Usability Testing of a Reusable Pulse Oximeter Probe Developed for Health-Care Workers Caring for Children < 5 Years Old in Low-Resource Settings

Hypoxemia measured by pulse oximetry predicts child pneumonia mortality in low-resource settings (LRS). Existing pediatric oximeter probes are prohibitively expensive and/or difficult to use, limiting LRS implementation. Using a human-centered design, we developed a low-cost, reusable pediatric oxim...

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Published in:	The American journal of tropical medicine and hygiene Vol. 99; no. 4; pp. 1096 - 1104
Main Authors:	Boyd, Nicholas, King, Carina, Walker, Isabeau A, Zadutsa, Beatiwel, Bernstein, Mike, Ahmed, Salahuddin, Roy, Arunangshu, Hanif, Abu A M, Saha, Subal C, Majumder, Kingshuk, Nambiar, Bejoy, Colbourn, Tim, Makwenda, Charles, Baqui, Abdullah H, Wilson, Iain, McCollum, Eric D
Format:	Journal Article
Language:	English
Published:	United States Institute of Tropical Medicine 01-01-2018 The American Society of Tropical Medicine and Hygiene
Subjects:	Adult Bangladesh Child Equipment Reuse Health Personnel Humans Hypoxia - blood Hypoxia - diagnosis Hypoxia - economics Infant Infant, Newborn Laboratory Proficiency Testing - statistics & numerical data Logistic Models Malawi Oximetry - economics Oximetry - instrumentation Oxygen - blood Oxyhemoglobins - analysis Pediatrics Pneumonia - blood Pneumonia - diagnosis Pneumonia - economics United Kingdom Usability testing Workers Malawi United Kingdom Bangladesh
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Summary:	Hypoxemia measured by pulse oximetry predicts child pneumonia mortality in low-resource settings (LRS). Existing pediatric oximeter probes are prohibitively expensive and/or difficult to use, limiting LRS implementation. Using a human-centered design, we developed a low-cost, reusable pediatric oximeter probe for LRS health-care workers (HCWs). Here, we report probe usability testing. Fifty-one HCWs from Malawi, Bangladesh, and the United Kingdom participated, and seven experts provided reference measurements. Health-care workers and experts measured the peripheral arterial oxyhemoglobin saturation (SpO ) independently in < 5 year olds. Health-care worker measurements were classed as successful if recorded in 5 minutes (or shorter) and physiologically appropriate for the child, using expert measurements as the reference. All expert measurements were considered successful if obtained in < 5 minutes. We analyzed the proportion of successful SpO measurements obtained in < 1, < 2, and < 5 minutes and used multivariable logistic regression to predict < 1 minute successful measurements. We conducted four testing rounds with probe modifications between rounds, and obtained 1,307 SpO readings. Overall, 67% (876) of measurements were successful and achieved in < 1 minute, 81% (1,059) < 2 minutes, and 90% (1,181) < 5 minutes. Compared with neonates, increasing age (infant adjusted odds ratio [aOR]; 1.87, 95% confidence interval [CI]: 1.16, 3.02; toddler aOR: 4.33, 95% CI: 2.36, 7.97; child aOR; 3.90, 95% CI: 1.73, 8.81) and being asleep versus being calm (aOR; 3.53, 95% CI: 1.89, 6.58), were associated with < 1 minute successful measurements. In conclusion, we designed a novel, reusable pediatric oximetry probe that was effectively used by LRS HCWs on children. This probe may be suitable for LRS implementation.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 Authors’ addresses: Nicholas Boyd, Great Ormond Street Hospital, UCL Institute of Child Health, London, United Kingdom, E-mail: drnickboyd@gmail.com. Carina King, Bejoy Nambiar, and Tim Colbourn, Institute for Global Health, University College London, London, United Kingdom, E-mails: c.king@ucl.ac.uk, b.nambiar@ucl.ac.uk, and t.colbourn@ucl.ac.uk. Isabeau A. Walker, Great Ormond Street Hospital, UCL Institute of Child Health, London, United Kingdom, and Lifebox Foundation, London, United Kingdom, E-mail: isabeau.walker@gosh.nhs.uk. Beatiwel Zadutsa and Charles Makwenda, Parent and Child Health Initiative, Lilongwe, Malawi, E-mails: beatzadutsa@gmail.com and charlesvmakwenda@gmail.com. Mike Bernstein, Physio Monitor, LLC, San Ramon, CA, E-mail: mike@physio-monitor.com. Salahuddin Ahmed, Arunangshu Roy, Abu A.M. Hanif, Subal C. Saha, and Kingshuk Majumder, Johns Hopkins University-Bangladesh, Dhaka, Bangladesh, E-mails: sahmed38@jhu.edu, aduttar1@jhu.edu, aamhanif@gmail.com, dr.subal8677@gmail.com, and kingshuk.afmc10@gmail.com. Abdullah H. Baqui, Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, E-mail: abaqui@jhu.edu. Iain Wilson, Lifebox Foundation, London, United Kingdom, E-mail: iainhwilson@me.com. Eric D. McCollum, Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, and Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, E-mail: emccoll3@jhmi.edu. Financial support: This study was funded by the Bill & Melinda Gates Foundation (grant number: OPP1133291). I. A. W. and I. W. are unpaid Trustees of the Lifebox Foundation; I. W. and M. B. report grants and personal fees from Lifebox Foundation during the conduct of the study.
ISSN:	0002-9637 1476-1645
DOI:	10.4269/ajtmh.18-0016