24 and 25 May 2023, ALIMA will bring together and mobilize key regional and international actors in Dakar on this issue.

Hypoxemia is a little-known, clinically underdiagnosed medical complication. Often associated with common illnesses in children under five, it can be fatal. For example, it is the most prevalent fatal complication of pneumonia, which is the single largest infectious cause of death in children worldwide. In sub-Saharan Africa, hypoxemia is deadlier than elsewhere because it is poorly diagnosed and therefore poorly treated. Early detection increases children’s chances of survival.

Improving the detection of hypoxemia with pulse oximeters

To improve the detection of hypoxemia in children, the World Health Organization recommends using pulse oximeters in the Integrated Management of Childhood Illness (IMCI) protocol. When attached to a toe or finger, this inexpensive and easy-to-use tool provides a rapid and reliable diagnosis of hypoxemia. In high-income countries, pulse oximeters have long been part of the routine practice of medical staff. However, primary healthcare centers in West Africa are not equipped with this tool. Health workers rely solely on clinical signs, which are often difficult to observe, contributing to the under-diagnosis of hypoxemia and delayed appropriate treatment.
In the last three years, with the support of the global health agency Unitaid, ALIMA and its partners Solthis, Terre des hommes, and Inserm have combined their expertise on this issue. In Burkina Faso, Guinea, Niger, and Mali, through the AIRE project (Improving Identification of Respiratory Distress in Children), they have equipped 202 health centers and eight referral hospitals with pulse oximeters, and trained more than 560 health workers to use the tool. One of the key objectives of this project was to generate scientific evidence to inform policymakers on integrating pulse oximeters into the IMCI protocol in primary healthcare centers and facilitate scaling up their use.

The pulse oximeter, an effective tool for early and adapted care

Qualitative and quantitative studies conducted in 16 primary healthcare centers assessed the effects of introducing pulse oximeters as a routine part of consultations on the health of children under five. The main results were as follows :

• The integration of the pulse oximeter during pediatric consultations is a well-accepted and easy-to-implement strategy at the primary healthcare level in the study countries.
• The pulse oximeter gives health staff greater confidence in their diagnosis and decision to refer to a hospital. It also strengthens children caregivers’ trust in the health staff.
• Even moderate hypoxemia is a significant life-threatening condition. Among children diagnosed as severe cases who died, 37.5% to 64.2% had moderate and severe hypoxemia, respectively. Severe hypoxemia increases the risk of death in severe cases by 4.3 times.
• The scaling up of pulse oximeter integration in primary healthcare centers should be accompanied by a revision of the Integrated Management of Childhood Illness protocol (IMCI, a reference document published by the WHO), the use of a digital algorithm that enhances the quality of medical consultations and promotes the scaling up of the IMCI protocol, training of health workers, and sufficient investment to ensure rapid transfer to hospital and quality access to oxygen for severe cases.

Diagnosis is crucial, treatment is vital

While improving diagnosis helps save children, challenges remain to reduce neonatal and infant mortality related to hypoxemia. One of these challenges is sufficient and sustainable access to medical oxygen. Oxygen therapy is a life-saving treatment unavailable to most critically ill children in middle- and low-income countries. The COVID-19 global pandemic highlighted this overlooked problem: affordable medical oxygen is sorely lacking in Africa.
“It’s time to make investment in pulse oximeters and access to oxygen a public health priority in sub-Saharan Africa,” insists Marine Vignon, ALIMA AIRE project manager. That is why ALIMA and its partners will bring together in Dakar on May 24 and 25, 2023, representatives of the Ministries of Health of eight West African countries (Burkina Faso, Guinea, Mali, Mauritania, Niger, Nigeria, Senegal, and Chad), technical partners (World Health Organization, Unicef and other United Nations agencies, NGOs…) and financial partners. “This meeting will be an opportunity to make political decision-makers and technical and financial partners aware of this emergency, and to mobilize them to contribute to achieving objective 3.2 of the Sustainable Development Goals by 2033.”

