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Objective To investigate implementation of outpatient pulse oximetry among children with pneumonia, in Malawi. Methods In 2011, 72 health-care providers at 18 rural health centres and 38 community health workers received training in the use of pulse oximetry to measure haemoglobin oxygen saturations. Data collected, between 1 January 2012 and 30 June 2014 by the trained individuals, on children aged 2-59 months with clinically diagnosed pneumonia were analysed. Findings Of the 14 092 children included in the analysis, 13 266 (94.1 %) were successfully checked by oximetry. Among the children with chest indrawing and/or danger signs, those with a measured oxygen saturation below 90% were more than twice as likely to have been referred as those with higher saturations (84.3% [385/457] vs 41.5% [871/2099]; P< 0.001). The availability of oximetry appeared to have increased the referral rate for severely hypoxaemic children without chest indrawing or danger signs from 0% to 27.2% {P< 0.001). In the absence of oximetry, if the relevant World Health Organization (WHO) guidelines published in 2014 had been applied, 390/568 (68.7%) severely hypoxaemic children at study health centres and 52/84 (61.9%) severely hypoxaemic children seen by community health workers would have been considered ineligible for referral. Conclusion Implementation of pulse oximetry by our trainees substantially increased the referrals of Malawian children with severe hypoxaemic pneumonia. When data from oximetry were excluded, retrospective application of the guidelines published by WHO in 2014 failed to identify a considerable proportion of severely hypoxaemic children eligible only via oximetry. Objectif Etudier l'utilisation de l'oxymetrie de pouls chez les enfants atteints de pneumonie en traitement ambulatoire au Malawi. Methodes En 2011,72 prestataires de soins de sante de 18 centres de sante ruraux et 38 agents de sante communautaires ont ete formes a l'utilisation de l'oxymetrie de pouls pour mesurer la saturation en oxygene de l'hemoglobine. Des donnees collectees entre le 1er janvler 2012 et le 30 juin 2014 par les individus formes sur des enfants ages de 2 a 59 mois atteints d'une pneumonle clinlquement diagnostiquee ont ete analysees. Resultats Sur les 14 092 enfants Indus dans l'analyse, 13 266 (94,1%) ont ete examlnes avec succes grace a roxymetrle. Parml les enfants presentant un tlrage sous-costal et/ou des signes de danger, ceux dont la saturation en oxygene mesuree etalt inferleure a 90% avalent plus de deux fois plus de chances d'etre orientes vers un spedaliste que ceux presentant une saturation plus Importante (84,3% [385/457] contre 41,5% [871/2099]; P< 0,001). L'utilisation de l'oxymetrie semble avoir augmente de 0% a 27,2% (P < 0.001) le taux d'orientation vers un spedaliste dans le cas des enfants souffrant d'hypoxemle severe sans tirage sous-costal ni signes de danger. En /absence d'oxymetrle, si les directives en la matlere publlees par /Organisation mondlale de la Sante (OMS) en 2014 avalent ete appllquees, 390/568 (68,7%) enfants souffrant d'hypoxemle severe examlnes dans les centres de sante conslderes et 52/84(61,9%) enfants souffrant d'hypoxemie severe examlnes par des agents de sante communautalres n'auraient pas pu beneficier d'une orientation vers un spedaliste. Conclusion L'utilisation de l'oxymetrie de pouls par les individus formes a considerablement accru l'orientation vers un spedaliste des enfants malawltes atteints de pneumonle severe et ayant developpe une hypoxemle. Lorsque les donnees provenant de l'oxymetrie etaient exclues, l'application retrospective des directives publlees par I'OMS en 2014 ne permettalt pas d'ldentlfier une proportion considerable d'enfants souffrant d'hypoxemle severe qul rempllssalent les conditions requises uniquement au vu de l'oxymetrie. Objetivo Investigar la implementacion investigar ia impiementacion de la oximetria de pulso ambulatoria en ninos con neumonia en Malawi. Metodos En 2011,72 profesionales de la salud de 18 centros de salud en zonas rurales y 38 trabajadores de la salud comunitarios recibieron formacion con respecto al uso de la oximetria de pulso para medir las saturaciones de oxigeno de la hemoglobina. Se analizaron los datos, que las personas formadas recopilaron entre el 1 de enero de 2012 y el 30 de junio de 2014, de ninos de 2 a 59 meses de edad con un diagnostico clinico de neumonia. Resultados De los 14 092 ninos incluidos en el analisis, se realizaron las pruebas con oximetria de manera satisfactoria a 13 266 (94,1%). Entre los ninos con retraccion costal y/o signos de peligro, aquellos con una medida de saturacion de oxigeno por debajo del 90% tenian mas del doble de probabilidades de haber sido derivados que aquellos con saturaciones mas elevadas (84,3% [385/457] frente al 41,5% [871/2 099]; P < 0,001). La disponibilidad de la oximetria parecio haber incrementado la tasa de derivacion para ninos hlpoxemicos graves sin retraccion costal ni signos de peligro del 0% al 27,2% (P < 0,001). A falta de oximetria, si se hubieran aplicado las directrices de la Organizacion Mundial de la Salud (OMS) pertinentes publicadas en 2014, se podria haber considerado que 390/568 (el 68,7%) de los ninos hipoxemlcos graves en los centros sanitarios del estudio y 52/84 (el 61,9%) de los ninos hlpoxemicos graves visitados por los trabajadores de salud comunitarios no eran elegibles para la derivacion. Conclusion La implementacion de la oximetria de pulso por las personas formadas Incremento de forma sustancial las derivaciones de los ninos de Malawi con neumonia hlpoxemlca grave. Cuando se excluyeron los datos procedentes de la oximetria, la aplicacion retrospectiva de las directrices publicadas por la OMS en 2014 no pudo identificar un porcentaje considerable de ninos hipoxemlcos graves que cumplian los requisitos unicamente a traves de la oximetria., Introduction Among children with pneumonia; hypoxaemia is common, predicts mortality and is a marker of severe illness. (1-3) Pulse oximetry--hereafter called oximetry--is the standard tool for non-invasively measuring peripheral arterial [...]

