{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T08:59:33Z","timestamp":1781168373218,"version":"3.54.1"},"reference-count":62,"publisher":"BMJ","issue":"Suppl 8","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"unspecified","delay-in-days":10,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100032626","name":"UNITAID","doi-asserted-by":"crossref","award":["2019-34-AIRE"],"award-info":[{"award-number":["2019-34-AIRE"]}],"id":[{"id":"10.13039\/100032626","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2026,5,14]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Integrated Management of Childhood Illness (IMCI) guidelines, used alone, fail to reliably identify severe hypoxaemia (SpO\n                      <jats:sub>2<\/jats:sub>\n                      &lt;90%), a predictor of mortality in children under five. The AIRE (Am\u00e9liorer l'Identification des D\u00e9tresses Respiratoires chez l\u2019Enfant; 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).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      All children aged 0\u201359 months attending IMCI consultations were eligible for SpO\n                      <jats:sub>2<\/jats:sub>\n                      measurement, except those 2\u201359 months classified as simple non-respiratory cases using IMCI. Monthly aggregated data were collected from 202 AIRE PHC\u2019s 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 514\u2009901 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\u2019 referral decisions were significantly higher for SCs with severe hypoxaemia (74.5%) than for those without (22.2%), p value &lt;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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>PanAfrican Clinical Trial Registry (PACTR202206525204526).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjgh-2024-017304","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T08:25:14Z","timestamp":1781166314000},"page":"e017304","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Added value of routine pulse oximetry use within Integrated Management of Childhood Illness guidelines in primary care in West Africa: insight from AIRE"],"prefix":"10.1136","volume":"10","author":[{"given":"Gildas Boris","family":"Hedible","sequence":"first","affiliation":[{"name":"Inserm, Center for Epidemiology and Research in Population Health (CERPOP), University of Toulouse, Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zineb","family":"Zair","sequence":"additional","affiliation":[{"name":"Inserm, Center for Epidemiology and Research in Population Health (CERPOP), University of Toulouse, Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5330-7434","authenticated-orcid":false,"given":"Sarah","family":"Louart","sequence":"additional","affiliation":[{"name":"CLERSE - Centre Lillois d\u2019\u00c9tudes et de Recherches Sociologiques et \u00c9conomiques, University of Lille, Lille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Solange","family":"Ou\u00e9draogo Yugbar\u00e9","sequence":"additional","affiliation":[{"name":"CHU de Bogodogo, Ouagadougou, Burkina Faso"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdoul Aziz","family":"Diakite","sequence":"additional","affiliation":[{"name":"CHU Gabriel Tour\u00e9, Bamako, Mali"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahima Sory","family":"Diallo","sequence":"additional","affiliation":[{"name":"Institut de Nutrition et de Sant\u00e9 pour Enfants, Conakry, Guinea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannatou","family":"Souleymane Abarry","sequence":"additional","affiliation":[{"name":"des populations et des affaires sociales, Minist\u00e8re de la Sant\u00e9, Niamey, Niger"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Triclin","sequence":"additional","affiliation":[{"name":"Tdh, Terre des Hommes Foundation, Dakar, Senegal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marine","family":"Vignon","sequence":"additional","affiliation":[{"name":"The Alliance for International Medical Action, ALIMA, Dakar, Senegal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6026-6445","authenticated-orcid":false,"given":"Franck","family":"Lamontagne","sequence":"additional","affiliation":[{"name":"Solthis, Solidarit\u00e9 Th\u00e9rapeutique et Initiatives pour la Sant\u00e9, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9299-8266","authenticated-orcid":false,"given":"Valery","family":"Ridde","sequence":"additional","affiliation":[{"name":"IRD, Inserm, Ceped, Universit\u00e9 Paris Cit\u00e9, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3542-8616","authenticated-orcid":false,"given":"Valeriane","family":"Leroy","sequence":"additional","affiliation":[{"name":"Inserm, Center for Epidemiology and Research in Population Health (CERPOP), University of Toulouse, Toulouse, 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