29 Nov Digital health tools to accelerate action toward child survival
This article is in support of #DigitalHealthWeek, 29 November – 3 December 2021
Author: Andolo Miheso, TIMCI Kenya Project Lead, 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 electronic health 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 electronic 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, accurate, and give health care workers critical patient information to detect children who are severely ill and need urgent care.
Despite their lifesaving potential, these simple tools are not widely available in primary health care (PHC) facilities. In Kenya, challenges impeding their widespread use include limited resources and lack of health impact data, lack of prioritization at the national and county levels, lack of supportive infrastructure for oxygen delivery, lack of health care provider training and adherence to the Integrated Management of Newborn and Childhood Illness (IMNCI) guidelines, and lack of a broader digital platform that helps strengthen that adherence.
That is why I am so excited about the work 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 (CDSAs)— 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 subcounty and county hospital facilities across six counties in Kenya, supported by training on their use and maintenance for the facility managers. “Pulse oximeters have made it easier for us to manage children, especially during the period of the COVID-19 pandemic,” said Dr. John Otieno, Kakamega County Director of Health Services. This is a good example of how small digital health tools can make a big difference.
Today, as part of the TIMCI research effort, we are introducing pulse oximetry and CDSAs in 60 PHC 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 PHC 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 and CDSAs 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:
- 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.
- CDSA use helps health care workers adhere to IMNCI guidelines, and identify frequently missed classifications, such as malnutrition, children who missed vitamin A supplementation, and deworming.
- CDSA use enables health care workers to reach the right diagnosis and calculate correct dosages of pediatric drugs, while circumventing inappropriate use of antibiotics.
- Pulse oximeter and CDSA use improve the overall standard of care, as more children are coming to the health facility.
Beyond these benefits, we are seeing improvements in data entry in the under-five registers and in the quality of counseling of caregivers and their children. “CDSAs 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.”
I am optimistic that our experience with CDSAs will help demonstrate the quality of care offered to sick children and how these digital tools reinforce the use of pulse oximetry and improve overall adherence to IMNCI guidelines by health care workers.
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.
29 November 2021