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:  01 September 2018
  • End date:  31 December 2020
  • 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

  • A National Sensitization Workshop on 6 January 2019, with representatives from the Ministry of Health (MoH) and other development partners including WHO, UNICEF, Save the Children and Bangladesh Paediatric Association, decided that Bangladesh will consider introducing pulse oximetry in MoH IMCI services, including in five districts with direct support from UNICEF and a sixth district with support from icddr,b. The feasibility of this approach will also be assessed through implementation research in this district by icddr,b.
  • A Memorandum of Understanding (MoU) has been signed between the Government of Bangladesh and icddr,b to conduct the implementation research.
  • An implementation plan development workshop was held on 13 June 2019, with representatives from government, WHO, UNICEF and Save the Children and a national committee has been formed to develop an Implementation Toolkit for introducing PO in IMCI services. The toolkit has been finalised through six consultative workshops and to be endorsed in a national workshop with wider stakeholder engagement.
  • Validation of the Lifebox pulse oximeter donated from the University of Edinburgh in Dhaka hospital of icddr,b. Piloting and data collection has been completed.
  • A full research protocol was developed and ethical approval was obtained from icddr,b IRB in November 2018 and the University of Edinburgh IRB in March 2019. The field implementation and data collection will start in September 2019.

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