Pfurtscheller Theresa, Baker Kevin, Habte Tedila, Lasmi Kévin, Matata Lena, Mucunguzi Akasiima, Nicholson Jill, Nuwa Anthony, Petzold Max, Posada González Mónica, Sebsibe Anteneh, Alfvén Tobias, Källander Karin
Department of Global Public Health, Karolinska Institutet, Solna, Sweden.
Malaria Consortium, London, United Kingdom.
PLOS Glob Public Health. 2023 Jul 18;3(7):e0001800. doi: 10.1371/journal.pgph.0001800. eCollection 2023.
Timely recognition and referral of severely ill children is especially critical in low-resource health systems. Pulse-oximeters can improve health outcomes of children by detecting hypoxaemia, a severity indicator of the most common causes of death in children. Cost-effectiveness of pulse-oximeters has been proven in low-income settings. However, evidence on their usability in community health settings is scarce.This study explores the usability of pulse-oximeters for community health and primary care workers in Cambodia, Ethiopia, South Sudan, and Uganda. We collected observational data, through a nine-task checklist, and survey data, using a five-point Likert scale questionnaire, capturing three usability aspects (effectiveness, efficiency, and satisfaction) of single-probe fingertip and multi-probe handheld devices. Effectiveness was determined by checklist completion rates and task completion rates per checklist item. Efficiency was reported as proportion of successful assessments within three attempts. Standardized summated questionnaire scores (min = 0, max = 100) determined health worker's satisfaction. Influencing factors on effectiveness and satisfaction were explored through hypothesis tests between independent groups (device type, cadre of health worker, country). Checklist completion rate was 78.3% [CI 72.6-83.0]. Choosing probes according to child age showed the lowest task completion rate of 68.7% [CI 60.3%-76.0%]. In 95.6% [CI 92.7%-97.4%] of assessments a reading was obtained within three attempts. The median satisfaction score was 95.6 [IQR = 92.2-99.0]. Significantly higher checklist completion rates were observed with single-probe fingertip devices (p<0.001) and children 12-59 months (p<0.001). We found higher satisfaction scores in South Sudan (p<0.001) and satisfaction varied slightly between devices. From a usability perspective single-probe devices for all age groups should be prioritized for scaled implementation. Further research on easy to use and accurate devices for infants is much needed.
在资源匮乏的卫生系统中，及时识别和转诊重症儿童尤为关键。脉搏血氧仪可通过检测低氧血症来改善儿童的健康结局，低氧血症是儿童最常见死因的严重程度指标。脉搏血氧仪的成本效益已在低收入环境中得到证实。然而，关于其在社区卫生环境中可用性的证据却很少。本研究探讨了脉搏血氧仪在柬埔寨、埃塞俄比亚、南苏丹和乌干达社区卫生和初级保健工作者中的可用性。我们通过一份包含九项任务的清单收集观察数据，并使用五点李克特量表问卷收集调查数据，以获取单探头指尖式和多探头手持式设备的三个可用性方面（有效性、效率和满意度）的信息。有效性由清单完成率和每个清单项目的任务完成率确定。效率以三次尝试内成功评估的比例报告。标准化汇总问卷得分（最小值 = 0，最大值 = 100）确定卫生工作者的满意度。通过独立组之间的假设检验（设备类型、卫生工作者类别、国家）探讨了对有效性和满意度的影响因素。清单完成率为78.3% [置信区间72.6 - 83.0]。根据儿童年龄选择探头的任务完成率最低，为68.7% [置信区间60.3% - 76.0%]。在95.6% [置信区间92.7% - 97.4%]的评估中，三次尝试内获得了读数。满意度中位数为95.6 [四分位距 = 92.2 - 99.0]。单探头指尖式设备（p < 0.001）和12 - 59个月的儿童（p < 0.001）的清单完成率显著更高。我们发现南苏丹的满意度得分更高（p < 0.001），并且不同设备之间的满意度略有差异。从可用性角度来看，应优先为所有年龄组推广使用单探头设备。非常需要对便于使用且准确的婴儿设备进行进一步研究。
