# Pulse Oximetry Accuracy and Integration into Pediatric Outpatient Care in South Africa

> **NIH NIH K23** · BAYLOR COLLEGE OF MEDICINE · 2024 · $183,259

## Abstract

Acute lower respiratory infections (ALRI) are the leading cause of death in children under 5 years old. There is
a high prevalence of pediatric ALRI-related hypoxemia in low- and middle-income countries (LMICs). Building
on past successes, this proposal aims to advance the use of pulse oximetry in LMICs. In Malawi a SpO2
(peripheral oxygen saturation) of 90-92% was associated with child ALRI mortality which is consistent with a
retrospective study from the United States that reported SpO2 may over-estimate arterial oxygen saturation
(SaO2) by 4.3% in Black children. Pulse oximeters are not universally available in outpatient settings in LMICs
due to a lack of health system financing. Government stakeholders often must prioritize low, or perceived, low
cost high output interventions. However, the cost of pulse oximetry implementation in these settings remains
unknown. For outpatient pulse oximeters to reduce child ALRI mortality, they must accurately and reliably
measure SpO2 and be financially and time cost effective.
The aims of this mixed methods study are to 1) examine the accuracy of SpO2 in children with dark and fair skin
tones and 2) compare the costs of ambulatory reflectance versus transmissive pulse oximetry implementation
for outpatient child ALRI care in South Africa. These aims address the NHLBI's mission to lead the world in
advancing translational research that bridges the gap between clinical research to practice and population to
health outcome.
Interventions to improve early identification of hypoxemic children and provision of appropriate care are critical
to reduce child ALRI mortality. This proposal leverages the unexplored roles of cost analysis and compares
objective findings with clinician perceptions of time-costs in pulse oximetry use and generates critical racial health
disparity-related data to inform future studies aimed at improving equitable care and treatment by refining SpO2
interpretation.
Dr. Hooli is a pediatric emergency medicine physician with years of clinical experience in LMICs and the United
States. These experiences framed the aims and shaped her career focus on patient-oriented research. The
educational plan includes formal, tutorial, and practical experiences in prospective study design and analysis,
cost analysis, and implementation science. She is mentored by internationally recognized scientists with
expertise in these fields and child pneumonia, global health, and pulse oximetry. Execution of these aims coupled
with the educational and mentorship plan outlined in the proposal will prepare Dr. Hooli to become an
independent investigator.

## Key facts

- **NIH application ID:** 10887006
- **Project number:** 1K23HL169901-01A1
- **Recipient organization:** BAYLOR COLLEGE OF MEDICINE
- **Principal Investigator:** Shubhada Hooli
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $183,259
- **Award type:** 1
- **Project period:** 2024-04-15 → 2029-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10887006

## Citation

> US National Institutes of Health, RePORTER application 10887006, Pulse Oximetry Accuracy and Integration into Pediatric Outpatient Care in South Africa (1K23HL169901-01A1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10887006. Licensed CC0.

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