Knowledge of pulse oximetry, indications for oxygen therapy, and integrated management of childhood illness among health care workers in Nigerian primary and secondary health facilities: a cross-sectional survey

Background
The WHO’s Integrated Management of Childhood Illness (IMCI) strategy aims to reduce deaths among children under the age of five. Pulse oximetry, a simple non-invasive method for measuring peripheral oxygen saturation - an indicator of severe illness, can enhance IMCI implementation. In Nigeria, despite efforts to incorporate pulse oximetry into IMCI, its adoption is sub-optimal. We assessed healthcare workers’ (HCWs) knowledge of pulse oximetry and IMCI in primary and secondary facilities to identify opportunities for improvement.
Methods
We conducted a cross-sectional study in 54 primary health facilities and 8 secondary hospitals purposively selected across five different states in Nigeria: Oyo, Lagos, Rivers, Kano and Jigawa. The data was collected between 6 March 2025 and 30 June 2025 through an interviewer-assisted questionnaire, which was developed from the national oxygen policy and WHO guidelines. We used descriptive statistics to summarise our findings. Pulse oximetry knowledge scores were dichotomised, and we used bivariate logistic regression to assess associations between HCWs’ cadre and pulse oximetry knowledge. For IMCI knowledge, we reported mean scores and used one-way analysis of variance to assess associations between mean scores and the HCWs’ cadre.
Results
Of the 463 eligible HCWs recruited, 75.4% were female, 52.3% were community health workers (CHWs), and 73.8 and 26.2% were employed by the government and facility, respectively. Overall, 49.7% knew that pulse oximetry should be performed for all presenting patients, with substantial variation across cadres (39.4% among CHWs, 74.4% among doctors, 52.9% among nurses). Doctors had 3.1 times higher odds of having good pulse oximetry knowledge compared to other HCWs (95% CI: 1.17–8.04). Knowledge of IMCI general danger signs was mixed with convulsion (93.5%), lethargy (80.9%) and loss of consciousness (84.6%) being mostly reported as general danger signs compared to vomiting everything and being unable to eat/drink. Less than 10% of the HCWs knew the four main symptoms for assessment in children aged 2–59 months.
Conclusion
IMCI Knowledge was generally poor across all HCW cadres, but pulse oximetry knowledge varied substantially. Strengthening pre-service and in-service IMCI and pulse oximetry training, particularly for CHWs and nurses is essential to improve childhood illness management and oxygen therapy practices in Nigeria.