# Development and implementation of pediatric mobile phone reflectance pulse oximeters and a hypoxemia surveillance system in South Africa

> **NIH NIH R33** · JOHNS HOPKINS UNIVERSITY · 2024 · $255,926

## Abstract

PROJECT SUMMARY:
 This is a submission for a National Institutes of Health R21/R33 award aiming to develop and validate a
context-appropriate, inexpensive mobile phone-based pediatric reflectance pulse oximeter compatible with an
interoperable hypoxemia surveillance system (R21 period), and then to evaluate the field implementation of a
mobile phone reflectance pulse oximeter and hypoxemia eHealth system using a cluster, randomized
controlled trial (R33 period). Lower respiratory infections (LRIs) are the leading infectious cause of death
globally among children below five years of age in low-income and middle-income countries (LMICs).
Hypoxemia, a low oxyhemoglobin saturation, is a key indicator of elevated LRI mortality risk. Pulse oximeters
are devices that non-invasively measure the peripheral oxyhemoglobin saturation (SpO2) to identify
hypoxemia, but are not widely available in LMICs for children, especially at primary healthcare clinics where
children first access care. Although oxygen is potentially a life-saving treatment for hypoxemic LRIs, health
systems in LMICs do not have well established oxygen systems to appropriately match supply with demand to
optimally benefit children.
 We aim to develop, validate, and rigorously evaluate the implementation of an innovative, inexpensive
mobile phone-based reflectance pulse oximeter, embedded within an electronic health DHIS2 platform for real-
time hypoxemia diagnosis and surveillance of children in LMICs. We hypothesize that the pulse oximeter's
performance will be valid and that its implementation within a DHIS2 electronic health platform will address key
implementation endpoints in a conceptual framework and theory of change construct for improving pediatric
LRI mortality in LMICs. To accomplish our overall project goal we will build upon our prior successful pediatric
pulse oximeter development work in sub-Saharan Africa and South Asia using an innovative, multidisciplinary
product development process called human centered design. During the two-year R21 period we will apply the
human centered design approach to develop a mobile phone-based reflectance pulse oximeter and eHealth
system (Aim 1). The device will be validated in a breath-down laboratory and field tested in various clinical
settings with a range of practitioners in Cape Town, South Africa. We will then implement the pulse oximeter
and DHIS2 system within a large township in Cape Town, South Africa and conduct a cluster, randomized
controlled trial to evaluate implementation fidelity as the primary outcome (Aim 2), as well as secondary
outcomes of implementation acceptability and feasibility.
 Successful completion of the research described in this application could lead to broader scale-up of an
affordable, sustainable interoperable hypoxemia eHealth system with advanced but accessible mobile phone
technology contextually appropriate for LMICs, where most pediatric deaths from hypoxemic LRIs occur.

## Key facts

- **NIH application ID:** 10906131
- **Project number:** 5R33TW012212-04
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Eric Douglass McCollum
- **Activity code:** R33 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $255,926
- **Award type:** 5
- **Project period:** 2021-08-10 → 2026-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10906131

## Citation

> US National Institutes of Health, RePORTER application 10906131, Development and implementation of pediatric mobile phone reflectance pulse oximeters and a hypoxemia surveillance system in South Africa (5R33TW012212-04). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/10906131. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*