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Webinar: Hypoxemia in primary health care settings and implications for oxygen services - Shared screen with speaker view
Serekeberehan Deres
16:29
HI
Serekeberehan Deres
16:44
Serekeberehan Seyoum
Annamarie Saarinen
17:12
Annamarie Saarinen, Newborn Foundation
HARISH kumar
17:28
Harish Kumar-IPE Global
Serekeberehan Deres
18:16
Serekeberehan-UNICEF
Emma Sacks
19:32
Welcome everyone! Emma Sacks, Unicef HQ
Anne Detjen
20:21
Please enter any questions you may have in the chat. The presenters will respond directly and we will address key topics in the discussion.
HARISH kumar
21:18
Accuracy of finger pulse oximeter vs hand held pulse oximter
HARISH kumar
22:31
How accurate is pleth based RR used in multimodal devices
Ashiru Abubakar
22:52
Ashiru Abubakar, CHAI Nigeria
Annamarie Saarinen
22:54
Yes, Harish. Important...plus size of sensors to accommodate youngest patients.
Eric McCollum
22:57
Accuracy of finger vs hand held pulse oximeters depend on multiple factors, including the fit on the child’s toe or finger, movement artifact, the child’s perfusion status, dirt on fingers/toes, and the quality of the device itself and its tolerance to movement artifact etc.
HARISH kumar
23:19
What are the various multimodal devices available and their approval status
Eric McCollum
23:20
Also the ability of the HCW to optimize the measurement on the child is key
HARISH kumar
24:19
What is the utility of Pox in newborn in Outpatient setting and can this be used for traiaging
HARISH kumar
25:26
Is their utility of keeping Chest Indrawing in IMCI algorythm in settings with pulse oximetery
Tedbabe Hailegebriel
26:13
Do you have the prevalence in newborns?
Eric McCollum
27:04
What pulse oximeter was used in Uganda?
Annamarie Saarinen
27:32
Doing routine Sp02 screening of newborns prior to discharge or in primary delivery setting is critical.
Eric McCollum
27:36
Were different probes used for different aged patients
montse Renom-Llonch
29:13
Are patients supposed to go first to CHW-HC1-HC2 before getting to HC3? Wondering if referral problem starts at lower levels and therefore losing kids who may benefit from oxygen.
Santa engol
32:26
In Uganda we used Eden & Biotech Pulse oximters
HARISH kumar
35:20
What type are these. Finger probe or hand held?
Chahana Singh
36:58
MUAC for malnutrition?
HARISH kumar
38:09
What was prevalance of chest indrawing who had normal SPO2 and no fast breathing
Anne Detjen
38:18
From Usman Gebi: in the Jigawa group did you screen for TB symptoms or contact?
Santa engol
38:37
Ideally not very sick patients are supposed to seek health care at HCI & HCII, however, due to various challenges ranging from distance, availability of drugs etc patients may choose to go direct to HCIII level or even to higher level of care
Santa engol
39:59
They were hand held pulse oximeters
Anne Detjen
40:09
From Usman Gebi: Was the Lagos study in urban Lagos and was there any measurement of environmental common pollutants?
Santa engol
40:42
They were hand held pulse oximeters
Annamarie Saarinen
41:07
Thank you for this important work @Carina!
Darby Kirven
41:51
Thank you, Santa and Carina
Carina King
42:18
@chahana - we used MUAC and weight for age z-scores for assessing nutritional status, and assessed for oedema
Chahana Singh
42:50
Thanks Carina for clarification
Carina King
44:15
@Harish, in Jigawa, chest in drawing was not commonly recorded, only 0.7%. It’s very possible we missed cases of indrawing
Santa engol
45:59
The Pulse oximeters used had 3 different probes to cater for all age groups-Neonatal probe, Paediatrics probe & adult probe
Carina King
46:09
@Usman, no, we did not asses for TB, or ask about contacts with TB cases, which is a limitation, along with not conducting mRDTs or checking for a wider range of symptoms, like diarrhoea
HARISH kumar
46:30
Thanks Carina. we also found similar results. If large data sets are available may be if POX is included and RR counted we may do away with Chest Indrawing from IMCI algorythm
montse Renom-Llonch
46:41
When referring to non pneumonia RTI, was it based on clinical diagnosis or was it confirmed by XR?
Carina King
47:58
@Usman, in Lagos, the setting is Ikorodu, which is a peri-urban area, with some remote and hard to reach areas and some densely populated areas, but which aren’t not necessarily well served with healthcare services. Sadly, we have not collected any information on environmental pollution
HARISH kumar
48:33
If CFR with Moderate hypoxemia is 3.8% shont IMCI algorythm use <94% cUT OFF compared to 90 as per current guidelines
Usman Gebi
48:39
Thanks Carina.
