ArticleBMJ global health2025
Missed opportunities for hospital referral of young children with severe pneumonia identified at primary care using pulse oximetry: an analysis from the AIRE study in West Africa.
Article in BMJ global health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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3 citing papers in PubMed.
- Increasing equitable access to pulse oximetry: progress and considerations for sustainable scale-up in a changing global health landscape.BMJ global health · 2026Article
- Beyond pulse oximetry: lessons from the AIRE project on translating innovation into improved child survival.BMJ global health · 2026Article
- Pulse oximetry to optimise first-line care and save children's lives: evidence from the AIRE project in West Africa.BMJ global health · 2025Article
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15 authors.
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Abstract
backgroundIn line with the Integrated Management of Childhood Illness (IMCI) guidelines, healthcare workers (HCWs) should refer all severe pneumonia among children under 5 seen in primary care in resource-limited settings. We investigated the frequency and correlates of missed opportunities for hospital referral (MOHR) of clinical severe pneumonia. Our study was embedded within the Améliorer l'Identification des détresses Respiratoires chez l'Enfant project, which involved the routine implementation of pulse oximetry (PO) within IMCI consultations at primary healthcare centres (PHCs) in West Africa: Burkina Faso, Guinea, Mali and Niger.
methodsAll children aged 2-59 months attending IMCI consultations in 16 PHCs and classified as severe cases using IMCI+PO were enrolled into a prospective cohort for 14 days, with parental consent. We estimated the rate of MOHR for IMCI-defined severe pneumonia, which was either not referred, or referred but did not make it to hospital. Correlates of MOHR at day 14 were investigated using logistic mixed regression with random effect for PHCs.
resultsFrom June 2021 to June 2022, among the 1786 children aged 2-59 months classified as severe cases by IMCI+PO, 682 (38.2%) were severe pneumonia. Of these, 35 (5.1%) also had severe anaemia, 47 (6.9%) severe hypoxaemia (SpO
conclusionMOHR for severe pneumonia was extremely high at PHC level in these settings, mainly explained by HCW's decisions. Strengthening the referral system and training HCW to reinforce their adherence to IMCI guidelines remains essential to improve the management of severe pneumonia. TRIAL REGISTRATION NUMBER: PACTR202206525204526; Pan African Clinical Trials Registry on 15 June 2022.
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