Knowledge and Practices of Hypoxemia Management in Rwandan Public Hospitals

Background Hypoxemia, characterized by low blood oxygen levels, poses significant risks to neonates and critically ill patients. Effective management relies on pulse oximetry screening and prompt oxygen therapy. In Rwanda, following recent national investments in oxygen systems, we aim to evaluate pulse oximetry usage, oxygen therapy practices, and knowledge of healthcare workers in managing hypoxemia. Methods A retrospective cohort study was conducted in public hospitals in Rwanda from July to September 2022, examining pulse oximetry use, hypoxemia prevalence and oxygen administration on day of admission, and subsequent patient outcomes, using data extracted from medical records. Additionally, we conducted a survey involving healthcare workers to assess their knowledge of hypoxemia management. Results Pulse oximetry on admission was documented for 87.7% (5025/5731, 95% CI 86.8-88.5%) of the patients who were admitted to 39 Rwandan hospitals during the study window. The highest usage observed was amongst neonates at 96.4% (585/607, 95% CI 94.6-97.6%), and the lowest in maternity wards at 78.9% of patients (1515/1921, 95% CI 77.0-80.6%). The prevalence of hypoxemia (SpO ₂ <90%) was found to be 9.4% (472/5025, 95% CI 8.6-10.2%), particularly affecting neonates at 27.9% (163/585, 95% CI 24.4-31.6%). Among patients identified as hypoxemic, 93.4% (441/472, 95% CI 90.8-95.4%) received oxygen therapy. The mean healthcare providers’ knowledge score was 66.6%. Among them, Physicians demonstrated the highest level of understanding of hypoxemia management, with an average score of 69.5%. Conclusion Our findings reveal that, pulse oximetry to diagnose hypoxemia, and oxygen therapy use in those hypoxemia was widespread across inpatients in Rwanda. There were some disparities across wards, especially maternity settings. While most hypoxemic patients receive oxygen, gaps in the knowledge of healthcare workers underscore the need for targeted training to ensure care is of good quality.