Webinar: Hypoxemia in primary health care settings and implications for oxygen services - Shared screen with speaker view
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Annamarie Saarinen, Newborn Foundation
Harish Kumar-IPE Global
Welcome everyone! Emma Sacks, Unicef HQ
Please enter any questions you may have in the chat. The presenters will respond directly and we will address key topics in the discussion.
Accuracy of finger pulse oximeter vs hand held pulse oximter
How accurate is pleth based RR used in multimodal devices
Ashiru Abubakar, CHAI Nigeria
Yes, Harish. Important...plus size of sensors to accommodate youngest patients.
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.
What are the various multimodal devices available and their approval status
Also the ability of the HCW to optimize the measurement on the child is key
What is the utility of Pox in newborn in Outpatient setting and can this be used for traiaging
Is their utility of keeping Chest Indrawing in IMCI algorythm in settings with pulse oximetery
Do you have the prevalence in newborns?
What pulse oximeter was used in Uganda?
Doing routine Sp02 screening of newborns prior to discharge or in primary delivery setting is critical.
Were different probes used for different aged patients
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.
In Uganda we used Eden & Biotech Pulse oximters
What type are these. Finger probe or hand held?
MUAC for malnutrition?
What was prevalance of chest indrawing who had normal SPO2 and no fast breathing
From Usman Gebi: in the Jigawa group did you screen for TB symptoms or contact?
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
They were hand held pulse oximeters
From Usman Gebi: Was the Lagos study in urban Lagos and was there any measurement of environmental common pollutants?
They were hand held pulse oximeters
Thank you for this important work @Carina!
Thank you, Santa and Carina
@chahana - we used MUAC and weight for age z-scores for assessing nutritional status, and assessed for oedema
Thanks Carina for clarification
@Harish, in Jigawa, chest in drawing was not commonly recorded, only 0.7%. It’s very possible we missed cases of indrawing
The Pulse oximeters used had 3 different probes to cater for all age groups-Neonatal probe, Paediatrics probe & adult probe
@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
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
When referring to non pneumonia RTI, was it based on clinical diagnosis or was it confirmed by XR?
@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
If CFR with Moderate hypoxemia is 3.8% shont IMCI algorythm use <94% cUT OFF compared to 90 as per current guidelines
Lack of appropriate patient files/documentation is a bottleneck to ensuring quality inpatient care
We’re the children started on antibioticspromptly?Their fluids snd electrolytes? Othe underlying
Prevalence of AMR?
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?
Part of this is the downstream capacity available, what happens to them once referred. Congenital heart disease can be an underlying condition in many.
@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
Hi Helena, Intersting study! For kids not being found in hospital, do you know/believe anything about reasons for this?
Thanks @Carl. We are currently looking into follow up data to better understand reasons
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)
@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...
@Helena @Carina Thanks!
@Angela, Malaria consortium did work exploring performance of different low cost paediatric oximeters, overall their results found fingertip devices were less reliable
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
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
For information: WHO will be reviewing pneumonia guidelines in the coming year.
Can hypoxemia measurement using pulse oximeter be done by CHWs at community level?
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
@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)
For a comprehensive toolbox of oxygen resources, please see here: https://drive.google.com/drive/folders/1HALIhx3ft75ifyrUpP784DEiARzvPULQ?usp=sharing
@montse; not 100% sure why <90% other than the scarcity of oxygen resources driving that threshold
Thanks everyone for an excellent session.
It may be…but still…
Thank you everyone! All presentations will be shared on the CHTF website
It was a great session.
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
Thanks for great presentation!
@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%...
Thank you very much for this important webinar
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