Background The mortality impact of pulse oximetry use during infant and childhood pneumonia management at the primary healthcare level in low-income countries is unknown. We sought to determine mortality outcomes of infants and children diagnosed and referred using clinical guidelines with or without pulse oximetry in Malawi. Methods and findings We conducted a data linkage study of prospective health facility and community case and mortality data. We matched prospectively collected community health worker (CHW) and health centre (HC) outpatient data to prospectively collected hospital and community-based mortality surveillance outcome data, including episodes followed up to and deaths within 30 days of pneumonia diagnosis amongst children 0-59 months old. All data were collected in Lilongwe and Mchinji districts, Malawi, from January 2012 to June 2014. We determined differences in mortality rates using Conclusions Pulse oximetry identified fatal pneumonia episodes at HCs in Malawi that would otherwise have been missed by WHO referral guidelines alone. Our findings suggest that pulse oximetry could be beneficial in supplementing clinical signs to identify children with pneumonia at high risk of mortality in the outpatient setting in health centres for referral to a hospital for appropriate management., Author(s): Tim Colbourn 1,*, Carina King 1,2, James Beard 1, Tambosi Phiri 3, Malizani Mdala 3, Beatiwel Zadutsa 3, Charles Makwenda 3, Anthony Costello 1, Norman Lufesi 4, Charles Mwansambo [...]

The Member States of the World Health Organization (WHO) are committed to achieve quality, equity and dignity for women, newborns and children as reflected in the four World Health Assembly [...]

The Global strategy for women's, children's and adolescents' health (2016-2030) recognizes that people have a central role in improving their own health. We propose that community participation, particularly communities working together with health services (co-production in health care), will be central for achieving the objectives of the global strategy. Community participation specifically addresses the third of the key objectives: to transform societies so that women, children and adolescents can realize their rights to the highest attainable standards of health and well-being. In this paper, we examine what this implies in practice. We discuss three interdependent areas for action towards greater participation of the public in health: improving capabilities for individual and group participation; developing and sustaining people-centred health services; and social accountability. We outline challenges for implementation, and provide policy-makers, programme managers and practitioners with illustrative examples of the types of participatory approaches needed in each area to help achieve the health and development goals. La Strategie mondiale pour la sante de la femme, de l'enfant et de l'adolescent (2016-2030) reconnait que les individus jouent un role central dans l'amelioration de leur propre sante. Nous pensons que la participation communautaire, et notamment des communautes qui travaillent avec les services de sante (coproduction en matiere de soins de sante), sera essentielle pour atteindre les objectifs de la strategie mondiale. La participation communautaire repond plus particulierement au troisieme objectif cle: transformer les societes afin que les femmes, les enfants et les adolescents puissent exercer leur droit dejouirdu meilleur etat de sante et de bien-etre possible. Dans le present rapport, nous examinons ce que ceci suppose dans la pratique. Nous analysons trois domaines interdependants dans le cadre d'une action visant une plus grande participation du public en matiere de sante: ameliorer la capacite de participation des individus et des groupes, developper et assurer la perennite des services de sante axes sur l'etre humain, et favoriser la responsabilisation sociale. Nous donnons par ailleurs un apercu des difficultes liees a la mise en oeuvre et fournissons aux decideurs, aux administrateurs de programmes et aux professionnels de la sante des exemples illustrant les differents types d'approches participatives necessaires dans chaque domaine pour atteindre les objectifs lies a la sante et au developpement. La Estrategia Mundial para la Salud de la Mujer, el Nino y el Adolescente (2016-2030) reconoce que las personas tienen un papel fundamental a la hora de mejorar su propia salud. Proponemos que la participacion comunitaria, concretamente las comunidades que trabajan junto con los servicios sanitarios (coproduccion de atencion sanitaria), sea fundamental para lograr los objetivos de la estrategia mundial. En particular, la participacion comunitaria aborda el tercer objetivo fundamental: transformar las sociedades de modo que las mujeres, los ninos y los adolescentes puedan ejercer sus derechos de salud y bienestar en la mayor medida posible. En este articulo se examina lo que esto implica en la practica. Se debaten tres ambitos de accion interdependientes que se encaminan hacia una mayor participacion del publico en la sanidad: mejorar las capacidades para la participacion individual y en grupo; desarrollar y mantener servicios sanitarios centrados en las personas; y contabilidad social. Se repasan los desafios para su implementacion,y se ofrece a los responsables politicos, gestores de programas y medicos ejemplos ilustrativos de los tipos de enfoques de participacion necesarios en cada ambito para contribuir a alcanzar los objetivos sanitarios y de desarrollo., Introduction The Global strategy for women's, children's and adolescents' health (2016-2030) calls for action towards three objectives for health: survive (end preventable deaths), thrive (ensure health and well-being) and transform [...]