Table 2.

Impact of pulse oximetry on management of acute febrile illness or associated syndromes

Study	Study design	Syndrome	Intervention and comparison groups	Outcome measure	Participants	Age range	Setting	Country (continent)	Reported effect
McCollum et al32	Retrospective secondary analysis of prospective cohort study data	Pneumonia	PO+IMCI vs PO+Malawi guideline 2000 vs IMCI35 vs Malawi guideline 200036*	Missed eligibility for referral to hospital	14092 children with pneumonia	2–59 months	18 rural health centres and 38 village clinics	Malawi (Africa)	At rural health centres, IMCI resulted in 390/938 (41.5%) missed eligible referrals and Malawi guideline 2000 in 143/1761 (8.1%) if PO not used At village clinics, both IMCI and Malawi guideline 2000 resulted in 52/990 (5.3%) missed eligible referrals if PO not used
Hooli et al29	Retrospective secondary analysis of prospective cohort study data	Pneumonia	PO+IMCI vs PO+Malawi guideline 2000 vs IMCI35 vs Malawi guideline 200036*	Missed eligibility for referral to hospital	261 infants with cough and/or shortness of breath	<2 months	18 rural health centres	Malawi (Africa)	IMCI resulted in 1/238 (0.4%) missed referral if PO not used, and Malawi guideline 2000 1/236 (0.4%) If hypoxaemia was defined as SpO2 <93%, IMCI resulted in 2/238 (0.8%) missed referral if PO not used, and Malawi guideline 2000 4/236 (1.7%)
Tesfaye et al31	Parallel cluster-randomised trial	Pneumonia	PO+IMCI vs IMCI35*	Referral to hospital	1804 children with cough or difficulty breathing <14 days	2–59 months	24 rural primary health centres	Ethiopia (Africa)	116/148 (78.4%, 95% CI 67.6 to 89.2) referred in PO+IMCI group vs 15/34 (44.1%, 95% CI 6.9 to 81.3) in IMCI group, p=0.496
Sylvies et al23	Uncontrolled before-and-after study	Non-malarial fever	PO+IMCI vs IMCI35 vs Malawi guideline 2019 vs Malawi guideline 2016*†	Antibiotic prescription	3504 children with non-malarial fever	0–59 months	Five mobile rural health clinics	Malawi (Africa)	336/795 (42.2%) prescribed antibiotics in PO+IMCI group vs 150/178 (84.2%) in IMCI group vs 485/571 (84.9%) in Malawi guideline 2019 group vs 1461/1960 (74.5%) in Malawi guideline 2016 group, p<0.001 OR for reduced antibiotic prescription in PO+IMCI group vs IMCI group 7.3 (95% CI 4.8 to 11.4); vs Malawi guideline 2019 group 7.9 (95% CI 6.1 to 10.5); vs Malawi guideline 2016 group 4.0 (95% CI 3.3 to 4.7)

All interventions incorporating pulse oximetry included a staff training component. Hypoxaemia was defined as peripheral oxygen saturation (SpO₂) <90% unless indicated otherwise.

*Intervention groups with pulse oximetry included a staff training component on the use of pulse oximetry.

†Hypoxaemia defined as SpO₂ <95%.

IMCI, WHO Integrated Management of Childhood Illness guideline 2014; PO, pulse oximetry.