Hypoxaemia prevalence and management among children and adults presenting to primary care facilities in Uganda: a prospective cohort study

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ABSTRACT Introduction Hypoxaemia (low blood oxygen) is common among hospitalised patients, increasing risk of death five-fold and requiring prompt detection and treatment. However, we know little about hypoxaemia prevalence in primary care and the role for pulse oximetry and oxygen therapy. This study assessed the prevalence and management of hypoxaemia at primary care facilities in Uganda. Methods Prospective cohort study in 30 primary care facilities in Uganda, Feb-Apr 2021. Clinical data collectors assessed blood oxygen level (SpO 2 ) of all acutely unwell children, adolescents, and adults, and followed up children aged under 15 years with SpO 2 <93% to determine subsequent care and outcome. Primary outcome: proportion of children under 5 years of age with severe hypoxaemia (SpO 2 <90%). Secondary outcomes: severe/moderate hypoxaemia (SpO 2 90-93%) by age/sex/complaint. Results Among children U5, the prevalence of severe hypoxaemia was 1.3% (95% CI 0.9 to 2.1); an additional 4.9% (3.9 to 6.1) had moderate hypoxaemia. Performing pulse oximetry according to World Health Organization guidelines exclusively on children with respiratory complaints would have missed 14% (3/21) of severe hypoxaemia and 11% (6/55) of moderate hypoxaemia. Hypoxaemia prevalence was low among children 5-14 years (0.3% severe, 1.1% moderate) and adolescents/adults 15+ years (0.1% severe, 0.5% moderate). A minority (12/27, 44%) of severely hypoxaemic patients were referred; 3 (12%) received oxygen. Conclusion Hypoxaemia is common among acutely unwell children under five years of age presenting to Ugandan primary care facilities. Routine pulse oximetry has potential to improve referral, management and clinical outcomes. Effectiveness, acceptability, and feasibility of pulse oximetry and oxygen therapy for primary care should be investigated in implementation trials. KEY QUESTIONS SUMMARY BOX What is already known? Hypoxaemia (low blood oxygen levels) is common among children and adults admitted to hospital with severe respiratory illness, increasing their risk of death at least 5-fold and requiring prompt detection and treatment. We know little about the prevalence of hypoxaemia in primary care, or whether pulse oximetry would improve decision-making or care for hypoxaemic patients. What are the new findings? In a Ugandan primary care context, hypoxaemia was common among acutely unwell children under five years of age and most were not referred to hospital for treatment. Hypoxaemia was uncommon among older children and adults presenting to Ugandan primary care facilities but prevalence increased with age into older adulthood. What do the new findings imply? Routine pulse oximetry screening may be warranted for acutely unwell children under five years of age, with a potential to improve referral, management and clinical outcomes. Effectiveness, acceptability, and feasibility of pulse oximetry and oxygen therapy for primary care should be investigated in further implementation trials.

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