NIHR Global Health Research Unit on Respiratory Health (RESPIRE)

Introducing pulse oximetry in IMCI services in Bangladesh

This project is based at icddr,b in Bangladesh


  • Project title: Assessing the feasibility and effectiveness of introducing pulse oximetry in IMCI services to manage acute respiratory infections in first level health facilities in Bangladesh
  • Acute or chronic:  Acute
  • Based at:  icddr,b
  • Start date:  September 2018
  • End date:  September 2021
  • Principal investigator:  Shams El Arifeen
  • Project team:  Ahmed Ehsanur Rahman, Md. Jobayer Chisti, Tazeen Tahsina, Sabrina Jabeen, Sojib Bin Zaman, Qazi Sadeq-ur Rahman, Md. Jahurul Islam, Harry Campbell, Harish Nair, David Dockrell, Steve Cunningham, John Norrie


Integrated Management of Childhood Illness (IMCI) is a global strategy, developed by WHO and UNICEF, for the management of common childhood illnesses, including pneumonia, in low-resource settings. IMCI guides a service provider to follow a step-by-step approach in history taking, clinical assessment, classification of the illness and treatment for a sick child. IMCI classifications depend on the clinical assessment skills of service providers and this subjectivity might lead to misclassification and inappropriate referral/treatment.

Hypoxemia (low levels of oxygen in the blood) is one of the strongest predictors of mortality due to pneumonia in children. Pulse oximetry (PO) is a non-invasive method for monitoring a person's blood oxygen level. The integration of PO in existing IMCI services could improve the accuracy of pneumonia diagnosis and treatment.

There are several health systems barriers and operational challenges associated with introducing a new technology, like PO, in developing country settings.

Aim and impact

The aim of the project is to assess the feasibility, acceptability and operational challenges of introducing PO in IMCI services through routine providers at first-level primary care health facilities in Bangladesh.

If successful, introducing PO would allow for a more accurate classification of pneumonia and the delivery of appropriate treatment, reducing neonatal and childhood mortality due to pneumonia by early detection of hypoxaemia.

Key developments

  • Icddr,b has updated a toolkit for integrating PO in routine IMCI services in Bangladesh through the RESPIRE funded study.
  • Obtained agreement from Bangladesh Ministry of Health to introduce updated PO toolkit (based upon RESPIRE study) into routine IMCI.
  • A national technical subcommittee (including several stakeholders from the Ministry of Health and international development partners) was formed to update the IMCI implementation package and discuss scalability.
  • The Ministry of Health IMCI Programme formally acknowledged icddr,b’s (and RESPIRE’s) contribution to the initiative.

Project data

Download the project Data Management Plan

View the project metadata on the Health Data Research Innovations Gateway

Embedded PhD project

RESPIRE PhD student Ahmed Ehsanur Rahman is conducting an embedded project as part of this wider study.

Find out more about Ehsanur's PhD