29 Nov Digital health tools for child survival
From Every Breath Counts member, PATH
Preventable deaths from hypoxemia, or low levels of oxygen in the blood, occur daily. Hypoxemia can be caused by a range of common conditions, including pneumonia, which stubbornly remains the leading infectious cause of death among children under five years of age. Inability to detect hypoxemia is often to blame. That is why tools like pulse oximetry are considered a critical component of the child survival agenda, as they offer a lifeline to those who urgently need oxygen therapy to breathe.
Pulse oximeters are devices that measure oxygen saturation in the blood (SpO2), along with heart rate. They are noninvasive and can be used across all populations, including newborns, infants, and children under five. Their main function is to alert health care workers to dangerously low oxygen levels and help assess the need for supplemental oxygen therapy. They are easy to use and give health care workers critical information to detect patients who are severely ill and need urgent care.
Despite their lifesaving potential, these tools are not widely available in primary health care facilities. In Kenya, challenges impeding their widespread use include lack of resources, impact data, prioritization at the national and county levels, supportive infrastructure for oxygen delivery, and health care provider training and adherence to the Integrated Management of Newborn and Childhood Illness (IMNCI) guidelines.
That is why PATH, in partnership with the Swiss Tropical and Public Health Institute and the University of Nairobi, is leading in Kenya as part of the Tools for Integrated Management of Childhood Illness (TIMCI) initiative. The project aims to improve screening and diagnosis in sick children under five in India, Kenya, Senegal, and Tanzania by increasing access to pulse oximetry and electronic clinical decision support algorithms — tools that organize patient data and symptoms through a digital application and connect that information to the relevant IMNCI guidelines.
In 2020, with support from Unitaid, TIMCI facilitated pulse oximeter donations as part of the COVID-19 pandemic response: 89 oximeters were donated to 65 hospital facilities across six counties in Kenya, supported by training on their use and maintenance “Pulse oximeters have made it easier for us to manage children, especially during the period of the COVID-19 pandemic,” said D. John Otieno, Kakamega County Director of Health Services. This is a good example of how small digital health tools can make a big difference.
In 2021, PATH is introducing pulse oximetry and decision support algorithms in 60 facilities across three counties in Kenya. Over the next two years, we will generate evidence and cost-effectiveness data for the use of these tools at the primary healthcare level that will help with broader scale-up and offer learnings for planning and introduction, including budgeting, supply chain management, training and supervision, monitoring, and community sensitization.
Benefits of using pulse oximetry are already being felt at the TIMCI pilot study sites, as highlighted by Christine Kingoo, a health care provider at our site in Kitui County, who reports:
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- Introduction of pulse oximeters allowed for monitoring of children’s pulse rates and SpO2 levels. Prior to that, health care workers depended on temperature and respiratory rate measurements to detect illness, and only very sick children had their pulse rate taken
- Clinical decision support algorithms help health care workers adhere to IMNCI guidelines, and identify frequently missed classifications, such as malnutrition, children who missed vitamin A supplementation, and deworming
- They also enable health care workers to reach the right diagnosis and calculate correct dosages of pediatric drugs, while circumventing inappropriate use of antibiotics
- Pulse oximeters and algorithms improve the overall standard of care, so more children come to the health facility
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Beyond these benefits, PATH is seeing improvements in data entry in the under-five registers and in the quality of counseling of caregivers and their children. “Clinical decision support algorithms leave no part untouched in the assessment of sick children and offer great insight into the needs of my patients,” said Joshua Masai, a health care provider from our site in Uasin Gishu County. “The digital tool offers step-by-step instructions for emergency, referral, and follow-up, and gives a caregiver a sense of comfort when they see us exploring all areas of their child’s illness.”
The overall project evidence will provide key information to help us address challenges and facilitate transition to digital health platforms in general as a country. It will also help inform country-level decisions on scale-up and global-level decisions on broader policy and guidelines for the use of pulse oximetry and CDSAs in PHC settings.
As we count down to 2030, it is more urgent than ever that countries maintain a strong focus on accelerating action to bring down child pneumonia deaths and improve progress toward child survival. Equitable access to pulse oximetry, paired with oxygen therapy, is a critical component of that ambitious target. It is paramount that champions at local, national, and international levels prioritize integrated approaches to pneumonia prevention and control that include access to critical electronic health tools like pulse oximetry, as well as digital platforms that enable their use, high on their agendas.
This article is in support of Digital Health Week
November 2021