Anne Detjen
50:54
Lack of appropriate patient files/documentation is a bottleneck to ensuring quality inpatient care
Tedbabe Hailegebriel
51:27
We’re the children started on antibioticspromptly?Their fluids snd electrolytes? Othe underlying
Tedbabe Hailegebriel
51:41
Conditions?
Tedbabe Hailegebriel
51:57
Prevalence of AMR?
Serekeberehan Deres
52:36
6. Consultant must submit a detailed work plan to his/her supervisor at the beginning of the contract period for the entire contract period.7. Supervisors will have the flexibility to review with the Consultant as needed on a monthly or quarterly basis.8. A monthly progress report should be provided by each Consultant to their supervisor for payment of Consultants fees.9. A detailed assignment report will be required at the end of the current contract period.@ Santa, How referral funds managed?
Bistra Zheleva
53:18
Part of this is the downstream capacity available, what happens to them once referred. Congenital heart disease can be an underlying condition in many.
Helena Hildenwall
54:58
@HARISH it is possible that the CFR was lower in our study due to the fact that study patients were all referred and thus more likely put on oxygen
Carl Schell
55:20
Hi Helena, Intersting study! For kids not being found in hospital, do you know/believe anything about reasons for this?
Helena Hildenwall
56:26
Thanks @Carl. We are currently looking into follow up data to better understand reasons
Angela Stene
57:16
Sorry--if this has been discussed (I missed some of this presentation)--have there been any recommendations of pulse oximeters that are cheaper than the $500 model discussed in the Bangladesh case? Are there any recommended pulse oximeters that aren't quite so expensive? What is the least expensive model that is still reliable? Would love recommendations. (Angela.Stene@thepalladiumgroup.com)
Carina King
57:47
@Carl, we also conducted qualitative interviews with caregivers who attended referrals and ones who did not, but just have not analysed these yet! But they were done to try and understand decision making...
Carl Schell
59:13
@Helena @Carina Thanks!
Carina King
59:43
@Angela, Malaria consortium did work exploring performance of different low cost paediatric oximeters, overall their results found fingertip devices were less reliable
Carina King
01:01:04
As part of the Lagos study, the healthcare workers will be randomised to recieve either a Lifebox, or a Masimo RadG, both around $250, so hopefully we’ll be able to see if there are any operational difference between these
montse Renom-Llonch
01:04:55
Below 94% kid has hypoxemia and this study shows that the need to provide O2 to kids with O2 sats below 94% since higher risk of mortality is there
Anne Detjen
01:05:17
For information: WHO will be reviewing pneumonia guidelines in the coming year.
Chahana Singh
01:05:19
Can hypoxemia measurement using pulse oximeter be done by CHWs at community level?
Santa engol
01:07:29
We didn't want to make things complicated that would end up being a barrier to referral itself. So the study nurses were requested to submit to CHAI a copy of referral forms with patients details, Ambulance or any other vehicle mileage & vehicle registration number as supporting document. Then Drivers' allowance & fuel would be reimbursed direct from CHAI office
montse Renom-Llonch
01:13:27
@Eric, as a Pediatritian had the same question mark. Why 90% in WHO guidelines? Usually we provide O2 when O2 sats <94-93% in developed countries unless this has changed in recent years…(taking into account all other aspects you mentioned of course)
Anne Detjen
01:14:29
For a comprehensive toolbox of oxygen resources, please see here: https://drive.google.com/drive/folders/1HALIhx3ft75ifyrUpP784DEiARzvPULQ?usp=sharing
Eric McCollum
01:14:36
@montse; not 100% sure why <90% other than the scarcity of oxygen resources driving that threshold
Usman Gebi
01:14:58
Thanks everyone for an excellent session.
montse Renom-Llonch
01:15:05
It may be…but still…
Anne Detjen
01:15:09
Thank you everyone! All presentations will be shared on the CHTF website
Anima Sharma
01:15:34
Thank you
Anima Sharma
01:15:49
It was a great session.
Anne Detjen
01:15:51
If you want to know more about the activities and webinars of the QoC subgroup check here: https://docs.google.com/spreadsheets/d/1X5XdqVb6AxZHy_AvivA3UfcO8mGjE3DWwMqFezp1jP4/edit?usp=sharing
montse Renom-Llonch
01:15:55
Thanks for great presentation!
Helena Hildenwall
01:15:59
@montse this is exactly what I fail to understand as well. In high income countries we would not send away a child with sats of 91%...
Chahana Singh
01:16:03
Thank you very much for this important webinar
Anne Detjen
01:16:07
Feel free to reach out with ideas of activities or work you would like to share