Table 3.

Impact of pulse oximetry on outcomes 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
Duke et al24	Uncontrolled before-and-after study	Community-acquired pneumonia	PO vs clinical signs*	30-day mortality	961 children with severe or very severe pneumonia	>28 days and <5 years	Single rural hospital at high altitude	Papua New Guinea (Australasia)	Mortality rate in PO group 46/703 (6.5%) vs 26/258 (10%) in clinical signs group RR 0.65 (95% CI 0.41 to 1.02, p=0.07)
Duke et al25	Uncontrolled before-and-after study	Community-acquired pneumonia	PO+improved oxygen system vs standard care†	In-hospital mortality	11291 children with pneumonia	>1 month and <5 years	Five rural hospitals	Papua New Guinea (Australasia)	Mortality in intervention group 133/4130 (3.22%, 95% CI 2.7% to 3.8%) vs 356/7161 (4.97%, 95% CI 4.5 to 5.5) in comparison group RR 0.65 (95% CI 0.52 to 0.78), p<0.0001
Graham et al26	Stepped-wedge cluster RCT	ALRI, malaria, AFE, neonatal sepsis	PO+improved oxygen system vs PO+standard care vs standard care§	Mortality (in-hospital or discharged expected to die)	3828 children with ALRI, 6113 children with AFE, 11 092 children with malaria and 7515 neonates with sepsis‡	0 days to <15 years	Nine general and three paediatric/maternity urban hospitals	Nigeria (Africa)	ALRI: aOR for PO+standard care vs standard care 0.33 (95% CI 0.12 to 0.92), p=0.035; for PO+improved oxygen package vs PO+standard care 1.42 (95% CI 0.60 to 3.36), p=0.427 Malaria, AFE and neonatal sepsis: neither PO+improved oxygen system nor PO+standard care significantly affected aORs for mortality from these conditions vs standard care
Colbourn et al27	Prospective data linkage study	Community-acquired pneumonia	PO+Malawi guideline 2000 vs Malawi guideline 2000†36	30-day mortality	13814 children with pneumonia	0–59 months	Mobile rural village clinics run by 38 community health workers and 18 rural health centres	Malawi (Africa)	PO would have identified 1/16 (6%) additional death at mobile rural village clinic level compared with Malawi guideline 2000 regardless of whether hypoxaemia was defined as SpO2 <90% or <93% PO would not have identified any additional deaths at rural health centre level compared with Malawi guideline 2000 regardless of whether hypoxaemia was defined as SpO2 <90% or <93%
Duke et al28	Uncontrolled before-and-after study	Community-acquired pneumonia	PO+improved oxygen system+QI vs Standard care†	In-hospital mortality	18933 neonates and children with pneumonia‡	0–13 years	36 rural hospitals	Papua New Guinea (Australasia)	IR for deaths per 100 pneumonia admissions in intervention group 1.17 (95% CI 0.48 to 1.86) vs 2.83 (95% CI 1.98 to 4.06) IRR 0.41 (95% CI 0.24 to 0.71, p<0.005)
Tesfaye et al31	Parallel cluster-randomised trial	Community-acquired pneumonia	PO+IMCI vs IMCI†35	Treatment failure at 14 days§	1804 children with cough or difficulty breathing <14 days	2–59 months	24 rural primary health centres	Ethiopia (Africa)	132/928 (14.2%, 95% CI 6.0 to 22.4) failed treatment in the PO+IMCI group vs 93/876 (10.6%, 95% CI 5.2 to 16.1) in the IMCI group, p=0.622

Hypoxaemia was defined as peripheral oxygen saturation (SpO₂) <90% unless indicated otherwise.

*Hypoxaemia defined as SpO₂ <85%.

†Intervention groups with pulse oximetry included a staff training component.

‡Prespecified subgroup analysis.

§Defined as the development or persistence of general danger signs, persistence of fever, persistence of tachypnoea, chest wall indrawing, presence of persistent cough, recurrence of fever, withdrawal from the trial or death.

AFE, acute febrile encephalopathy; ALRI, acute lower respiratory infection; aOR, adjusted OR; IMCI, WHO Integrated Management of Childhood Illness 2014; IR, incidence rate; IRR, incidence rate ratio; PO, pulse oximetry; QI, quality improvement; RCT, randomised controlled trial; RR, risk ratio.