{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T06:19:10Z","timestamp":1783491550084,"version":"3.55.0"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The WHO\u2019s Integrated Management of Childhood Illness (IMCI) strategy aims to reduce deaths among children under the age of five. Pulse oximetry, a simple non-invasive method for measuring peripheral oxygen saturation - an indicator of severe illness, can enhance IMCI implementation. In Nigeria, despite efforts to incorporate pulse oximetry into IMCI, its adoption is sub-optimal. We assessed healthcare workers\u2019 (HCWs) knowledge of pulse oximetry and IMCI in primary and secondary facilities to identify opportunities for improvement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a cross-sectional study in 54 primary health facilities and 8 secondary hospitals purposively selected across five different states in Nigeria: Oyo, Lagos, Rivers, Kano and Jigawa. The data was collected between 6 March 2025 and 30 June 2025 through an interviewer-assisted questionnaire, which was developed from the national oxygen policy and WHO guidelines. We used descriptive statistics to summarise our findings. Pulse oximetry knowledge scores were dichotomised, and we used bivariate logistic regression to assess associations between HCWs\u2019 cadre and pulse oximetry knowledge. For IMCI knowledge, we reported mean scores and used one-way analysis of variance to assess associations between mean scores and the HCWs\u2019 cadre.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 463 eligible HCWs recruited, 75.4% were female, 52.3% were community health workers (CHWs), and 73.8 and 26.2% were employed by the government and facility, respectively. Overall, 49.7% knew that pulse oximetry should be performed for all presenting patients, with substantial variation across cadres (39.4% among CHWs, 74.4% among doctors, 52.9% among nurses). Doctors had 3.1 times higher odds of having good pulse oximetry knowledge compared to other HCWs (95% CI: 1.17\u20138.04). Knowledge of IMCI general danger signs was mixed with convulsion (93.5%), lethargy (80.9%) and loss of consciousness (84.6%) being mostly reported as general danger signs compared to vomiting everything and being unable to eat\/drink. Less than 10% of the HCWs knew the four main symptoms for assessment in children aged 2\u201359\u202fmonths.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>IMCI Knowledge was generally poor across all HCW cadres, but pulse oximetry knowledge varied substantially. Strengthening pre-service and in-service IMCI and pulse oximetry training, particularly for CHWs and nurses is essential to improve childhood illness management and oxygen therapy practices in Nigeria.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1789259","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T05:58:42Z","timestamp":1783490322000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Knowledge of pulse oximetry, indications for oxygen therapy, and integrated management of childhood illness among health care workers in Nigerian primary and secondary health facilities: a cross-sectional survey"],"prefix":"10.3389","volume":"14","author":[{"given":"Ayobami A.","family":"Bakare","sequence":"first","affiliation":[{"name":"Department of Community Medicine, University College Hospital","place":["Ibadan, Nigeria"]},{"name":"Department of Global Public Health, Karolinska Institutet","place":["Solna, Sweden"]},{"name":"Oxygen for Life Initiative","place":["Ibadan, Nigeria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olumide Ebenezer","family":"Olufayo","sequence":"additional","affiliation":[{"name":"Oxygen for Life Initiative","place":["Ibadan, Nigeria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Obioma","family":"Uchendu","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, University College Hospital","place":["Ibadan, Nigeria"]},{"name":"Department of Community Medicine, University of Ibadan","place":["Ibadan, Nigeria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Yewande","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, University College Hospital","place":["Ibadan, Nigeria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julius","family":"Salako","sequence":"additional","affiliation":[{"name":"Department of Global Public Health, Karolinska Institutet","place":["Solna, Sweden"]},{"name":"Oxygen for Life Initiative","place":["Ibadan, Nigeria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omotayo","family":"Olojede","sequence":"additional","affiliation":[{"name":"School of Health Sciences, Ulster University","place":["Derry, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayodamola","family":"Bakare","sequence":"additional","affiliation":[{"name":"Department of Global Public Health, Karolinska Institutet","place":["Solna, Sweden"]},{"name":"Oxygen for Life Initiative","place":["Ibadan, Nigeria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carina","family":"King","sequence":"additional","affiliation":[{"name":"Department of Global Public Health, Karolinska Institutet","place":["Solna, Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adegoke G.","family":"Falade","sequence":"additional","affiliation":[{"name":"Oxygen for Life Initiative","place":["Ibadan, Nigeria"]},{"name":"Department of Paediatrics, University College Hospital","place":["Ibadan, Nigeria"]},{"name":"Department of Paediatrics, University of