Hypoxaemia in Mozambican children < 5 years of age admitted to hospital with clinical severe pneumonia: clinical features and performance of predictor models.

Objective To determine the prevalence of hypoxaemia among under-five children admitted to hospital with clinical severe pneumonia and to assess the performance to diagnose hypoxaemia of models based on clinical signs. Methods We conducted a hospital-based survey in a district hospital from Southern Mozambique. Results A total of 825 children were recruited after obtaining an informed consent. The prevalence of hypoxaemia on admission was 27.9% and 19.8% of these children died (OR compared to non-hypoxaemic children 3.22 95%CI 1.98 - 5.21 p<0.001). The model with larger area under the ROC curve (AUC-ROC) to predict hypoxaemia included cyanosis or thoracoabdominal breathing or respiratory rate =70 breaths per minute. None of the models performed well when tested in different case scenarios of oxygen availability through mathematical modelling with over 50% of hypoxaemic children not receiving oxygen even in favourable case scenarios. Conclusions Clinical signs alone or in combination are not suitable to diagnose hypoxaemia. The use of pulse oximeters should be strongly encouraged.