To follow the conference online, register here. The agenda is available via the link.

QUOTES:

Professor Kissou, a pediatrician at University Hospital SANOU SOURO, Burkina Faso: “The introduction of the pulse oximeter at primary healthcare level is an innovation that we must accelerate in our country, given that respiratory diseases are deadly. Hypoxemia sets in at home and patients arrive late to referral hospitals. Treatment is costly and more difficult, with poor prognosis.”

Dr. Hannatou Abarry, Head of the Neonatal and Child Health Division of the Ministry of Public Health, Population, and Social Affairs of Niger: “Niger, with the support of Solthis and its partners, is determined to scale up by integrating the pulse oximeter into national IMCI recommendations and equipping all of the country’s health facilities with this tool.”

Dr. Valériane Leroy, AIRE project Research Coordinator and Research Director at Inserm (University of Toulouse): “This research conducted by Inserm, in collaboration with researchers from IRD (Institute of Research for Development) and the PACCI program in Abidjan (Côte d’Ivoire), as well as NGOs, has provided evidence on the value of using the pulse oximeter at the primary health center level to improve the health of children under five in West Africa. This interdisciplinary study is essential to guide the formulation of national public health recommendations and their optimal implementation in a context of fragile health systems.”

Dr. Philippe Duneton, Executive Director of Unitaid: “Without access to essential tools like pulse oximeters, frontline health workers often struggle to identify children in need of immediate medical attention. Unitaid is proud to support efforts to enable the implementation of these easy-to-use, life-saving devices in low- and middle-income countries, and help protect countless children from preventable health complications and death.”

About ALIMA – The Alliance for International Medical Action

ALIMA (The Alliance for International Medical Action) is a medical humanitarian organization based in Dakar, Senegal, that has been saving lives since 2009 in emergency situations in Africa. ALIMA strives to transform humanitarian medicine by fostering research and innovation to improve care and help communities prepare for the future. ALIMA has treated more than 10 million patients in 14 countries, and launched more than 30 research projects – notably on malnutrition, maternal and child health, malaria, Ebola and COVID-19. This work has won several international awards such as the Game-Changing Innovator REACH Award and the EU Health Award.

About Solthis

Solidarité thérapeutique et initiatives pour la santé (Solthis) is an international solidarity NGO whose objective is to improve access to quality healthcare by strengthening the health systems and services of the countries where it operates. Founded in 2003, Solthis is committed to a sustainable development approach in order to meet the long-term challenges of public health in countries with limited resources.

About Terre des hommes

Tdh is Switzerland’s largest child relief organization and works through three programs focused on health, migration, and access to justice. Its programs are supported by three areas of expertise that contribute to protecting the lives, well-being, and rights of children and young people: child protection, access to water, sanitation and quality hygiene (WaSH), and information and communication technologies for development (ICT4D). In collaboration with international institutions and organizations as well as numerous local actors, Terre des hommes has been active in more than 30 countries in five regions of the world since its creation in 1960.

About Inserm

Founded in 1964, Inserm is a public scientific and technological institute which operates under the joint authority of the French Ministries of Health and Research. The institute is the only public research organization in France entirely dedicated to human health and it aims to improve the health of all through the advancement of knowledge on diseases, innovation in treatments, and public health research. It also partners with the most prestigious research institutions in the world that are committed to scientific challenges and progress in these fields.

About Unitaid

Unitaid is a global health agency engaged in finding innovative solutions to prevent, diagnose, and treat diseases more quickly, cheaply and effectively, in low- and middle-income countries. Its work includes funding initiatives to address major diseases such as HIV/AIDS, malaria, and tuberculosis, as well as HIV co-infections and comorbidities such as cervical cancer and hepatitis C, and cross-cutting areas, such as fever management. Unitaid is a partnership hosted by the World Health Organization.