Ibadan","place":["Ibadan, Nigeria"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"key":"ref1","article-title":"Child and adolescent health: Integrated Management of Childhood Illness (IMCI)","year":""},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e019079","DOI":"10.1136\/bmjopen-2017-019079","article-title":"Global implementation survey of integrated Management of Childhood Illness (IMCI): 20 years on","volume":"8","author":"Boschi-Pinto","year":"2018","journal-title":"BMJ 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Inter-Agency Group for Child Mortality Estimation, United Nations Children\u2019s Fund","year":"2024"},{"key":"ref7","volume-title":"Nigeria Child Survival Action 2025\u20132029","year":"2025"},{"key":"ref8","volume-title":"Oxygen Therapy for children: a Manual for Health Workers","year":"2016"},{"key":"ref9","volume-title":"National Policy on Medical Oxygen in Health Facilities","year":"2017"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"e001211","DOI":"10.1136\/bmjph-2024-001211","article-title":"Understanding pulse oximetry adoption in primary healthcare facilities in Nigeria: a realist process evaluation of the INSPIRING-Lagos stabilisation room project","volume":"2","author":"Olojede","year":"2024","journal-title":"BMJ Public Health"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e001210","DOI":"10.1136\/bmjph-2024-001210","article-title":"Pulse oximetry and oxygen services for under-five children with community-acquired pneumonia attending primary and secondary level health facilities in Lagos, Nigeria (INSPIRING-Lagos): a pre-implementation and post implementation study","volume":"2","author":"Colbourn","year":"2024","journal-title":"BMJ Public Health"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"e528","DOI":"10.1016\/S2214-109X(24)00496-0","article-title":"Reducing global inequities in medical oxygen access: the lancet Global Health Commission on medical oxygen security","volume":"13","author":"Graham","year":"2025","journal-title":"Lancet Glob Health"},{"key":"ref13","volume-title":"National Strategy for the Scale-up of Medical Oxygen in Health Facilities (2023\u20132027)","year":"2023"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"e006069","DOI":"10.1136\/bmjgh-2021-006069","article-title":"Measuring oxygen access: lessons from health facility assessments in Lagos, Nigeria","volume":"6","author":"Graham","year":"2021","journal-title":"BMJ Glob Health"},{"key":"ref15","volume-title":"Knowledge and 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Illnesses (IMCI) among health care workers in selected primary health centres in Ibadan, Nigeria","volume-title":"African Journal of Health Sciences","author":"Oladokun","year":""},{"key":"ref19","first-page":"2994-0826","article-title":"IMCI intervention strategy awareness amongst Port Harcourt primary healthcare providers: an investigative study","author":"Abubakar","year":"2023","journal-title":"Top Acad J Nur Sci"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1535","DOI":"10.2147\/AMEP.S378533","article-title":"Doctors' and nurses' knowledge and perceived barriers regarding acute oxygen therapy in a tertiary Care Hospital in Nigeria","volume":"13","author":"Desalu","year":"2022","journal-title":"Adv Med Educ Pract"},{"key":"ref21","volume-title":"Multiple Indicator Cluster Survey 2021, Survey Findings Report","year":"2022"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"67","DOI":"10.4103\/npmj.npmj_19_20","article-title":"Sample size estimation for health and social science researchers: the principles and considerations for different study designs","volume":"27","author":"Bolarinwa","year":"2020","journal-title":"Niger Postgrad Med J"},{"key":"ref23","volume-title":"Integrated Management of Childhood Illness Chart Booklet","year":"2014"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1198225","DOI":"10.3389\/fpubh.2023.1198225","article-title":"Pneumonia knowledge and care seeking behavior for children under-five years in Jigawa, Northwest Nigeria: a cross-sectional study","volume":"11","author":"Bakare","year":"2023","journal-title":"Front Public Health"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13063-021-05859-5","article-title":"Integrated sustainable childhood pneumonia and infectious disease reduction in Nigeria (INSPIRING) through whole system strengthening in Jigawa, Nigeria: study protocol for a cluster randomised controlled 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A systematic review","volume":"13","author":"Wilkes","year":"2023","journal-title":"J Glob Health"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"e0213937","DOI":"10.1371\/journal.pone.0213937","article-title":"Retrospective study on the usefulness of pulse oximetry for the identification of young children with severe illnesses and severe pneumonia in a rural outpatient clinic of Papua New Guinea","volume":"14","author":"Blanc","year":"2019","journal-title":"PLoS One"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"e000812","DOI":"10.1136\/bmjgh-2018-000812","article-title":"Adoption of paediatric and neonatal pulse oximetry by 12 hospitals in Nigeria: a mixed-methods realist evaluation","volume":"3","author":"Graham","year":"2018","journal-title":"BMJ Glob Health"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"S78","DOI":"10.1002\/ppul.24660","article-title":"Health system challenges for improved childhood pneumonia case management in Lagos and 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