NIHR Global Health Research Unit on Respiratory Health (RESPIRE)

Introducing pulse oximetry in IMCI services in Pune district, India

This project is based at King Edward Memorial (KEM) Hospital Research Centre, Pune in India


  • Project title: Assessment of feasibility of introducing pulse oximetry in IMCI services in primary health facilities in Pune district
  • Acute or chronic:  Acute
  • Based at:  KEM Hospital Research Centre
  • Start date: 1 October, 2019
  • End date: 30 November, 2021
  • Principal investigator:  Ashish Bavdekar
  • Project team:  Shams El Arifeen, Steve Cunningham, Anand Kawade, Harish Nair


Pneumonia is a leading cause of childhood mortality, accounting for 16% of under-five deaths globally – with the majority occurring in low- and middle-income countries.

For the management of common childhood illnesses, including pneumonia, in low-resource settings, adoption of Integrated Management of Childhood Illness (IMCI) is globally recommended. 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 pneumonia mortality. Hypoxemia can be measured simply and effectively using pulse oximetry (PO).

The latest IMCI guidelines, from the World Health Organization (WHO), include the use of PO to classify severity of pneumonia in children and manage accordingly. Current IMCI practices in Pune district do not include PO in the treatment algorithms.

Aim and impact

The aim of the project is to assess the feasibility of introducing PO in the IMCI programme in Pune and explore barriers to and facilitators of effective implementation with assessment of the readiness of the public health system.

At the end of this study we plan to come up with an implementation model of adapted IMCI guidelines, i.e. provide a sustainable route to implement PO for classification of pneumonia within the public health system.

Introducing PO will help to reduce misclassification of pneumonia, identifying those with hypoxemia for immediate referral for treatment – with the potential to reduce childhood mortality from pneumonia.

Key developments

  • The study baseline survey and in-depth interviews were completed.
  • Training was provided to public health staff in six primary health centres.
  • Data collection is ongoing.

Project data

Download the project Data Management Plan

View project metadata on the Health Data Research Innovation Gateway