BMJ Open (Sep 2021)

Pulse oximetry adoption and oxygen orders at paediatric admission over 7 years in Kenya: a multihospital retrospective cohort study

  • Grace Irimu,
  • George Mbevi,
  • Samuel Akech,
  • Mike English,
  • Jalemba Aluvaala,
  • Ambrose Agweyu,
  • Mercy Chepkirui,
  • Paul Mwaniki,
  • Emma Namulala,
  • Juma Vitalis,
  • Rachel Inginia,
  • Melab Musabi,
  • Grace Ochieng,
  • Lydia Thuranira,
  • Esther Njiru,
  • Charles Nzioki,
  • Caren Emadau,
  • Christine Manyasi,
  • Agnes Mithamo,
  • Fred Were,
  • Roselyne Malangachi,
  • Supa Tunje,
  • Magdalene Kuria,
  • Mary Waiyego,
  • Beth Maina,
  • Catherine Mutinda,
  • Laura Oyiengo,
  • Muthoni Ogola,
  • Edith Gicheha,
  • Lynda Isaaka,
  • Timothy Tuti,
  • Naomi Muinga,
  • Joseph Nganga,
  • Esther Mwangi,
  • Esther Muthiani,
  • Mary Nguri,
  • Samuel Soita,
  • Margaret Waweru,
  • Alfred Wanjau,
  • Caroline Mwangi,
  • John Wainaina,
  • Livingstone Mumelo,
  • Nyumbile Bonface,
  • Wagura Mwangi,
  • Penina Mwangi,
  • Josephine Ojigo,
  • Bernadette Lusweti,
  • Amilia Ngoda,
  • Dolphine Mochache,
  • Jane Mbungu,
  • Joan Baswetty,
  • Josephine Aritho,
  • Beatrice Njambi,
  • Zainab Kioni,
  • Alice Oguda,
  • Nancy Mburu,
  • Celestine Muteshi,
  • Salome Okisa Muyale,
  • Faith Mueni,
  • Rosemary Mututa,
  • Joyce Oketch,
  • Orina Nyakina,
  • Faith Njeru,
  • Margaret Wanjiku Mwaura,
  • Seline Kulubi,
  • Susan Wanjala,
  • Pauline Njeru,
  • John Ollongo,
  • Jeska Kuya,
  • Benjamin Tanui,
  • Judith Onsongo,
  • Peter Muigai,
  • Arnest Namayi,
  • Cynthia Khaenzi,
  • Monica Musa,
  • David Kibiwott Kimutai,
  • Rukia Aden,
  • Elizabeth Atieno Jowi,
  • Cecilia Muithya,
  • Penina Musyoka,
  • Mwangi Ngina,
  • Felicitas Makokha,
  • Angeline Ithondeka,
  • Julie Barasa,
  • Meshack Liru,
  • Elizabeth Kibaru,
  • Alice Nkirote Nyaribari,
  • Joyce Akuka,
  • Joyce Wangari,
  • Aggrey Nzavaye Emenwa,
  • Patricia Nafula Wesakania,
  • George Lipesa,
  • Marystella Mutenyo,
  • Joyce Mbogho,
  • Ann Jambi,
  • Felisters Mucheke,
  • Lucy Kinyua Jeniffer,
  • Margaret Kethi,
  • Salome Nashimiyu Situma,
  • Nancy Gachaja,
  • Loise N Mwangi,
  • Ruth Mwai,
  • Irginia Wangari Muruga,
  • Abigael Bwire,
  • Naomi Situma,
  • Hellen Mwaura,
  • Caroline Lavu,
  • Jane Hore Olum,
  • Rebecca Chelimo,
  • Ann Wambugu,
  • Epharus Njeri Mburu,
  • Linda Awino Tindi,
  • Jane Akumu,
  • Ruth Otieno,
  • Slessor Osok,
  • Rebbecca Mukami Mbogo,
  • Judith Mirenja,
  • Mary Akoth Oruko,
  • Caroline Muthuri,
  • Elizabeth Kosiom,
  • Dorcas Cherop,
  • Faith Marete,
  • Johanness Simiyu,
  • Collince Danga,
  • Arthur Otieno Oyugi,
  • Fredrick Keya Okoth

DOI
https://doi.org/10.1136/bmjopen-2021-050995
Journal volume & issue
Vol. 11, no. 9

Abstract

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Objectives To characterise adoption and explore specific clinical and patient factors that might influence pulse oximetry and oxygen use in low-income and middle-income countries (LMICs) over time; to highlight useful considerations for entities working on programmes to improve access to pulse oximetry and oxygen.Design A multihospital retrospective cohort study.Settings All admissions (n=132 737) to paediatric wards of 18 purposely selected public hospitals in Kenya that joined a Clinical Information Network (CIN) between March 2014 and December 2020.Outcomes Pulse oximetry use and oxygen prescription on admission; we performed growth-curve modelling to investigate the association of patient factors with study outcomes over time while adjusting for hospital factors.Results Overall, pulse oximetry was used in 48.8% (64 722/132 737) of all admission cases. Use rose on average with each month of participation in the CIN (OR: 1.11, 95% CI 1.05 to 1.18) but patterns of adoption were highly variable across hospitals suggesting important factors at hospital level influence use of pulse oximetry. Of those with pulse oximetry measurement, 7% (4510/64 722) had hypoxaemia (SpO2 <90%). Across the same period, 8.6% (11 428/132 737) had oxygen prescribed but in 87%, pulse oximetry was either not done or the hypoxaemia threshold (SpO2 <90%) was not met. Lower chest-wall indrawing and other respiratory symptoms were associated with pulse oximetry use at admission and were also associated with oxygen prescription in the absence of pulse oximetry or hypoxaemia.Conclusion The adoption of pulse oximetry recommended in international guidelines for assessing children with severe illness has been slow and erratic, reflecting system and organisational weaknesses. Most oxygen orders at admission seem driven by clinical and situational factors other than the presence of hypoxaemia. Programmes aiming to implement pulse oximetry and oxygen systems will likely need a long-term vision to promote adoption, guideline development and adherence and continuously examine impact.