Background:
The Integrated Management of Childhood Illness (IMCI) guidelines for children under 5 is a symptom-based algorithm guiding health care workers in resource-limited countries at the primary health center (PHC) level. Hypoxaemia (SpO2< 90%) is a life-threatening condition underdiagnosed in West Africa. To improve the diagnosis and care-management of hypoxaemia, the AIRE project, UNITAID-funded, has implemented the routine Pulse Oximeter use into IMCI consultations at PHCs level in Burkina Faso, Guinea, Mali and Niger. This study aimed to measure the added value of PO integrated into IMCI.

Methods:
In 16 AIRE research PHCs (4/country), all children aged 0-59 months attending IMCI consultations, except those aged 2-59 months classified as green non-respiratory cases were eligible for PO use, and enrolled in a cross-sectional study with parent’s consent. Those classified as severe cases were followed for 14 days. Socio-demographic and clinical data including data about PO use, pathways, patterns of care and health outcomes at D14 were collected.

Results:
From June 2021 to June 2022, 39,496 children attended IMCI consultations; 31,721 were eligible for PO use of whom 80.3% had an SpO2 measurement. The prevalence of severe case using IMCI+PO was at 10% (n=3,179; 95% confidence interval [95%CI]: 9.7-10.4). Hypoxemia prevalence was 0.7% (95%CI: 0.58-0.76) among eligible children for PO use and 6.6% (95%CI: 5.8– 7.5) among all severe cases. Of all severe cases identified with IMCI+PO, 1,981 were enrolled and followed-up, their D-14 mortality rate was 4.8% (95%CI: 3.5 -5.3). The PO allowed to identify +1.9% (95% CI: 1.5 -2.5) severe cases.

Conclusion:
Based on this large sample study, the uptake of PO integrated into IMCI consultations was high and the identification of severe cases have been increased for +1.9% using PO. However, hospital referral and timely oxygen therapy to manage them remain challenges for governments in the West African settings.