Acceptability of the routine use of pulse oximeters into the Integrated Management of Childhood Illness guidelines at primary health centers in West Africa: a mixed-methods study.

Introduction: To better identify illnesses with severe hypoxemia in children aged under-5 years, the AIRE project has implemented the routine use of a Pulse Oximeter (PO) into the Integrated Management of Childhood Illness (IMCI) guidelines at primary health centers (PHC) in Burkina Faso, Guinea, Mali, and Niger. We aimed to measure and understand the acceptability among healthcare worker.s (HCW) and children.s families (CF) of using PO in these contexts. Methods: Based on an original conceptual framework, we conducted a convergent mixed methods study to assess HCW.s and CF.s acceptability. We used quantitative questionnaires based on the Likert scale to conduct four repeated cross-sectional studies among all HCW on duty in the 202 PHC involved in the AIRE project before the intervention (before and after PO use training), six months after the introduction of the PO, and two months after project completion. We also conducted semi-structured interviews with HCW (n=102) and CF (n=59). Results: From March 2021 to December 2022, 486, 537, 538, and 476 HCW completed the four acceptability surveys. Overall, 31% of HCW had mitigated feelings about PO use before the training, 46% found it rather acceptable and 23% strongly acceptable. At the end of the project, it was respectively 15%, 34%, and 51%. PO training was consistently associated with greater HCW acceptability. HCW found many advantages in using PO, such as improved care for children, more accurate diagnosis, and a boost in their confidence in childcare management. Nevertheless, perceived increased workload and consultation time, as well as difficulties in referring children to hospital remain challenging. CF did not necessarily understand the new device's purpose, but their opinions of the technology were generally positive. Conclusion: The PO use, integrated into IMCI consultations, seems to be accepted by HCW and CF, although sustainable challenges remain. Keywords: Acceptability, Innovation, West Africa, Children under five, Pulse oximeters