Hypoxaemia in Mozambican children <5 years of age admitted to hospital with clinical severe pneumonia: clinical features and performance of predictor models.
To determine the prevalence of hypoxaemia among under-five children admitted to hospital with clinical severe pneumonia and to assess the performance to diagnose hypoxaemia of models based on clinical signs.



We conducted a hospital-based survey in a district hospital from Southern Mozambique.



A total of 825 children were recruited after obtaining an informed consent. The prevalence of hypoxaemia on admission was 27.9%, and 19.8% of these children died (OR compared with non-hypoxaemic children 3.22, 95% CI 1.98-5.21, P < 0.001). The model with larger area under the ROC curve (AUC-ROC) to predict hypoxaemia included cyanosis or thoracoabdominal breathing or respiratory rate ≥70 breaths per minute. None of the models performed well when tested in different case scenarios of oxygen availability through mathematical modelling, with over 50% of hypoxaemic children not receiving oxygen even in favourable case scenarios.



Clinical signs alone or in combination are not suitable to diagnose hypoxaemia. The use of pulse oximeters should be strongly encouraged.
ISGlobal, Barcelona Centre of International Health Research, Universitat de Barcelona, Barcelona, Spain.|Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.
Quique
Q
Bassat
ISGlobal, Barcelona Centre of International Health Research, Universitat de Barcelona, Barcelona, Spain.|Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.
Miguel
M
Lanaspa
Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.
Sónia
S
Machevo
ISGlobal, Barcelona Centre of International Health Research, Universitat de Barcelona, Barcelona, Spain.|Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.|Centre for Research in Environmental Epidemiology, Barcelona, Spain.
Cristina
C
O'Callaghan-Gordo
ISGlobal, Barcelona Centre of International Health Research, Universitat de Barcelona, Barcelona, Spain.|Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.
Lola
L
Madrid
Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.|National Institute of Health, Ministry of Health, Maputo, Mozambique.
Tacilta
T
Nhampossa
Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.|National Institute of Health, Ministry of Health, Maputo, Mozambique.
Sozinho
S
Acácio
Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.|Medical Research Council Unit, Banjul, The Gambia.
Anna
A
Roca
ISGlobal, Barcelona Centre of International Health Research, Universitat de Barcelona, Barcelona, Spain.|Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.
Pedro L
PL
Alonso
D019540:Area Under Curve; D002675:Child, Preschool; D003490:Cyanosis / Q000209:etiology; D005260:Female; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D000860:Hypoxia / Q000150:complications / Q000175:diagnosis*; D007223:Infant; D008297:Male; D008954:Models, Biological; D016017:Odds Ratio; D010100:Oxygen / Q000378:metabolism*; D010343:Patient Admission; D011014:Pneumonia / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D015995:Prevalence; D012372:ROC Curve; D012119:Respiration; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
D010100:Oxygen
Mozambique; child; clinical decision-making; enfant; hipoxemia; hypoxaemia; hypoxémie; infant; lactante; neumonía; niño, preescolar; nourrisson; pneumonia; pneumonie; preschool; prise de décision clinique; préscolaire; toma de decisiones clínica