Evaluation of the routine implementation of pulse oximeters into integrated management of childhood illness (IMCI) guidelines at primary health care level in West Africa: the AIRE mixed-methods research protocol

• Published in: BMC health services research Vol. 22; no. 1; pp. 1579 - 20
• Main Authors: Hedible, Gildas Boris, Louart, Sarah, Neboua, Désiré, Catala, Laura, Anago, Gildas, Sawadogo, Abdoul-Guaniyi, Kargougou, G Désiré, Meda, Bertrand, Kolié, Jacques Séraphin, Hema, Adama, Keita, Sory, Niome, Mactar, Savadogo, Abdoul Salam, Peters-Bokol, Lucie, Agbeci, Honorat, Zair, Zineb, Lenaud, Severin, Vignon, Marine, Ouedraogo Yugbare, Solange, Abarry, Hannatou, Diakite, Abdoul Aziz, Diallo, Ibrahima Sory, Lamontagne, Franck, Briand, Valérie, Dahourou, Désiré Lucien, Cousien, Anthony, Ridde, Valéry, Leroy, Valériane
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 24.12.2022; BioMed Central; BMC
• Subjects: Antibiotics; Burkina Faso; Child; Children; Children & youth; Cross-Sectional Studies; Delivery of Health Care, Integrated; Demographic aspects; Diseases; Evaluation; Hospitals; Human health and pathology; Humans; Illnesses; Implementation research; Integrated management of childhood illness; Life Sciences; Malaria; Malnutrition; Management; Medical personnel; Meningitis; Mixed methods research; Mortality; Oxygen; Oxygen saturation; Oxygen therapy; Pediatrics; Pneumonia; Practice guidelines (Medicine); Primary care; Primary Health Care; Prospective Studies; Pulse oximeter; Pulse oximetry; Respiratory diseases; Santé publique et épidémiologie; Sepsis; Study Protocol; Tissues and Organs; West Africa; Burkina Faso; Africa; Uganda; Nigeria; West Africa; Integrated management of childhood illness; Pulse oximeter; Implementation research; Children; Primary health care; West Africa
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-022-08982-4

The AIRE operational project will evaluate the implementation of the routine Pulse Oximeter (PO) use in the integrated management of childhood illness (IMCI) strategy for children under-5 in primary health care centers (PHC) in West Africa. The introduction of PO should promote the accurate identification of hypoxemia (pulse blood oxygen saturation Sp02 < 90%) among all severe IMCI cases (respiratory and non-respiratory) to prompt their effective case management (oxygen, antibiotics and other required treatments) at hospital. We seek to understand how the routine use of PO integrated in IMCI outpatients works (or not), for whom, in what contexts and with what outcomes. The AIRE project is being implemented from 03/2020 to 12/2022 in 202 PHCs in four West African countries (Burkina Faso, Guinea, Mali, Niger) including 16 research PHCs (four per country). The research protocol will assess three complementary components using mixed quantitative and qualitative methods: a) context based on repeated cross-sectional surveys: baseline and aggregated monthly data from all PHCs on infrastructure, staffing, accessibility, equipment, PO use, severe cases and care; b) the process across PHCs by assessing acceptability, fidelity, implementation challenges and realistic evaluation, and c) individual outcomes in the research PHCs: all children under-5 attending IMCI clinics, eligible for PO use will be included with parental consent in a cross-sectional study. Among them, severe IMCI cases will be followed in a prospective cohort to assess their health status at 14 days. We will analyze pathways, patterns of care, and costs of care. This research will identify challenges to the systematic implementation of PO in IMCI consultations, such as health workers practices, frequent turnover, quality of care, etc. Further research will be needed to fully address key questions such as the best time to introduce PO into the IMCI process, the best SpO2 threshold for deciding on hospital referral, and assessing the cost-effectiveness of PO use. The AIRE research will provide health policy makers in West Africa with sufficient evidence on the context, process and outcomes of using PO integrated into IMCI to promote scale-up in all PHCs. Trial registration number: PACTR202206525204526 retrospectively registered on 06/15/2022.