{
  "abstract": "Background The Integrated Management of Childhood Illness (IMCI) guidelines are symptom-based algorithms used to identify critically ill children under five in primary health centres (PHC) in resource-limited countries. Hypoxaemia, a life-threatening event, is clinically underdiagnosed. The Amélioration de l'Identification des détresses Respiratoires de l'Enfant/Improving Identification of Respiratory Distress in Children (AIRE) project implemented the routine use of pulse oximetry (PO) within IMCI consultations to improve the diagnosis and management of severe hypoxaemia (pulse blood oxygen saturation <90%) at PHC level in Burkina Faso, Guinea, Mali and Niger. In this context, we measured the prevalence of severe cases and their associated social and structural factors among outpatients.Methods In 16 AIRE research PHC (4/country), all the children under five attending IMCI consultations, except those aged 2–59 months classified as simple case without cough or breathing difficulties, were eligible for the use of PO and enrolled in a cross-sectional study with parental consent. Severe IMCI+PO cases were IMCI severe cases or those with severe hypoxaemia.Results From June 2021 to June 2022, 968 neonates (0–59 days) and 14 868 children (2–59 months) were included. Prevalence of severe IMCI+PO cases was heterogeneous between countries: 5.0% in Burkina Faso, 6.1% in Niger, 18.9% in Mali and 44.6% in Guinea. Among neonates, 21.9% (95% CI 19.3 to 24.6) were severe cases versus 12.0% (95% CI 11.4 to 12.5) in older children, of which 3.3% versus 0.8%, respectively (p<0.001), had severe hypoxaemia. The adjusted social and structural factors associated with disease severity common to all four countries were as follows: age <2 months or >2 years, IMCI consultation delay >2 days, home to PHC travel time >30 min.Conclusion The prevalence of seriously ill children under five, including severe hypoxaemia, was high in PHC, particularly in neonates. The high between-country heterogeneity may be explained by differences in case definitions (Guinea) and structural factors (accessibility). Improving early access to primary care could be an actionable lever to improve the health of West African children.",
  "authors": [
    {
      "affiliations": [
        "Toulouse University, Inserm, Centre for Epidemiology and Research in Population Health (CERPOP), Toulouse, France"
      ],
      "name": "Kessièdé Gildas Boris Hedible"
    },
    {
      "affiliations": [
        "Tdh, Terre des Hommes, Ouagadougou, Burkina Faso"
      ],
      "name": "Abdoul Guaniyi Sawadogo"
    },
    {
      "affiliations": [
        "Toulouse University, Inserm, Centre for Epidemiology and Research in Population Health (CERPOP), Toulouse, France"
      ],
      "name": "Zineb Zair"
    },
    {
      "affiliations": [
        "ALIMA, The Alliance for International Medical Action, Bamako, Mali"
      ],
      "name": "Désiré G Kargougou"
    },
    {
      "affiliations": [
        "Toulouse University, Inserm, Centre for Epidemiology and Research in Population Health (CERPOP), Toulouse, France"
      ],
      "name": "Honorat Agbeci"
    },
    {
      "affiliations": [
        "Solthis, Solidarité Thérapeutique et Initiatives pour la Santé, Niamey, Niger"
      ],
      "name": "Bertrand Meda"
    },
    {
      "affiliations": [
        "Toulouse University, Inserm, Centre for Epidemiology and Research in Population Health (CERPOP), Toulouse, France"
      ],
      "name": "Lucie Peters Bokol"
    },
    {
      "affiliations": [
        "ALIMA, Conakry, Guinea"
      ],
      "name": "Jacques Kolié"
    },
    {
      "affiliations": [
        "CLERSE (Lille Centre for Sociological and Economic Research and Studies), University of Lille, Lille, France"
      ],
      "name": "Sarah Louart"
    },
    {
      "affiliations": [
        "CHU de Bogodogo, Ouagadougou, Burkina Faso"
      ],
      "name": "Solange Ouédraogo Yugbaré"
    },
    {
      "affiliations": [
        "CHU Gabriel Touré, Bamako, Mali"
      ],
      "name": "Abdoul Aziz Diakite"
    },
    {
      "affiliations": [
        "Institut de Nutrition et de Santé pour Enfants, Conakry, Guinea"
      ],
      "name": "Ibrahima Sory Diallo"
    },
    {
      "affiliations": [
        "Ministère de la Santé, des Populations et des Affaires Sociales, Niamey, Niger"
      ],
      "name": "Hannatou Abarry Souleymane"
    },
    {
      "affiliations": [
        "ALIMA, The Alliance for International Medical Action, Dakar, Senegal"
      ],
      "name": "Désiré Neboua"
    },
    {
      "affiliations": [
        "ALIMA, The Alliance for International Medical Action, Dakar, Senegal"
      ],
      "name": "Marine Vignon"
    },
    {
      "affiliations": [
        "Tdh, Terre des Hommes, Dakar, Sénégal"
      ],
      "name": "Sandrine Busière"
    },
    {
      "affiliations": [
        "Solthis, Solidarité Thérapeutique et Initiatives pour la Santé, Paris, France"
      ],
      "name": "Franck Lamontagne"
    },
    {
      "affiliations": [
        "Université Paris Cité and Université Sorbonne Paris Nord, IRD, Inserm, Ceped, F-75006, Paris, France",
        "Institut de Santé et Développement, Université Cheikh Anta Diop, Dakar, Sénégal"
      ],
      "name": "Valery Ridde"
    },
    {
      "affiliations": [
        "Toulouse University, Inserm, Centre for Epidemiology and Research in Population Health (CERPOP), Toulouse, France"
      ],
      "name": "Valeriane Leroy"
    },
    {
      "affiliations": [],
      "name": "for the AIRE Research Study Group"
    }
  ],
  "title": "Prevalence and factors associated with severe illness in West African children under 5 years of age detected with routine pulse oximetry in primary care",
  "uid": "3a16f639-eb75-5191-a174-a64cf0f4ce57"
}