Bibliographic information
Recommendation
In settings where pulse oximetry is not available, in children 2–59 months of age diagnosed with pneumonia (fast breathing or chest indrawing, without danger sign- not able to drink or breastfeed, or vomits everything, or has had convulsions, or is lethargic or unconscious, or stridor or hypoxaemia-), WHO suggests evaluation of respiratory distress using a combination of signs and symptoms (head nodding or nasal flaring or grunting or severe tachypnoea (respiratory rate ≥20 breaths per minute above the age-specific cutoff) to detect hypoxaemia
Recommended in favor
Conditional
Certainty of evidence
Very low
Notes and Remarks
Remarks The GDG emphasized that the signs and symptoms considered are only appropriate for use by trained health workers at the facility level and not for community-level health workers. Before implementing this recommendation, facility-level health workers should be trained in using these signs and symptoms when a pulse oximeter is not available. Various issues were raised by the GDG about the variation in risk depending on age and nutritional status, and the need to connect this recommendation to other related WHO recommendations. The GDG stated strongly that pulse oximetry should be available at the primary health care level to detect hypoxaemia in children.