Table 2

Impact of pulse oximetry on management of acute febrile illness or associated syndromes

StudyStudy designSyndromeIntervention and comparison groupsOutcome measureParticipantsAge rangeSettingCountry (continent)Reported effect
McCollum et al32Retrospective secondary analysis of prospective cohort study dataPneumoniaPO+IMCI vs PO+Malawi guideline 2000 vs IMCI35 vs Malawi guideline 200036*Missed eligibility for referral to hospital14092 children with pneumonia2–59 months18 rural health centres and 38 village clinicsMalawi (Africa)At rural health centres, IMCI resulted in 390/938 (41.5%) missed eligible referrals and Malawi guideline 2000 in 143/1761 (8.1%) if PO not used
At village clinics, both IMCI and Malawi guideline 2000 resulted in 52/990 (5.3%) missed eligible referrals if PO not used
Hooli et al29Retrospective secondary analysis of prospective cohort study dataPneumoniaPO+IMCI vs PO+Malawi guideline 2000 vs IMCI35 vs Malawi guideline 200036*Missed eligibility for referral to hospital261 infants with cough and/or shortness of breath<2 months18 rural health centresMalawi (Africa)IMCI resulted in 1/238 (0.4%) missed referral if PO not used, and Malawi guideline 2000 1/236 (0.4%)
If hypoxaemia was defined as SpO2 <93%, IMCI resulted in 2/238 (0.8%) missed referral if PO not used, and Malawi guideline 2000 4/236 (1.7%)
Tesfaye et al31Parallel cluster-randomised trialPneumoniaPO+IMCI vs IMCI35*Referral to hospital1804 children with cough or difficulty breathing <14 days2–59 months24 rural primary health centresEthiopia (Africa)116/148 (78.4%, 95% CI 67.6 to 89.2) referred in PO+IMCI group vs 15/34 (44.1%, 95% CI 6.9 to 81.3) in IMCI group, p=0.496
Sylvies et al23Uncontrolled before-and-after studyNon-malarial feverPO+IMCI vs IMCI35 vs Malawi guideline 2019 vs Malawi guideline 2016*†Antibiotic prescription3504 children with non-malarial fever0–59 monthsFive mobile rural health clinicsMalawi (Africa)336/795 (42.2%) prescribed antibiotics in PO+IMCI group vs 150/178 (84.2%) in IMCI group vs 485/571 (84.9%) in Malawi guideline 2019 group vs 1461/1960 (74.5%) in Malawi guideline 2016 group, p<0.001
OR for reduced antibiotic prescription in PO+IMCI group vs IMCI group 7.3 (95% CI 4.8 to 11.4); vs Malawi guideline 2019 group 7.9 (95% CI 6.1 to 10.5); vs Malawi guideline 2016 group 4.0 (95% CI 3.3 to 4.7)
  • All interventions incorporating pulse oximetry included a staff training component. Hypoxaemia was defined as peripheral oxygen saturation (SpO2) <90% unless indicated otherwise.

  • *Intervention groups with pulse oximetry included a staff training component on the use of pulse oximetry.

  • †Hypoxaemia defined as SpO2 <95%.

  • IMCI, WHO Integrated Management of Childhood Illness guideline 2014; PO, pulse oximetry.