Table 4.

Studies describing pulse oximetry training initiatives: paediatric assessment and monitoring*

WHERE: country (LMIC designation), sites	WHEN: year of training	WHO: population trained	WHY: purpose of training	WHAT: structure of training	HOW: pulse oximetry related outcomes
African Region
Ethiopia (LIC), first-level health facilities and in the community in Sodo Zuria, Damote Sore, and Damote Gale districts [66]	2018	Health extension workers and first-level health facility workers	Assessment of children with respiratory illness	2-d iCCM/IMNCI and pulse oximetry training	83.9% of pneumonia consultations were assessed using pulse oximetry in the 2 mo following training
Malawi (LIC), Health centres in Lilongwe and Mchinji districts [67,68]	2011	Rural practitioners and community health workers	Improve identification of children with severe respiratory illness	1-d training with continued monthly mentorship visits	94.1% of children had oxygen saturation measured during the 3 y after training. Moderate agreement was found between expert oxygen saturation measurements and newly trained providers. Pulse oximetry identified fatal episodes of childhood pneumonia that did not have identified clinical signs.
Malawi (LIC), 1 hospital in Lilongwe [69]	2011	Nurses, clinicians, and vital sign assistants (VSAs)	Improve inpatient paediatric surveillance	Half-day training for nurses, 2-d training for VSAs based on PEWS concepts	Patients' vital signs, including oxygen saturation, were monitored more frequently and accurately than before the training when VSAs were included in the health care team.
Malawi (LIC), 2 clinics in the Mulanje district [70]	2019	Clinical officers and nurses	Assessing whether pulse oximeter screening in addition to IMCI education improves respiratory illness diagnosis and decreases antibiotic prescriptions in children	1-h long session using WHO pulse oximetry manual supplemented with additional recommendations	30% of children were evaluated with pulse oximeters at clinics with this capability. Clinic sites with pulse oximeters improved illness classification (diagnosed severe respiratory illnesses less frequently in children with normal oxygen saturation and more frequently in children with low oxygen saturation) and prescribed antibiotics less frequently. Pulse oximeters improved provider confidence.
Sierra Leone (LIC), 1 hospital in Freetown [71]	2009	Nurses	Improve paediatric hospital emergency medical care	4-d adapted WHO Emergency Triage Assessment and Treatment course	Decreased mortality rate immediately and 4 mo after interventions
Zambia (LMIC), 1 hospital in Lusaka [72]	2013	Nurses	Implementation of a clinical guidance tool, which included prompts for regular vital sign checks (including oxygen saturation), to improve the care of children hospitalised with pneumonia	Modified WHO recommendations for the management of acute respiratory illness were used to make the tool	Nurses believed the clinical guidance tool led to improved care through closer and more consistent monitoring and rapid identification of problems. Increase of the proportion of children with oxygen saturation ≤92% receiving oxygen on admission (83.3% vs. 93.8%) and at 48 h follow-up (76.4% vs. 95.3%)

LMIC – lower middle-income country, LIC – low-income country, d – days, iCCM/IMNCI – integrated community case management/integrated management of newborn and childhood illnesses, mo – months, PEWS – paediatric early warning score, IMCI – integrated management of childhood illness, h – hours, WHO – World Health Organization

*Stratified by WHO Regions.