, Volume 3, Issue 4, pp 351-356,
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Date: 11 Nov 2010

Prevalence of undiagnosed hypoxemia in adults and children in an under-resourced district hospital in Zambia

Abstract

Background

In adequately resourced clinical environments, diagnosis of hypoxemia via pulse oximetry is routine. Unfortunately, pulse oximetry is rarely utilized in under-resourced hospitals in developing countries.

Aim

The prevalence of undiagnosed hypoxemia among adults and children with illnesses other than pneumonia in these environments remains poorly described.

Methods

This cross-sectional analysis of the prevalence of hypoxemia was conducted in Kapiri Mposhi, Zambia, at the 60-bed District Hospital, which serves a population of 320,000. The resting room air oxygen saturations of two consecutive samples of all adult and pediatric inpatients were measured in December 2008 and March 2009 using handheld pulse oximetry. Hypoxemia was defined as resting room air SpO2 less than 90%.

Results

A total of 192 patients were enrolled: 68 young children (<5 years old), 15 older children (5–17 years old), and 109 adults (≥18 years old). Five young children (7%), 0 older children (0%), and 10 adults (9%) were hypoxemic. No hypoxemic patients were receiving oxygen therapy at the time of diagnosis. Pneumonia, tuberculosis, and malnutrition were the most common conditions among those with hypoxemia. Oximetry data changed clinical management in all observed cases of hypoxemia and several cases of normoxemia, leading to application of supplemental oxygen, initiation of further diagnostic testing, prolongation of inpatient stay, or expedited discharge home.

Conclusions

Undiagnosed hypoxemia is present among inpatients at this district hospital in rural Zambia with high prevalence in both adults and young children. These results support routine screening for hypoxemia in similar facilities in both age groups. Further investigation is warranted into the clinical impact and cost-effectiveness of pulse oximetry, provision of oxygen concentrators, and training on their use in developing countries.

Prior Presentations

Mediterranean Emergency Medicine Congress V, Valencia, Spain, September 2009 and American Public Health Association Annual Meeting, Philadelphia, November 2009.

Funding Sources

Massachusetts College of Emergency Physicians EM Resident Research Grant and MGH Division of Global Health and Human Rights.

Disclaimer

The views expressed in this paper are those of the author(s) and not those of the editors, editorial board or publisher.