Assessing the Feasibility and Effectiveness of Introducing Pulse Oximetry in IMCI Services

NCT03750747 | Unknown

• 1 other identifier: PR-18054
• Study Type: interventional
• Target: 612
• Locations: 1 country
• Sites: 1

Brief Summary

The purpose of the study is to assess the feasibility, acceptability and operational challenges of introducing Pulse Oximeter (PO) in IMCI services to manage acute respiratory infections at first-level primary care facilities in Bangladesh (phase 1). The investigators will also evaluate the effectiveness and cost-effectiveness of introducing PO in IMCI services at first level primary care health facilities (phase 2). This study will employ a cluster randomized controlled trial design to evaluate the effectiveness of introducing PO in IMCI services (phase-2 objective). The feasibility assessment (phase-1 objective) will be nested within the larger effectiveness trail as internal piloting; which will help in generating evidence for designing a robust phase-2 trial. First-level primary healthcare facilities providing IMCI services will be regarded as clusters and the unit of randomization. Sixteen first level primary care health facilities (UH\&FWC) will be randomly assigned to comparison and intervention facilities.

Conditions

Childhood Pneumonia; Hypoxemia

Keywords

IMCI services; Pulse Oximeter; Acute respiratory infections; Implementation research; Hypoxaemia; Childhood Pneumonia; Resource poor settings

Outcome Measures

Primary Outcomes (1)

• Treatment failure rate

  The primary outcome of interest is treatment failure rate among those who are clinically classified as 'Pneumonia'. Operational definition of treatment failure will be finalized based on expert consultation and opinion of the caretakers of sick children through PPI. For illustrative purpose, an operational definition of the treatment failure is presented below which is based on some similar studies, i.e. SAT, AFRINEST, NO-SHOT, etc.Presence of any of the followings signs on day-6 and day-12 will be a considered as treatment failure: * Death * Appearance of any of the danger signs: * Inability to drink * Vomits everything * Lethargy or unconsciousness * Convulsions or history of convulsion * Persistence of * Low oxygen saturation (SpO2\<90%) * Chest indrawing * Fast breathing

  up to 12 months

Study Arms (2)

Intervention (Pulse Oximeter)

EXPERIMENTAL

The intervention facilities will provide IMCI services with PO in addition to following existing IMCI guidelines. The IMCI service providers will classify and treat children presenting with cough and difficult breathing based on history and clinical signs. In addition, they will use PO to measure the SpO2 status of the sick children. Children clinically classified as 'Pneumonia' but having SpO2\<90% will be referred to higher-level facilities for in-patient management. Only the children clinically classified 'Pneumonia' and having SpO2\>90% will be treated through home-based management with oral antibiotics (amoxicillin, twice daily for five day).

Device: Pulse Oximeter

Comparison

NO INTERVENTION

The comparison facilities will continue providing routine IMCI services as per the existing guidelines. In routine IMCI services, IMCI service providers classify and treat children presenting with cough and difficult breathing based on history and clinical signs only. In routine IMCI services in Bangladesh, PO has not been introduced. Therefore, in the comparison facilities all children clinically classified as 'Pneumonia' will be treated through home-based management with oral antibiotics (amoxicillin, twice daily for five day)

Interventions

Pulse Oximeter DEVICE

SpO2 will be measured using a handheld PO device (selected for this study) applying the low noise cabled sensor. For patients weighing \<10 kg, the sensor will be placed on the big toe. For patients weighing \>10 kg, the sensor will be placed on an index finger. In case of failure in the first attempt, the alternate toe or index finger will be tried (second attempt). First, the sensor will be placed on toe or index finger and then the PO will be powered-on. A stable Sp02 reading will be considered to be obtained if SpO2 reading is stable by ±1 % for at least 10 seconds and the device signal strength is displayed to be adequate (green signal). Second attempt will be warranted if a stable reading is not obtaining within 1-2 minutes.

Intervention (Pulse Oximeter)

Eligibility Criteria

• Age: 2 Months - 59 Months
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)

You may qualify if:

• Sick children aged 2 to 59 months
• Presenting with cough or difficult breathing
• Receiving IMCI services in the selected facilities will be enrolled

You may not qualify if:

• Severely ill children who need to be referred immediately
• If the parents of the children are unwilling to participate

Sponsors & Collaborators

• International Centre for Diarrhoeal Disease Research, Bangladesh: lead
• University of Edinburgh: collaborator

Study Sites (1)

International Centre for Diarrhoeal Disease Research, Bangladesh

Dhaka, 1212, Bangladesh

RECRUITING

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MeSH Terms

Conditions

Hypoxia

Condition Hierarchy (Ancestors)

Signs and Symptoms, Respiratory; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• Ahmed Ehsanur Rahman, MBBS, MPH

  International Centre for Diarrhoeal Disease Research, Bangladesh

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Shams El Arifeen, DrPH

CONTACT

+8801713366936; shams@icddrb.org

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: November 14, 2018
• First Posted: November 23, 2018
• Study Start: December 1, 2018
• Primary Completion: December 31, 2022
• Study Completion: December 31, 2022
• Last Updated: March 31, 2022

Record last verified: 2022-02

Data Sharing

• IPD Sharing: Will not share

Locations

BA (1)